Minichino Amedeo, Ando' Agata, Francesconi Marta, Salatino Adriana, Delle Chiaie Roberto, Cadenhead Kristin
Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
Department of Psychology, University of Turin, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Jul 3;77:9-22. doi: 10.1016/j.pnpbp.2017.03.020. Epub 2017 Mar 29.
Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug-naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta-analysis investigating GM and WM abnormalities in drug-naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug-naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug-naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention.
有证据表明，在普通人群中，肥胖和超重可能与严重的脑结构异常以及认知和功能预后不良有关。尽管有这些观察结果，且精神病谱系障碍（PSD）患者体重增加异常的患病率很高，但尚无研究调查这些代谢紊乱在PSD早期阶段可能对脑结构和发育产生的影响。在本综述中，我们阐明了体重增加与脑结构异常之间的关联，这种关联可能会影响未使用药物治疗的首发精神病性障碍（FEP）患者的病程。鉴于缺乏直接研究此问题的研究，我们首先识别并批判性地评估了评估健康肥胖/超重青少年和年轻人体重增加异常以及灰质或白质（GM，WM）体积（整体或在特定感兴趣区域）的文献。然后，我们将这一系统综述的结果与最近两项调查未使用药物治疗的FEP患者GM和WM异常的荟萃分析结果进行了比较。健康受试者的体重增加与额叶和颞叶GM萎缩以及胼胝体WM完整性降低始终相关。相关的是，所有这些脑区在未使用药物治疗的FEP患者中均受到影响，并且它们的完整性与临床、认知和功能预后相关。我们广泛讨论了可能解释健康受试者和未使用药物治疗的FEP患者体重增加、肥胖与脑损伤之间关联的潜在机制。基于这些知识，我们试图：a）推导精神病谱系障碍中肥胖发展的综合模型；b）确定体重增加与精神病之间关联的关键脆弱因素；c）提供有关新的潜在干预靶点的信息。
