Longitudinal study of brain morphology in first episode schizophrenia
Longitudinal study of brain morphology in first episode schizophrenia
复制标题
DOI：
10.1016/s0006-3223(01)01067-8
复制
发表时间：
2001-03-15
影响因子：
10.6
通讯作者：
Bilder, R
中科院分区：
文献类型：
--
作者：
Lieberman, J;Chakos, M;Bilder, R
背景：从克雷佩林开始，精神分裂症一直被视为一种进行性疾病。尽管对精神分裂症纵向病程的大量研究已经证明临床恶化主要发生在疾病的早期阶段，但这种临床现象的病理生理学尚未确定。该疾病的这一方面可能对于了解精神分裂症的发病机制和确定预防性治疗策略至关重要。精神分裂症的大脑形态异常一直被描述，但尚不清楚它们在疾病自然史中何时出现以及是否进行性进展。以前对大脑形态学的研究尚无定论，部分原因是图像采集和分析方法的可变性、对已经处于疾病慢性阶段且先前接受广泛治疗的患者的评估以及随访时间不足。方法：为了解决这些问题，我们使用高分辨率磁共振成像（MRI）和临床检查了 107 名精神分裂症或分裂情感性障碍首次发作的患者和 20 名健康志愿者。 长达 6 年的精神病理学和治疗结果评估。 51 名患者和 13 名对照受试者在至少 12 个月的随访后进行了 MRI 检查，结果：结果证实了先前报道的首发精神分裂症患者的心室扩大和前海马体积减少的发现，此外，我们发现选定结构随时间的变化与治疗结果相关，包括与预后不良患者相关的心室体积增加。与我们的假设相反， 结论：在预后不良的精神分裂症患者中发现进行性脑室扩大，这与持续的阳性和阴性症状导致脑室扩大形式的进行性大脑变化的假设是一致的，这可能是由于神经退行性变，而不是治疗的混杂效应。未来对精神分裂症首次发作的研究应利用更高分辨率的成像技术，比较临床上明确特征的患者（有或没有不良结果和复发症状），以控制与患者年龄和性别匹配的受试者。还需要控制典型抗精神病药物对大脑结构的治疗效果。生物精神病学 2001；49：487-499 (C) 2001 生物精神病学协会。
Background: Beginning with Kraepelin, schizophrenia has been viewed as a progressive disorder. Although numerous studies of the longitudinal course of schizophrenia have demonstrated the clinical deterioration that occurs predominantly in the early stages of the illness, the pathophysiology of this clinical phenomenon has not been established. This aspect of the illness may be of critical importance to understanding the pathogenesis of schizophrenia and determining preventive therapeutic strategies. Abnormalities in brain morphology have been consistently described in schizophrenia but it is not known when in the natural history of the illness they arise and whether they are progressive. Previous studies of brain morphology have been inconclusive, in part because of the variability of methods far image acquisition and analysis, assessment of patients already at chronic stages of their illness with extensive prior treatment exposure, and inadequate periods of follow-up,Methods: To address these questions we examined 107 patients in their first episode of schizophrenia or schizoaffective disorder and 20 healthy volunteers using high resolution magnetic resonance imaging (MRI) and clinical assessments of psychopathology and treatment outcome for periods of up to 6 years. Fifty-one patients and 13 control subjects had MRIs after at least 12 months of follow-up,Results: Results confirm the findings of ventricular enlargement and anterior hippocampal volume reductions in first episode schizophrenia patients that have been previously reported, In addition, we found changes in selected structures over time in relation to treatment outcome, including increases in ventricular volume that were associated with poor outcome patients, Contrary to our hypothesis, there were no significant reductions in cortical and hippocampal volumes over time.Conclusions: The finding of progressive ventricular enlargement in patients with poor outcome schizophrenia is consistent with the hypothesis that persistent positive and negative symptoms result in progressive brain changes in the form of ventricular enlargement, possibly due to neurodegeneration rather than the confounding effects of treatment. Future studies of first episodes of schizophrenia should utilize higher resolution imaging techniques that compare clinically well characterized patients with and without poor outcome and recurrent symptoms to control subjects who are well matched to patients for age and gender. There is also a need to control for treatment effects of typical antipsychotic medication on brain structure. Biol Psychiatry 2001;49:487-499 (C) 2001 Society of Biological Psychiatry.