Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis
Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis
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DOI：
10.1016/j.schres.2010.09.021
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发表时间：
2011-01-01
影响因子：
4.5
通讯作者：
Lepage, Martin
中科院分区：
文献类型：
--
作者：
Malla, Ashok K.;Bodnar, Michael;Lepage, Martin
背景资料：精神病治疗的延迟与临床和社会结局不良相关，并以首次发作治疗前未治疗精神病（DUP）的持续时间进行测量。有人认为，这可能是通过精神病对大脑结构和功能的毒性作用来介导的。关于较长的DUP和神经解剖学变化之间的关联存在不明确的证据，例如，大脑特定区域的灰质体积减少和神经认知功能缺陷。目的：研究精神病首次发作治疗前未治疗精神病（DUP）的持续时间是否与脑结构异常和神经认知功能缺陷相关。我们使用基于体素的形态测量技术和多个认知领域研究了DUP和灰质体积之间的关系。80例首次发作精神病的患者根据中位数分为两个相等大小的组（18周）的DUP。结果：与短DUP组相比（平均DUP 7.9周+/- 5.6），长DUP组（平均113.7周± 170.4周）显示眶额区灰质体积显著减少（双侧内侧额回和双侧直肠回，BA 11）和顶叶区（中央后回和上级顶叶小叶）以及全脑灰质体积显著减少（p < 0.04）。对于精神分裂症谱系病例，仅这些发现局限于左侧直肠。在白色物质或脑脊液体积或认知功能方面没有差异。结果对照抗精神病药物暴露。局限性：在分离缓慢和阴险的发病从长期DUP的固有困难可能会限制我们的结果的解释，可能有一个重叠的DUP和病程（包括前驱症状）。结论：患者在精神病治疗的较长时间延迟显示出显着减少，具体减少在走廊-眼眶区域的整体灰质体积。这些结果为长期未经治疗的精神病可能的神经毒性作用提供了一些支持。(C)2010 Elsevier B. V.保留所有权利。
Background: Delay in treatment of psychosis is associated with poor clinical and social outcome and is measured as the duration of untreated psychosis (DUP) prior to treatment of the first episode. It has been suggested that this may be mediated through toxic effects of psychosis on the structure and function of the brain. Equivocal evidence exists regarding association between longer DUP and neuro-anatomical changes such as, reduced grey matter volume in specific regions in the brain and deficits in neurocognitive functions.Objective: To examine if duration of untreated psychosis (DUP) preceding treatment of a first episode of psychosis is associated with structural brain abnormalities and deficits in neurocognitive functions.Method: We investigated the relationship between DUP and grey matter volume using voxel-based morphometry techniques and with multiple domains of cognition. Eighty patients with a first episode of psychosis were separated into two equal sized groups based on a median split (18 weeks) of their DUP.Results: Compared to the short-DUP group (mean DUP 7.9 weeks +/- 5.6), the long-DUP group (mean 113.7 weeks +/- 170.4) showed significant grey matter volume reductions in orbital-frontal regions (bilateral medial frontal gyms and bilateral rectal gyms, BA 11) and parietal regions (postcentral gyms and superior parietal lobule) as well as a significant reduction in whole brain grey matter volume (p < 0.04). For schizophrenia spectrum cases only these findings were confined to left rectal gyms. There were no differences in white matter or cerebral spinal fluid volumes or on cognitive functions. Results are controlled for antipsychotic medication exposure. Limitations: The inherent difficulty in separating slow and insidious onset from long-DUP may limit the interpretation of our results and there may be an overlap between DUP and duration of illness (including the prodrome).Conclusion: Patients with a longer delay in treatment of psychosis show a significant reduction in overall grey matter volume with specific reductions in the inferior-orbital region. These results provide some support to a possible neurotoxic effect of prolonged untreated psychosis. (C) 2010 Elsevier B.V. All rights reserved.