早期精神病的神经影像学改变与复发。
Neuroimaging alterations and relapse in early-stage psychosis.
机构信息
Departments of Psychiatry (Mihaljevic, Nagpal, Etyemez, Narita, Ross, Schaub, Cascella, Coughlin, Nestadt, Nucifora, Sedlak, Yang, Sawa), Radiology and Radiological Sciences (Faria), Neuroscience (Sawa), Biomedical Engineering (Sawa), Phamarchology (Sawa), and Genetic Medicine (Sawa), Johns Hopkins University School of Medicine; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. (Sawa); Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Ga. (Calhoun).
Departments of Psychiatry (Mihaljevic, Nagpal, Etyemez, Narita, Ross, Schaub, Cascella, Coughlin, Nestadt, Nucifora, Sedlak, Yang, Sawa), Radiology and Radiological Sciences (Faria), Neuroscience (Sawa), Biomedical Engineering (Sawa), Phamarchology (Sawa), and Genetic Medicine (Sawa), Johns Hopkins University School of Medicine; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. (Sawa); Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Ga. (Calhoun)
出版信息
J Psychiatry Neurosci. 2024 Apr 3;49(2):E135-E142. doi: 10.1503/jpn.230115. Print 2024 Jan-Feb.
BACKGROUND
Recent reports have indicated that symptom exacerbation after a period of improvement, referred to as relapse, in early-stage psychosis could result in brain changes and poor disease outcomes. We hypothesized that substantial neuroimaging alterations may exist among patients who experience relapse in early-stage psychosis.
METHODS
We studied patients with psychosis within 2 years after the first psychotic event and healthy controls. We divided patients into 2 groups, namely those who did not experience relapse between disease onset and the magnetic resonance imaging (MRI) scan (no-relapse group) and those who did experience relapse between these 2 timings (relapse group). We analyzed 3003 functional connectivity estimates between 78 regions of interest (ROIs) derived from resting-state functional MRI data by adjusting for demographic and clinical confounding factors.
RESULTS
We studied 85 patients, incuding 54 in the relapse group and 31 in the no-relapse group, along with 94 healthy controls. We observed significant differences in 47 functional connectivity estimates between the relapse and control groups after multiple comparison corrections, whereas no differences were found between the no-relapse and control groups. Most of these pathological signatures (64%) involved the thalamus. The Jonckheere-Terpstra test indicated that all 47 functional connectivity changes had a significant cross-group progression from controls to patients in the no-relapse group to patients in the relapse group.
LIMITATIONS
Longitudinal studies are needed to further validate the involvement and pathological importance of the thalamus in relapse.
CONCLUSION
We observed pathological differences in neuronal connectivity associated with relapse in early-stage psychosis, which are more specifically associated with the thalamus. Our study implies the importance of considering neurobiological mechanisms associated with relapse in the trajectory of psychotic disorders.
背景
近期有报告指出，早期精神病症状改善后出现的恶化，即复发，可能导致大脑发生变化和疾病预后不良。我们假设在早期精神病发作后出现复发的患者中可能存在大量神经影像学改变。
方法
我们研究了发病后 2 年内的精神病患者和健康对照者。我们将患者分为两组，一组是在发病到磁共振成像（MRI）扫描之间没有复发的患者（无复发组），另一组是在这两个时间点之间有复发的患者（复发组）。我们通过调整人口统计学和临床混杂因素，分析了来自静息态功能 MRI 数据的 78 个感兴趣区（ROI）之间的 3003 个功能连接估计值。
结果
我们共研究了 85 名患者，包括 54 名复发组患者和 31 名无复发组患者，以及 94 名健康对照者。在多次比较校正后，我们观察到复发组和对照组之间有 47 个功能连接估计值存在显著差异，而无复发组和对照组之间则没有差异。这些病理性特征中（64%）大多数涉及丘脑。Jonckheere-Terpstra 检验表明，在无复发组患者和复发组患者中，所有 47 个功能连接变化都具有从对照组到无复发组患者到复发组患者的显著跨组进展。
局限性
需要进行纵向研究以进一步验证丘脑在复发中的参与和病理性重要性。
结论
我们观察到与早期精神病复发相关的神经元连接的病理性差异，这些差异更具体地与丘脑有关。我们的研究表明，在精神障碍的病程中，考虑与复发相关的神经生物学机制是很重要的。
Zotero 插件