Longitudinal brain changes in first-episode psychosis: A 10 year follow-up MRI study

现在人们普遍认为精神分裂症与大脑结构的变化有关。直到最近，这些结构变化被认为是在疾病发作之前发生的，并且保持不变。然而，我们自己的工作提出了一种替代模型，将精神分裂症与特定生命阶段的大脑变化联系起来。为了证明这一点，我们打算对100名患者进行重复脑成像，这些患者在10年前开始精神病时进行了首次扫描。这将是世界上最大的首次精神病发作的随访研究，第一次和第二次大脑扫描之间的间隔最长。此外，对于一部分患者，我们将在发病时、发病后2-4年进行3次MRI扫描，然后在10年时进行第三次扫描，从而提供独特的随访脑成像数据。根据我们自己和其他研究，我们打算探索十年内大脑渐进变化与以下因素之间的关系：（i）病人的诊断（ii）患者的临床和功能结果，（仍然患有慢性疾病或没有进一步的精神病发作），以及（iii）患者的认知状态（他们在记忆力、计划等测试中表现良好的能力）。我们能够进行这项研究，是因为有一个为跟踪病人而开发的基础设施，在1992年和1993年收治的病人中，再接触率为70%。在这项研究中，我们试图实施这些策略，为1994年后确定的患者。这项研究的结果将检验我们从主要精神病模型中得出的想法，并可能确定与慢性精神分裂症和其他精神病发展相关的大脑结构变化。另一个新的结果将是纳入保持良好的患者，并确定良好预后的结构相关性。

It is now widely accepted that schizophrenia is associated with changes in the structure of the brain. Until recently these structural changes were considered to predate the onset of illness and to remain static. However, our own work has suggested an alternative model, which relates schizophrenia to brain changes at specific life stages. In order to demonstrate this, we intend to acquire repeat brain images on 100 patients who were initially scanned 10 years ago at the start of their psychotic illness. This would be the largest follow-up study of first episode psychosis in the world, with the longest interval between the first and second brain scan. Further, for a proportion of patients we will have 3 MRI scans, at illness onset, 2-4 years post-onset, followed by a third scan at 10 years, thereby providing unique follow-up brain imaging data. Based on our own and other research, we intend to explore the relationship between progressive brain change over a ten year period and: (i) the diagnosis of the patient (schizophrenia or other disorder), (ii) the clinical and functional outcome of the patient (still chronically ill or with no further episode of psychosis), and (iii) the cognitive state of the patient (their ability to perform well on tests of memory, planning and so on). We are able to conduct this study because of the existence of an infrastructure developed to follow-up patients, with a recontact rate of 70% of those patients admitted in 1992 and 1993. In this study we seek to implement these strategies for the patients identified after 1994. The results of this study will test our ideas derived from our model of the major psychotic illnesses and may identify the structural brain changes which are associated with the development of chronic schizophrenia and other psychoses. A further novel outcome will be the inclusion of patients who have remained well and identiifying the structural correlates of a good prognosis.