Cao Peiyu, Chen Congxin, Si Qi, Li Yuting, Ren Fangfang, Han Chongyang, Zhao Jingjing, Wang Xiying, Xu Guoxin, Sui Yuxiu
Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China.
Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China.
Front Psychiatry. 2023 Jul 20;14:1191170. doi: 10.3389/fpsyt.2023.1191170. eCollection 2023.
There is considerable debate as to whether the continuum of major psychiatric disorders exists and to what extent the boundaries extend. Converging evidence suggests that alterations in hippocampal volume are a common sign in psychiatric disorders; however, there is still no consensus on the nature and extent of hippocampal atrophy in schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (BD). The aim of this study was to verify the continuum of SZ - BD - MDD at the level of hippocampal subfield volume and to compare the volume differences in hippocampal subfields in the continuum.
A total of 412 participants (204 SZ, 98 MDD, and 110 BD) underwent 3 T MRI scans, structured clinical interviews, and clinical scales. We segmented the hippocampal subfields with FreeSurfer 7.1.1 and compared subfields volumes across the three diagnostic groups by controlling for age, gender, education, and intracranial volumes.
The results showed a gradual increase in hippocampal subfield volumes from SZ to MDD to BD. Significant volume differences in the total hippocampus and 13 of 26 hippocampal subfields, including CA1, CA3, CA4, GC-ML-DG, molecular layer and the whole hippocampus, bilaterally, and parasubiculum in the right hemisphere, were observed among diagnostic groups. Medication treatment had the most effect on subfields of MDD compared to SZ and BD. Subfield volumes were negatively correlated with illness duration of MDD. Positive correlations were found between subfield volumes and drug dose in SZ and MDD. There was no significant difference in laterality between diagnostic groups.
The pattern of hippocampal volume reduction in SZ, MDD and BD suggests that there may be a continuum of the three disorders at the hippocampal level. The hippocampus represents a phenotype that is distinct from traditional diagnostic strategies. Combined with illness duration and drug intervention, it may better reflect shared pathophysiology and mechanisms across psychiatric disorders.
关于主要精神障碍的连续性是否存在以及其边界扩展到何种程度存在相当大的争议。越来越多的证据表明，海马体积改变是精神障碍的一个常见迹象；然而，对于精神分裂症（SZ）、重度抑郁症（MDD）和双相情感障碍（BD）中海马萎缩的性质和程度仍未达成共识。本研究的目的是在海马亚区体积水平上验证SZ - BD - MDD的连续性，并比较连续体中海马亚区的体积差异。
共有412名参与者（204名SZ、98名MDD和110名BD）接受了3T磁共振成像扫描、结构化临床访谈和临床量表评估。我们使用FreeSurfer 7.1.1对海马亚区进行分割，并通过控制年龄、性别、教育程度和颅内体积来比较三个诊断组之间的亚区体积。
结果显示，从SZ到MDD再到BD，海马亚区体积逐渐增加。在诊断组之间观察到双侧海马总体积以及26个海马亚区中的13个存在显著体积差异，包括CA1、CA3、CA4、GC - ML - DG、分子层和整个海马，以及右侧半球的副海马体。与SZ和BD相比，药物治疗对MDD亚区的影响最大。亚区体积与MDD的病程呈负相关。在SZ和MDD中，亚区体积与药物剂量呈正相关。诊断组之间的偏侧性没有显著差异。
SZ、MDD和BD中海马体积减少的模式表明，这三种疾病在海马水平上可能存在连续性。海马代表了一种与传统诊断策略不同的表型。结合病程和药物干预，它可能更好地反映精神障碍之间共同的病理生理学和机制。
