Hippocampal and amygdala volumes according to psychosis stage and diagnosis - A magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals
Hippocampal and amygdala volumes according to psychosis stage and diagnosis - A magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals
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DOI：
10.1001/archpsyc.63.2.139
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发表时间：
2006-02-01
影响因子：
--
通讯作者：
Pantelis, C
中科院分区：
文献类型：
--
作者：
Velakoulis, D;Wood, SJ;Pantelis, C
内容：磁共振成像研究发现，精神分裂症患者海马体积减小，双相情感障碍患者杏仁核体积增大，这表明这些疾病中存在不同的内侧颞叶异常。这些研究受到小样本和缺乏早期病程患者的限制。目的：研究慢性精神分裂症患者、首发精神病患者和极高危精神病患者与对照组的海马和杏仁核体积。设计：患者组和对照组之间的横断面比较。设置：慢性精神分裂症患者是从精神健康康复服务机构招募的，而首发精神病和超高风险患者是从ORYGEN青年健康服务机构招募的。研究对象：473名受试者，包括89名慢性精神分裂症患者，162名首发精神病患者，135名精神病高危人群（其中39人随后发展为精神病），和87名对照。在高分辨率磁共振图像上估计海马、杏仁核、全脑和颅内体积，并在各组之间进行比较，包括首次发作亚组。我们使用单向和双向方差分析设计来比较各组海马和杏仁核体积，校正颅内体积并随年龄和性别协变。我们调查了药物治疗和病程对结构volumes.Results的影响：慢性精神分裂症患者显示双侧海马体积减少。首发精神分裂症而非分裂样精神病的患者显示左侧海马体积减小。与对照组相比，其余首次发病亚组的海马体积正常。杏仁核体积增大仅见于首发的非精神分裂症性精神病患者。精神病超高风险患者的基线海马和杏仁核体积正常，无论他们随后是否发展为精神病。服用非典型抗精神病药物与典型抗精神病药物的患者之间的结构体积没有差异，并且当用锂治疗的患者被排除在分析之外时，它们保持不变。结论：直到精神病发作后才看到内侧颞叶结构变化，并且结构变化的模式根据精神病的类型而不同。这些发现对未来精神障碍的神经生物学研究具有重要意义，并强调了在精神病发作前后对患者进行纵向研究的重要性。
Context: Magnetic resonance imaging studies have identified hippocampal volume reductions in schizophrenia and amygdala volume enlargements in bipolar disorder, suggesting different medial temporal lobe abnormalities in these conditions. These studies have been limited by small samples and the absence of patients early in the course of illness.Objective: To investigate hippocampal and amygdala volumes in a large sample of patients with chronic schizophrenia, patients with first-episode psychosis, and patients at ultra-high risk for psychosis compared with control subjects.Design: Cross-sectional comparison between patient groups and controls.Setting: Individuals with chronic schizophrenia were recruited from a mental health rehabilitation service, and individuals with first-episode psychosis and ultra-high risk were recruited from the ORYGEN Youth Health Service. Control subjects were recruited from the community.Participants: The study population of 473 individuals included 89 with chronic schizophrenia, 162 with first-episode psychosis, 135 at ultra-high risk for psychosis (of whom 39 subsequently developed a psychotic illness), and 87 controls.Main Outcome Measures: Hippocampal, amygdala, whole-brain, and intracranial volumes were estimated on high-resolution magnetic resonance images and compared across groups, including first-episode subgroups. We used 1- and 2-way analysis of variance designs to compare hippocampal and amygdala volumes across groups, correcting for intracranial volume and covarying for age and sex. We investigated the effects of medication and illness duration on structural volumes.Results: Patients with chronic schizophrenia displayed bilateral hippocampal volume reduction. Patients with first episode schizophrenia but not schizophreniform psychosis displayed left hippocampal volume reduction. The remaining first-episode subgroups had normal hippocampal volumes compared with controls. Amygdala volume enlargement was identified only in first-episode patients with nonschizophrenic psychoses. Patients at ultra-high risk for psychosis had normal baseline hippocampal and amygdala volumes whether or not they subsequently developed a psychotic illness. Structural volumes did not differ between patients taking atypical vs typical antipsychotic medications, and they remained unchanged when patients treated with lithium were excluded from the analysis.Conclusions: Medial temporal structural changes are not seen until after the onset of a psychotic illness, and the pattern of structural change differs according to the type of psychosis. These findings have important implications for future neurobiological studies of psychotic disorders and emphasize the importance of longitudinal studies examining patients before and after the onset of a psychotic illness.