Koenders Laura, Machielsen Marise W J, van der Meer F J, van Gasselt Angelique C M, Meijer Carin J, van den Brink Wim, Koeter Maarten W J, Caan Matthan W A, Cousijn Janna, den Braber Anouk, van 't Ent Dennis, Rive Maaike M, Schene Aart H, van de Giessen Elsmarieke, Huyser Chaim, de Kwaasteniet Bart P, Veltman Dick J, de Haan Lieuwe
Department of Psychiatry, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
Department of Nuclear Medicine, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
J Psychiatry Neurosci. 2015 May;40(3):197-206. doi: 10.1503/jpn.140081.
Schizophrenia is highly comorbid with cannabis use disorders (CUDs), and this comorbidity is associated with an unfavourable course. Early onset or frequent cannabis use may influence brain structure. A key question is whether comorbid CUDs modulate brain morphology alterations associated with schizophrenia.
We used surface-based analysis to measure the brain volume, cortical thickness and cortical surface area of a priori-defined brain regions (hippocampus, amygdala, thalamus, caudate, putamen, orbitofrontal cortex, anterior cingulate cortex, insula, parahippocampus and fusiform gyrus) in male patients with schizophrenia or related disorders with and without comorbid CUDs and matched healthy controls. Associations between age at onset and frequency of cannabis use with regional grey matter volume were explored.
We included 113 patients with (CUD, n = 80) and without (NCUD, n = 33) CUDs and 84 controls in our study. As expected, patients with schizophrenia (with or without a CUD) had smaller volumes of most brain regions (amygdala, putamen, insula, parahippocampus and fusiform gyrus) than healthy controls, and differences in cortical volume were mainly driven by cortical thinning. Compared with the NCUD group, the CUD group had a larger volume of the putamen, possibly driven by polysubstance use. No associations between age at onset and frequency of use with regional grey matter volumes were found.
We were unable to correct for possible confounding effects of smoking or antipsychotic medication.
Patients with psychotic disorders and comorbid CUDs have larger putamen volumes than those without CUDs. Future studies should elaborate whether a large putamen represents a risk factor for the development of CUDs or whether (poly)substance use causes changes in putamen volume.
精神分裂症与大麻使用障碍（CUDs）高度共病，且这种共病与不良病程相关。早期发病或频繁使用大麻可能会影响脑结构。一个关键问题是，共病的CUDs是否会调节与精神分裂症相关的脑形态改变。
我们采用基于表面的分析方法，测量了患有或未患有共病CUDs的男性精神分裂症或相关疾病患者以及匹配的健康对照者中预先定义的脑区（海马体、杏仁核、丘脑、尾状核、壳核、眶额皮质、前扣带回皮质、岛叶、海马旁回和梭状回）的脑容量、皮质厚度和皮质表面积。探讨了发病年龄和大麻使用频率与区域灰质体积之间的关联。
我们的研究纳入了113例患有（CUD，n = 80）和未患有（NCUD，n = 33）CUDs的患者以及84名对照者。正如预期的那样，患有精神分裂症（无论是否患有CUDs）的患者大多数脑区（杏仁核、壳核、岛叶、海马旁回和梭状回）的体积比健康对照者小，皮质体积的差异主要由皮质变薄引起。与NCUD组相比，CUD组的壳核体积更大，可能是由多种物质使用导致的。未发现发病年龄和使用频率与区域灰质体积之间存在关联。
我们无法校正吸烟或抗精神病药物可能产生的混杂效应。
患有精神病性障碍且共病CUDs的患者比未患有CUDs的患者壳核体积更大。未来的研究应阐明壳核体积增大是否代表CUDs发生的危险因素，或者（多种）物质使用是否会导致壳核体积变化。
