Birur Badari, Kraguljac Nina Vanessa, Shelton Richard C, Lahti Adrienne Carol
Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL USA.
NPJ Schizophr. 2017 Apr 3;3:15. doi: 10.1038/s41537-017-0013-9. eCollection 2017.
Since Emil Kraepelin's conceptualization of endogenous psychoses as dementia praecox and manic depression, the separation between primary psychotic disorders and primary affective disorders has been much debated. We conducted a systematic review of case-control studies contrasting magnetic resonance imaging studies in schizophrenia and bipolar disorder. A literature search in PubMed of studies published between January 2005 and December 2016 was conducted, and 50 structural, 29 functional, 7 magnetic resonance spectroscopy, and 8 combined imaging and genetic studies were deemed eligible for systematic review. Structural neuroimaging studies suggest white matter integrity deficits that are consistent across the illnesses, while gray matter reductions appear more widespread in schizophrenia compared to bipolar disorder. Spectroscopy studies in cortical gray matter report evidence of decreased neuronal integrity in both disorders. Functional neuroimaging studies typically report similar functional architecture of brain networks in healthy controls and patients across the psychosis spectrum, but find differential extent of alterations in task related activation and resting state connectivity between illnesses. The very limited imaging-genetic literature suggests a relationship between psychosis risk genes and brain structure, and possible gene by diagnosis interaction effects on functional imaging markers. While the existing literature suggests some shared and some distinct neural markers in schizophrenia and bipolar disorder, it will be imperative to conduct large, well designed, multi-modal neuroimaging studies in medication-naïve first episode patients that will be followed longitudinally over the course of their illness in an effort to advance our understanding of disease mechanisms.
自从埃米尔·克雷佩林将内源性精神病概念化为早发性痴呆和躁狂抑郁症以来，原发性精神障碍与原发性情感障碍之间的区分一直备受争议。我们对对比精神分裂症和双相情感障碍磁共振成像研究的病例对照研究进行了系统综述。在PubMed上检索了2005年1月至2016年12月发表的研究，50项结构研究、29项功能研究、7项磁共振波谱研究以及8项成像与基因联合研究被认为符合系统综述的条件。结构神经影像学研究表明，这两种疾病存在一致的白质完整性缺陷，而与双相情感障碍相比，精神分裂症的灰质减少更为广泛。皮质灰质的波谱研究报告了这两种疾病中神经元完整性降低的证据。功能神经影像学研究通常报告，健康对照者和整个精神病谱系患者的脑网络功能结构相似，但发现不同疾病在任务相关激活和静息态连接方面的改变程度存在差异。非常有限的成像遗传学文献表明，精神病风险基因与脑结构之间存在关联，并且可能存在基因与诊断对功能成像标记的相互作用效应。虽然现有文献表明精神分裂症和双相情感障碍存在一些共同的和一些独特的神经标记，但有必要对未用药的首发患者进行大规模、设计良好的多模态神经影像学研究，并在其病程中进行纵向跟踪，以增进我们对疾病机制的理解。
