Transition to Psychosis Associated With Prefrontal and Subcortical Dysfunction in Ultra High-Risk Individuals
Transition to Psychosis Associated With Prefrontal and Subcortical Dysfunction in Ultra High-Risk Individuals
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DOI：
10.1093/schbul/sbr194
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发表时间：
2012-11-01
影响因子：
6.6
通讯作者：
McGuire, Philip
中科院分区：
文献类型：
--
作者：
Allen, Paul;Luigjes, Judy;McGuire, Philip
背景资料：精神病超高风险（UHR）的人发展为精神障碍的风险较高，但很难预测哪些人会转变为坦率的疾病。我们研究了功能性磁共振成像（fMRI）结合语音流畅性任务，在介绍是否可以区分受试者谁随后发展为精神病，从那些谁没有。研究方法：65名受试者（41名UHR和24名健康对照）在临床表现进行了评估，使用功能磁共振成像，结合语言流畅性任务。[18F]-DOPA正电子发射断层扫描（PET）数据也可在21例UHR和14例健康对照受试者的亚组中获得。对UHR受试者进行至少2年的临床随访。结果如下：与未发生精神病的UHR受试者相比，随后发生精神病的UHR受试者显示双侧前额叶皮层（PFC）、脑干（中脑/基底脑桥）、左侧海马和更大的中脑-PFC连接的激活增加。此外，[18 F]-DOPA PET数据的探索性分析显示，向精神病的转变与脑干区域多巴胺能功能升高相关。结论：在精神病高危人群中，皮层和皮层下区域网络的激活增加可能预示着随后的疾病发作。功能性神经影像学，结合临床评估和其他调查，可能有助于预测易患精神病的受试者的结局。
Background: People at ultra high risk (UHR) of psychosis have an elevated risk of developing a psychotic disorder, but it is difficult to predict which individuals will make a transition to frank illness. We investigated whether functional magnetic resonance imaging (fMRI) in conjunction with a phonological fluency task at presentation could distinguish subjects who subsequently developed psychosis from those who did not. Methods: Sixty-five subjects (41 with an UHR and 24 healthy controls) were assessed at clinical presentation using fMRI, in conjunction with a verbal fluency task. [18F]-DOPA positron emission tomography (PET) data were also available in a subgroup of 21 UHR and 14 healthy controls subjects. UHR subjects were followed clinically for at least 2 years. Results: Compared with UHR subjects who did not become psychotic, UHR subjects who subsequently developed psychosis showed increased activation in bilateral prefrontal cortex (PFC), brainstem (midbrain/basilar pons), the left hippocampus, and greater midbrain-PFC connectivity. Furthermore, exploratory analysis of [18F]-DOPA PET data showed that transition to psychosis was associated with elevated dopaminergic function in the brainstem region. Conclusions: In people at high risk of psychosis, increased activation in a network of cortical and subcortical regions may predict the subsequent onset of illness. Functional neuroimaging, in conjunction with clinical assessment and other investigations, may facilitate the prediction of outcome in subjects who are vulnerable to psychosis.