Roalf David R, Quarmley Megan, Calkins Monica E, Satterthwaite Theodore D, Ruparel Kosha, Elliott Mark A, Moore Tyler M, Gur Ruben C, Gur Raquel E, Moberg Paul J, Turetsky Bruce I
Department of Psychiatry, Neuropsychiatry Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Schizophr Bull. 2017 May 1;43(3):601-610. doi: 10.1093/schbul/sbw112.
Structural brain abnormalities have been amply demonstrated in schizophrenia. These include volume decrements in the perirhinal/entorhinal regions of the ventromedial temporal lobe, which comprise the primary olfactory cortex. Olfactory impairments, which are a hallmark of schizophrenia, precede the onset of illness, distinguish adolescents experiencing prodromal symptoms from healthy youths, and may predict the transition from the prodrome to frank psychosis. We therefore examined temporal lobe regional volumes in a large adolescent sample to determine if structural deficits in ventromedial temporal lobe areas were associated, not only with schizophrenia, but also with a heightened risk for psychosis. Seven temporal lobe regional volumes (amygdala [AM], hippocampus, inferior temporal gyrus, parahippocampal gyrus, superior temporal gyrus, temporal pole, and entorhinal cortex [EC]) were measured in 386 psychosis spectrum adolescents, 521 adolescents with other types of psychopathology, and 359 healthy adolescents from the Philadelphia Neurodevelopment Cohort. Total intracranial and left EC volumes, which were both smallest among the psychosis spectrum, were the only measures that distinguished all 3 groups. Left AM was also smaller in psychosis spectrum compared with healthy subjects. EC volume decrement was strongly correlated with impaired cognition and less robustly associated with heightened negative/disorganized symptoms. AM volume decrement correlated with positive symptoms (persecution/special abilities). Temporal lobe volumes classified psychosis spectrum youths with very high specificity but relatively low sensitivity. These MRI measures may therefore serve as important confirmatory biomarkers denoting a worrisome preclinical trajectory among at-risk youths, and the specific pattern of deficits may predict specific symptom profiles.
精神分裂症患者大脑结构异常已得到充分证实。这些异常包括腹内侧颞叶的嗅周/内嗅区域体积减小，该区域包含初级嗅觉皮层。嗅觉障碍是精神分裂症的一个标志，在疾病发作之前就已出现，可将有前驱症状的青少年与健康青年区分开来，并且可能预测从前驱期向明显精神病的转变。因此，我们在一个大型青少年样本中检查了颞叶区域体积，以确定腹内侧颞叶区域的结构缺陷是否不仅与精神分裂症有关，还与精神病风险增加有关。在来自费城神经发育队列的386名精神病谱系青少年、521名患有其他类型精神病理学的青少年和359名健康青少年中，测量了七个颞叶区域体积（杏仁核[AM]、海马体、颞下回、海马旁回、颞上回、颞极和内嗅皮层[EC]）。总颅内体积和左EC体积在精神病谱系中最小，是区分所有三组的唯一指标。与健康受试者相比，精神病谱系中的左AM也较小。EC体积减小与认知障碍密切相关，与阴性/紊乱症状加重的相关性较弱。AM体积减小与阳性症状（被害妄想/特殊能力）相关。颞叶体积对精神病谱系青年的分类具有非常高的特异性，但敏感性相对较低。因此，这些MRI测量结果可能作为重要的确认性生物标志物，表明高危青年中令人担忧的临床前轨迹，并且特定的缺陷模式可能预测特定的症状特征。
