Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study.
Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study.
复制标题
DOI：
10.1176/appi.ajp.2013.12050674
复制
发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Ho BC
中科院分区：
文献类型：
--
作者：
Andreasen NC;Liu D;Ziebell S;Vora A;Ho BC
纵向结构MRI研究表明，精神分裂症患者发病后脑组织进行性丧失。复发被认为是造成这种损失的一个原因，但复发与结构性 MRI 测量之间的关系尚未经过严格评估。作者分析了纵向数据来研究这个问题。作者研究了来自爱荷华州首发精神分裂症纵向研究的 202 名患者的数据，这些患者的足够结构 MRI 数据（N = 659 扫描）来自平均 7 年定期获得的扫描。由于临床随访数据是每隔 6 个月获得的，因此作者能够计算复发次数和持续时间的测量值，并将其与结构 MRI 测量值联系起来。由于较高的治疗强度与较小的脑组织体积相关，因此作者还根据剂量年研究了这种反作用。复发持续时间与一般（例如，总脑容量）和区域（例如，额叶）脑测量值的显着下降有关。复发次数与大脑测量无关。还观察到治疗强度的显着影响。长时间的复发可能会对精神分裂症的大脑完整性产生负面影响，这表明采取积极措施预防复发和提高治疗依从性的重要性。通过检查效果的相对平衡，即复发持续时间与抗精神病药物治疗强度的关系，这项研究揭示了临床医生面临的一个棘手的困境。预防复发很重要，但应使用尽可能低的药物剂量来控制症状，以持续预防复发。
Longitudinal structural MRI studies have shown that patients with schizophrenia have progressive brain tissue loss after onset. Recurrent relapses are believed to play a role in this loss, but the relationship between relapse and structural MRI measures has not been rigorously assessed. The authors analyzed longitudinal data to examine this question. The authors studied data from 202 patients drawn from the Iowa Longitudinal Study of first-episode schizophrenia for whom adequate structural MRI data were available (N=659 scans) from scans obtained at regular intervals over an average of 7 years. Because clinical follow-up data were obtained at 6-month intervals, the authors were able to compute measures of relapse number and duration and relate them to structural MRI measures. Because higher treatment intensity has been associated with smaller brain tissue volumes, the authors also examined this countereffect in terms of dose-years. Relapse duration was related to significant decreases in both general (e.g., total cerebral volume) and regional (e.g., frontal) brain measures. Number of relapses was unrelated to brain measures. Significant effects were also observed for treatment intensity. Extended periods of relapse may have a negative effect on brain integrity in schizophrenia, suggesting the importance of implementing proactive measures that may prevent relapse and improve treatment adherence. By examining the relative balance of effects, that is, relapse duration versus antipsychotic treatment intensity, this study sheds light on a troublesome dilemma that clinicians face. Relapse prevention is important, but it should be sustained using the lowest possible medication dosages that will control symptoms.
登录
查看更多内容
影响因子：
158.5
作者：
Csernansky, JG;Mahmoud, R;Brenner, R
通讯作者：
Brenner, R
影响因子：
10.6
作者：
Lieberman, J;Chakos, M;Bilder, R
通讯作者：
Bilder, R
影响因子：
--
作者：
Cahn, W;Pol, HEH;Kahn, RS
通讯作者：
Kahn, RS
影响因子：
10.6
作者：
Andreasen, Nancy C.;Pressler, Marcus;Nopoulos, Peg;Miller, Del;Ho, Beng-Choon
通讯作者：
Ho, Beng-Choon
影响因子：
17.7
作者：
Ho, BC;Andreasen, NC;Miller, D
通讯作者：
Miller, D