Bartholomeusz Cali F, Cropley Vanessa L, Wannan Cassandra, Di Biase Maria, McGorry Patrick D, Pantelis Christos
1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.
2 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
Aust N Z J Psychiatry. 2017 May;51(5):455-476. doi: 10.1177/0004867416670522. Epub 2016 Oct 12.
This review critically examines the structural neuroimaging evidence in psychotic illness, with a focus on longitudinal imaging across the first-episode psychosis and ultra-high-risk of psychosis illness stages.
A thorough search of the literature involving specifically longitudinal neuroimaging in early illness stages of psychosis was conducted. The evidence supporting abnormalities in brain morphology and altered neurodevelopmental trajectories is discussed in the context of a clinical staging model.
In general, grey matter (and, to a lesser extent, white matter) declines across multiple frontal, temporal (especially superior regions), insular and parietal regions during the first episode of psychosis, which has a steeper trajectory than that of age-matched healthy counterparts. Although the ultra-high-risk of psychosis literature is considerably mixed, evidence indicates that certain volumetric structural aberrations predate psychotic illness onset (e.g. prefrontal cortex thinning), while other abnormalities present in ultra-high-risk of psychosis populations are potentially non-psychosis-specific (e.g. hippocampal volume reductions).
We highlight the advantages of longitudinal designs, discuss the implications such studies have on clinical staging and provide directions for future research.
本综述批判性地审视了精神病性疾病的结构性神经影像学证据，重点关注首次发作精神病和精神病性疾病超高风险阶段的纵向影像学研究。
对专门涉及精神病早期疾病阶段纵向神经影像学的文献进行了全面检索。在临床分期模型的背景下，讨论了支持脑形态异常和神经发育轨迹改变的证据。
总体而言，在精神病首次发作期间，多个额叶、颞叶（尤其是上部区域）、岛叶和顶叶区域的灰质（以及程度较轻的白质）会减少，其轨迹比年龄匹配的健康对照更为陡峭。尽管关于精神病超高风险的文献结果差异很大，但有证据表明某些体积结构异常在精神病性疾病发作之前就已出现（例如前额叶皮质变薄），而在精神病超高风险人群中出现的其他异常可能并非精神病所特有（例如海马体体积减小）。
我们强调了纵向设计的优势，讨论了此类研究对临床分期的影响，并为未来研究提供了方向。
