Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain.
Schizophr Bull. 2017 Oct 21;43(6):1176-1189. doi: 10.1093/schbul/sbx126.
Ample evidence supports a neurodevelopmental origin in some cases of schizophrenia (SZ). More inconsistent information is available for bipolar disorder (BD). We herein review studies with a focus on premorbid (adjustment and functionality) and early developmental milestones that include both SZ and BD patients. A search was performed in the PubMed electronic database, retrieving 619 abstracts; 30 were ultimately included in this systematic review. Eight prospective cohorts, 15 retrospective studies, and 7 studies based on national registries. Psychomotor developmental deviations and general adjustment problems characterize the childhood of subjects later diagnosed with SZ or BD; they are more marked in those later diagnosed with SZ vs BD, earlier onset vs later onset, and psychotic vs nonpsychotic disorders. Cognitive impairment follows a linear risk trend for SZ and a U-shaped trend for BD. Social isolation and visuoperceptual/reading anomalies more frequently antecede SZ. Pervasive developmental disorders increase the risk for both SZ and BD, more so in cases with normal intelligence. The predictive risk of each isolated developmental marker is low, but a significant percentage of subjects with SZ and a minority of adults with BD showed signs of premorbid abnormalities in childhood. The great limitation is still the lack of studies comparing SZ and BD that include psychotic and nonpsychotic bipolar cases separately. There are many cases, even in childhood/adolescent SZ, where no premorbid anomalies are found, and immunological disorders or other etiologies should be searched for. At least in cases with clear neurodevelopmental markers, rare genetic variants should be investigated.
大量证据支持精神分裂症（SZ）的某些病例存在神经发育起源。关于双相情感障碍（BD），则有更多不一致的信息。我们在此回顾了一些研究，重点关注了SZ 和 BD 患者的病前（调整和功能）和早期发育里程碑。在 PubMed 电子数据库中进行了搜索，检索到 619 篇摘要；最终有 30 篇被纳入本系统评价。其中包括 8 项前瞻性队列研究、15 项回顾性研究和 7 项基于国家登记的研究。精神运动发育障碍和一般适应问题是后来被诊断为 SZ 或 BD 的患者的儿童期特征；与后来被诊断为 BD 的患者相比，这些问题在后来被诊断为 SZ 的患者中更为明显，在发病较早的患者中比发病较晚的患者更明显，在精神病性障碍患者中比非精神病性障碍患者更明显。认知障碍对 SZ 呈线性风险趋势，对 BD 呈 U 型趋势。社会孤立和视知觉/阅读异常更常先于 SZ 出现。广泛性发育障碍增加了 SZ 和 BD 的风险，在智力正常的情况下风险更高。每个孤立的发育标志物的预测风险都较低，但 SZ 患者中有很大比例、BD 患者中有少数成人在儿童期表现出病前异常迹象。最大的局限性仍然是缺乏比较 SZ 和 BD 的研究，这些研究分别包括精神病性和非精神病性双相情感障碍病例。即使在儿童/青少年 SZ 中，也有很多病例没有发现病前异常，应该寻找免疫紊乱或其他病因。至少在有明确神经发育标志物的病例中，应该调查罕见的遗传变异。
