Oh Sanghoon, Kim Minah, Kim Taekwan, Lee Tae Young, Kwon Jun Soo
Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
Aust N Z J Psychiatry. 2020 May;54(5):509-518. doi: 10.1177/0004867419885452. Epub 2019 Nov 8.
The persistent disease burden of psychotic disorders often comes from negative symptoms; however, prognostic biomarkers for negative symptoms have not been fully understood. This study investigated whether the altered functional connectivity of the striatum predicts improvement in negative symptoms and functioning after 1 year of usual treatment in patients with first-episode psychosis.
Resting-state functional magnetic imaging was obtained from 40 first-episode psychosis patients and 40 age- and sex-matched healthy control subjects. Whole-brain functional connectivity maps were generated with subdivisions of the striatum as seed regions and compared between first-episode psychosis patients and healthy controls. In 22 patients with first-episode psychosis, follow-up assessments of negative symptom severity and general functional status were conducted after 1 year of usual treatment. Multiple regression analyses were performed to examine factors predictive of symptomatic or functional improvements over the 1-year period.
First-episode psychosis patients showed greater functional connectivity between the left dorsal caudate and left primary motor cortex, as well as between the left ventral rostral putamen and right temporal occipital fusiform cortex, than healthy controls. Lower functional connectivity between the right dorsal rostral putamen and anterior cingulate cortex was observed in the first-episode psychosis patients than in healthy controls. In multiple regression analyses, lower functional connectivity of the left dorsal caudate-left primary motor cortex/right dorsal rostral putamen-anterior cingulate cortex predicted improvement in negative symptoms. In addition, lower right dorsal rostral putamen-anterior cingulate cortex functional connectivity predicted improvement in general functioning.
These results suggest that altered striatal functional connectivity can be a potent neurobiological marker in the prognosis prediction of first-episode psychosis. Furthermore, altered striatal functional connectivity may provide a potential target in developing treatments for negative symptoms.
精神障碍持续的疾病负担通常源于阴性症状；然而，阴性症状的预后生物标志物尚未完全明确。本研究调查了纹状体功能连接的改变是否能预测首发精神病患者在接受1年常规治疗后阴性症状及功能的改善情况。
对40例首发精神病患者和40名年龄及性别匹配的健康对照者进行静息态功能磁共振成像检查。以纹状体的各亚区为种子区域生成全脑功能连接图，并在首发精神病患者和健康对照者之间进行比较。对22例首发精神病患者在接受1年常规治疗后进行阴性症状严重程度和总体功能状态的随访评估。进行多元回归分析以检验预测1年内症状或功能改善的因素。
与健康对照者相比，首发精神病患者左侧背侧尾状核与左侧初级运动皮层之间以及左侧腹侧喙部壳核与右侧颞枕梭状回皮层之间的功能连接更强。与健康对照者相比，首发精神病患者右侧背侧喙部壳核与前扣带回皮层之间的功能连接更低。在多元回归分析中，左侧背侧尾状核-左侧初级运动皮层/右侧背侧喙部壳核-前扣带回皮层较低的功能连接预测了阴性症状的改善。此外，右侧背侧喙部壳核-前扣带回皮层较低的功能连接预测了总体功能的改善。
这些结果表明，纹状体功能连接的改变可能是首发精神病预后预测中一种有效的神经生物学标志物。此外，纹状体功能连接的改变可能为开发阴性症状治疗方法提供潜在靶点。
