根據(jù)1月份Archives of General Psychiatry上的一篇報(bào)道,，與無精神病診斷的健康青少年相比,，具精神分裂癥與其他精神病診斷的青少年灰白質(zhì)體積減少更多，額葉中的腦脊液增加更多,。
"在兒童期首發(fā)精神分裂癥中已報(bào)道了大腦灰質(zhì)（GM）逐步喪失,，然而，目前尚不能確定這些變化是否是不同的精神病小兒患者所共有的",，"作者在這項(xiàng)研究的背景信息中這樣寫道,。
西班牙馬德里Gregorio Marañón醫(yī)科大學(xué)的Celso Arango博士和同事在西班牙的6歲與青少年精神病患者中，檢查了首發(fā)早發(fā)性精神病大腦變化的進(jìn)展和后續(xù)兩年的診斷及預(yù)后的關(guān)系,。作者對61例患者（25例精神分裂癥患者,，16例雙相性精神障礙和20例其他精神病）和71例健康對照者進(jìn)行大腦磁共振成像（MRI）檢查,。磁共振成像掃描作為研究基線,，并在隨后兩年繼續(xù)進(jìn)行,。
與對照組相比,，在隨后的兩年內(nèi)，那些精神分裂癥患者的額葉表現(xiàn)出更大的灰質(zhì)體積損失,。精神分裂癥患者左側(cè)額葉還顯示出腦脊液增加,。另外，精神分裂癥患者的全腦灰質(zhì)和左頂葉灰質(zhì)變化明顯不同于對照組患者。
在精神分裂癥患者中,，某些區(qū)域的腦體積進(jìn)展性變化與預(yù)后較差的標(biāo)志有關(guān),，如隨訪期間的數(shù)周住院治療和改善陰性癥狀更少改善。更大的左側(cè)額葉灰質(zhì)體積損失與數(shù)周住院治療相關(guān),，而與陰性癥狀嚴(yán)重性不相關(guān),，其中陰性癥狀嚴(yán)重性與精神分裂癥患者腦脊液增加相關(guān)。
在雙相性精神障礙患者中,，作者沒有發(fā)現(xiàn)任何比對照組患者更重大的變化,，對照組縱向腦變化與描繪健康青少年的預(yù)期模式相符合。
"總之,，在隨訪患者兩年后,，與健康對照組相比，我們在最后診斷為精神分裂癥而不是雙相性精神障礙的患者中發(fā)現(xiàn)進(jìn)展性灰質(zhì)體積損失",，作者寫道,，"這些病理生理過程中的一些似乎標(biāo)志著預(yù)后較差。為制定阻止這些病理性進(jìn)展性大腦變化的治療策略,，將來的研究應(yīng)側(cè)重于他們的神經(jīng)生物學(xué)基礎(chǔ),。"（生物谷bioon.com）
doi:10.1001/archgenpsychiatry.2011.150
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Progressive Brain Changes in Children and Adolescents With First-Episode Psychosis
Celso Arango, MD, PhD; Marta Rapado-Castro, PhD; Santiago Reig, PhD; Josefina Castro-Fornieles, MD, PhD; Ana González-Pinto, MD, PhD; Soraya Otero, MD, PhD;Inmaculada Baeza, MD, PhD; Carmen Moreno, MD; Montserrat Graell, MD; Joost Janssen, PhD; Mara Parellada, MD, PhD; Dolores Moreno, MD, PhD;Nuria Bargalló, MD, PhD; Manuel Desco, MD, PhD
Context Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses. Objective To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up. Design Prospective, multicenter, naturalistic, 2-year follow-up study. Setting Six child and adolescent psychiatric units in Spain. Participants A total of 110 patients and 98 healthy controls were recruited between March 1, 2003, and November 31, 2005. Magnetic resonance imaging of the brain was performed for 61 patients with schizophrenia (n = 25), bipolar disorder (n = 16), or other psychoses (n = 20) and 70 controls (both at baseline and after 2 years of follow-up). Mean age at baseline was 15.5 years (patients) and 15.3 years (controls). Main Outcome Measures The GM and cerebrospinal fluid (CSF) volumes in the total brain and frontal, parietal, and temporal lobes. Results Compared with controls, patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up (left: -3.3 vs -0.6 cm3, P = .004; right: -3.7 vs -0.8 cm3, P = .005) and left frontal CSF volume increase (left: 6.7 vs 2.4 cm3, P = .006). In addition to frontal volume, changes for total GM (-37.1 vs -14.5 cm3, P = .001) and left parietal GM (-4.3 vs -2.2 cm3, P = .04) were significantly different in schizophrenic patients compared with controls. No significant differences emerged for patients with bipolar disease. Greater left frontal GM volume loss was related to more weeks of hospitalization, whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia. Conclusions Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls. Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder. These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis.
