Zipursky R B, Lambe E K, Kapur S, Mikulis D J
Clarke Institute of Psychiatry, Department of Psychiatry, University of Toronto School of Medicine, Ontario, Canada.
Arch Gen Psychiatry. 1998 Jun;55(6):540-6. doi: 10.1001/archpsyc.55.6.540.
Structural brain differences including decreased gray matter and increased cerebrospinal fluid volumes have been observed in the brains of chronically ill patients with schizophrenia. We hypothesized that deficits in gray matter volume would be present in patients presenting with a first episode of nonaffective psychosis.
We used magnetic resonance imaging to compare the brains of 77 patients assessed as having a first episode of psychosis (meeting DSM-III-R criteria for schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorder not otherwise specified) with those of 61 healthy controls matched for age, sex, race, and parental socioeconomic status. Axial, dual-echo scans of the whole brain were segmented into gray matter, white matter, and cerebrospinal fluid compartments using a computerized volumetric approach. These measures were corrected for the significant effects of intracranial volume and age prior to performing between-group comparisons.
The first episode psychosis group had significantly smaller gray matter volume (t[136] = -2.2; P = .03) and greater cerebrospinal fluid volume (t[136] = 2.5; P = .02) than normal controls. In the patient group, gray matter volumes were positively correlated with estimates of IQ but not with age of onset, duration of illness, or measures of premorbid functioning.
Deficits in gray matter volume are present in patients experiencing first episode nonaffective psychosis. The magnitude of these differences is smaller than has been described in more chronically ill patients.
在患有精神分裂症的慢性病患者大脑中，已观察到包括灰质减少和脑脊液体积增加在内的脑结构差异。我们假设，首次发作非情感性精神病的患者会出现灰质体积缺陷。
我们使用磁共振成像，将77名被评估为首次发作精神病（符合精神分裂症、分裂样障碍、分裂情感性障碍、妄想性障碍或未另行规定的精神病性障碍的《精神疾病诊断与统计手册》第三版修订版标准）的患者的大脑，与61名在年龄、性别、种族和父母社会经济地位方面匹配的健康对照者的大脑进行比较。使用计算机化体积测量方法，将全脑的轴向双回波扫描分割为灰质、白质和脑脊液区域。在进行组间比较之前，对这些测量值进行了颅内体积和年龄显著影响的校正。
首次发作精神病组的灰质体积显著小于正常对照组（t[136] = -2.2；P = .03），脑脊液体积显著大于正常对照组（t[136] = 2.5；P = .02）。在患者组中，灰质体积与智商估计值呈正相关，但与发病年龄、病程或病前功能测量值无关。
首次发作非情感性精神病的患者存在灰质体积缺陷。这些差异的程度小于在病程更长的患者中所描述的程度。
