From the Robarts Research Institute & The Brain and Mind Institute, Western University, London, Ont., Canada (Palaniyappan, Das); the Department of Psychiatry, Western University, London, Ont., Canada (Palaniyappan, Das, Dempster); and the Lawson Health Research Institute, London, Ont., Canada (Palaniyappan, Das).
J Psychiatry Neurosci. 2017 Sep;42(5):294-299. doi: 10.1503/jpn.170137.
The prepsychotic phase of schizophrenia is not only important for indicated prevention strategies, but also crucial for developing mechanistic models of the emergence of frank psychosis (transition). This commentary highlights the work of Dukart and colleagues, published in this issue of the , who sought to identify MRI-based anatomic endophenotypes of psychosis in a well-characterized sample of patients with at-risk mental state (ARMS) and first-episode psychosis (FEP). Conceptual and translational challenges in clarifying the neurobiology of transitional prepsychotic states are discussed. A role of intracortical myelin in the neurobiology of transition is proposed. Transition may not be an outcome of "progressive structural deficits"; it may occur due to inadequate compensatory responses in the predisposed. The need to revise our current "deficit-oriented" models of neurobiology of psychosis in the wake of burgeoning evidence indicating a dynamic process of cortical reorganization is emphasized.
精神分裂症的前驱期不仅对有针对性的预防策略很重要，而且对发展明确精神病出现的机制模型（转变）也至关重要。这篇评论强调了 Dukart 及其同事的工作，他们在本期的《分子精神病学》杂志上发表了一项研究，旨在确定风险精神状态 (ARMS)和首发精神病 (FEP)患者的特征明确样本中基于 MRI 的精神病解剖内表型。讨论了阐明过渡前精神病状态神经生物学的概念和转化挑战。提出了皮质内髓鞘在过渡神经生物学中的作用。转变可能不是“进行性结构缺陷”的结果；它可能是由于易感性者的代偿反应不足而发生的。强调需要在不断涌现的表明皮质重组的动态过程的证据的基础上，修改我们当前以“缺陷为导向”的精神病神经生物学模型。
