Yunzhi Pan, Chen Xudong, Chen Eric, Lee Edwin, Zhening Liu, Ouyang Xuan, Palaniyappan Lena
Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, PR China.
Robarts Research Institution, University of Western Ontario, London, ON, Canada.
Schizophrenia (Heidelb). 2022 Oct 29;8(1):88. doi: 10.1038/s41537-022-00296-y.
The aberration in cortical gyrification seen in schizophrenia likely originates in the earliest phase of life, as gyrification begins in utero and reaches its peak in infancy. However, emerging observations have indicated a later reduction in gyrification, especially in early adulthood, may also occur in schizophrenia. At present, it is unclear whether the baseline and later gyrification reduction has any prognostic importance in schizophrenia. We address this question in a longitudinal design in patients minimally medicated at inception. About 108 minimally medicated (duration of medication = <14 days of antipsychotics) patients and 106 healthy controls underwent structural magnetic resonance imaging, with 34 patients being selectively re-scanned when clinically stable following antipsychotic treatment. The cortical surface from each structural image was reconstructed, and the local gyrification index and cortical thickness were computed for each vertex on the surface. We found minimally medicated schizophrenia patients during the first episode had a relatively higher gyrification in bilateral supramarginal, left superior temporal, and right posterior cingulate and paracentral regions. However, poor prognostic features were more likely in patients with lower baseline gyrification. Longitudinal reductions in left superior parietal and right precentral gyrification were associated with lower improvements in both positive and negative symptoms over time. The spatial pattern of longitudinal changes in gyrification was distinct from the changes in cortical thickness. These results indicated that schizophrenia is characterized by a relative hypergyrification in parieto-temporal and medial cortical areas at a group level at first presentation, but poor outcomes relate to lower-gyrification elsewhere both at the onset and during the early course. The early post-onset reduction of gyrification is rather limited in space and magnitude, but occurs unrelated to the progressive thinning, representing a distinct, prognostically important structural trajectory.
精神分裂症中所见的皮质脑回形成异常可能起源于生命的最早阶段，因为脑回形成始于子宫内并在婴儿期达到高峰。然而，新出现的观察结果表明，精神分裂症患者在生命后期，尤其是成年早期，脑回形成也可能减少。目前，尚不清楚基线时及后期脑回形成减少在精神分裂症中是否具有任何预后意义。我们在一项纵向研究设计中对起始时用药极少的患者进行了研究。约108名用药极少（抗精神病药物用药时间 = <14天）的患者和106名健康对照者接受了结构磁共振成像检查，其中34名患者在抗精神病药物治疗后临床稳定时接受了选择性重新扫描。对每个结构图像的皮质表面进行重建，并计算表面上每个顶点的局部脑回形成指数和皮质厚度。我们发现，首次发作时用药极少的精神分裂症患者在双侧缘上回、左侧颞上回、右侧后扣带回和中央旁小叶区域的脑回形成相对较高。然而，基线脑回形成较低的患者预后较差的特征更常见。随着时间的推移，左侧顶上回和右侧中央前回脑回形成的纵向减少与阳性和阴性症状的改善较少相关。脑回形成纵向变化的空间模式与皮质厚度的变化不同。这些结果表明，精神分裂症在首次就诊时在组水平上的特征是顶颞叶和内侧皮质区域相对脑回过度形成，但预后不良与发病时及病程早期其他部位脑回形成较低有关。发病后早期脑回形成的减少在空间和程度上相当有限，但与渐进性变薄无关，代表了一种独特的、对预后有重要意义的结构轨迹。
