Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Vic., Australia.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Eur J Clin Invest. 2016 Jul;46(7):658-74. doi: 10.1111/eci.12641. Epub 2016 Jun 15.
Bipolar disorder and schizophrenia are highly heritable, often chronic and debilitating psychotic disorders that can be difficult to differentiate clinically. Their brain phenotypes appear to overlap in both cross-sectional and longitudinal structural neuroimaging studies, with some evidence to suggest areas of differentiation with differing trajectories. The aim of this review was to investigate the notion that longitudinal trajectories of alterations in brain structure could differentiate the two disorders.
Narrative review. We searched MEDLINE and Web of Science databases in May 2016 for studies that used structural magnetic resonance imaging to investigate longitudinal between-group differences in bipolar disorder and schizophrenia. Ten studies met inclusion criteria, namely longitudinal structural magnetic resonance studies comparing bipolar disorder (or affective psychosis) and schizophrenia within the same study.
Our review of these studies implicates illness-specific trajectories of morphological change in total grey matter volume, and in regions of the frontal, temporal and cingulate cortices. The findings in schizophrenia suggest a trajectory involving progressive grey matter loss confined to fronto-temporal cortical regions. Preliminary findings identify a similar but less severely impacted trajectory in a number of regions in bipolar disorder, however, bipolar disorder is also characterized by differential involvement across cingulate subregions.
The small number of available studies must be interpreted with caution but provide initial evidence supporting the notion that bipolar disorder and schizophrenia have differential longitudinal trajectories that are influenced by brain maturation.
双相情感障碍和精神分裂症具有高度遗传性，常为慢性致残性精神疾病，临床上难以区分。在横断面和纵向结构神经影像学研究中，这两种疾病的脑表型似乎存在重叠，有证据表明不同的轨迹存在不同的分化区域。本综述的目的是探讨大脑结构改变的纵向轨迹是否可以区分这两种疾病。
叙述性综述。我们于 2016 年 5 月在 MEDLINE 和 Web of Science 数据库中搜索了使用结构磁共振成像来研究双相情感障碍和精神分裂症之间纵向组间差异的研究。符合纳入标准的研究有 10 项，即比较同一研究中双相情感障碍（或情感性精神病）和精神分裂症的纵向结构磁共振研究。
我们对这些研究的综述表明，全灰质体积和额、颞和扣带回皮质区域的形态变化存在特定疾病的轨迹。精神分裂症的研究结果表明，存在一个涉及额颞皮质区域进行性灰质丧失的轨迹。初步研究结果表明，在双相情感障碍的多个区域存在类似但影响程度较小的轨迹，但双相情感障碍的特征还在于扣带回亚区的不同参与。
可用的研究数量较少，必须谨慎解释，但提供了初步证据支持这样一种观点，即双相情感障碍和精神分裂症具有不同的纵向轨迹，受大脑成熟的影响。
