Gur R E, Maany V, Mozley P D, Swanson C, Bilker W, Gur R C
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
Am J Psychiatry. 1998 Dec;155(12):1711-7. doi: 10.1176/ajp.155.12.1711.
This study examined whether subcortical volumes of the basal ganglia and thalamus in schizophrenic patients are related to neuroleptic exposure and symptom severity.
Basal ganglia substructures and thalamic volumes were measured with magnetic resonance imaging in 96 patients with schizophrenia (50 men and 46 women) and 128 healthy comparison subjects (60 men and 68 women). Twenty-one of the patients were neuroleptic-naive; of the 75 previously treated patients, 48 had received typical neuroleptics only, and 27 had received typical and atypical neuroleptics. The relation of volume measures to treatment status, exposure to neuroleptics, and symptoms was examined.
The neuroleptic-naive patients did not differ from the healthy comparison subjects in subcortical volumes except for lower thalamic volume. In the neuroleptic-naive group, volumes did not correlate with severity of negative symptoms, but higher volumes in both the thalamus and the putamen were associated with more severe positive symptoms. The previously treated group showed higher volumes in the putamen and globus pallidus than the healthy comparison subjects and the neuroleptic-naive patients. In the treated group, a higher dose of a typical neuroleptic was associated with higher caudate, putamen, and thalamus volumes, whereas a higher dose of an atypical neuroleptic was associated only with higher thalamic volume. Higher subcortical volumes were mildly associated with greater severity of both negative and positive symptoms.
Increased subcortical volumes in treated schizophrenic patients seem to be medication-induced hypertrophy. This hypertrophy could reflect structural adaptation to receptor blockade and may moderate the effects of neuroleptic treatment.
本研究探讨精神分裂症患者基底神经节和丘脑的皮质下体积是否与抗精神病药物暴露及症状严重程度相关。
采用磁共振成像测量96例精神分裂症患者（50例男性和46例女性）及128名健康对照者（60例男性和68例女性）的基底神经节亚结构和丘脑体积。21例患者未使用过抗精神病药物；在75例曾接受治疗的患者中，48例仅接受过传统抗精神病药物治疗，27例接受过传统和非传统抗精神病药物治疗。研究了体积测量值与治疗状态、抗精神病药物暴露及症状之间的关系。
未使用过抗精神病药物的患者除丘脑体积较小外，皮质下体积与健康对照者无差异。在未使用过抗精神病药物的组中，体积与阴性症状严重程度无相关性，但丘脑和壳核体积较大与阳性症状更严重相关。曾接受治疗的组与健康对照者及未使用过抗精神病药物的患者相比，壳核和苍白球体积更大。在治疗组中，较高剂量的传统抗精神病药物与尾状核、壳核和丘脑体积增大相关，而较高剂量的非传统抗精神病药物仅与丘脑体积增大相关。较高的皮质下体积与阴性和阳性症状的更严重程度轻度相关。
接受治疗的精神分裂症患者皮质下体积增加似乎是药物引起的肥大。这种肥大可能反映了对受体阻断的结构适应性，并可能调节抗精神病药物治疗的效果。
