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Schizophrenia Bulletin Advance Access originally published online on July 14, 2005
Schizophrenia Bulletin 2005 31(3):672-696; doi:10.1093/schbul/sbi034
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© The Author 2005. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oupjournals.org.

Structural Brain Imaging Evidence for Multiple Pathological Processes at Different Stages of Brain Development in Schizophrenia

Christos Pantelis 2
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital and National Neuroscience Facility, Melbourne, Victoria

Murat Yücel
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital and National Neuroscience Facility, Melbourne, Victoria
ORYGEN Research Centre, Early Psychosis Prevention and Intervention Centre and Department of Psychiatry, University of Melbourne

Stephen J Wood
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital and National Neuroscience Facility, Melbourne, Victoria

Dennis Velakoulis
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital and National Neuroscience Facility, Melbourne, Victoria

Daqiang Sun
Clinical Neuroscience Lab, University of California, Los Angeles

Gregor Berger
ORYGEN Research Centre, Early Psychosis Prevention and Intervention Centre and Department of Psychiatry, University of Melbourne

Geoff W Stuart
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Sunshine Hospital and National Neuroscience Facility, Melbourne, Victoria

Alison Yung
ORYGEN Research Centre, Early Psychosis Prevention and Intervention Centre and Department of Psychiatry, University of Melbourne

Lisa Phillips
ORYGEN Research Centre, Early Psychosis Prevention and Intervention Centre and Department of Psychiatry, University of Melbourne

Patrick D McGorry
ORYGEN Research Centre, Early Psychosis Prevention and Intervention Centre and Department of Psychiatry, University of Melbourne

To whom correspondence should be addressed; e-mail: cpant{at}unimelb.edu.au.

The underlying neurobiology of emerging psychotic disorders is not well understood. While there is evidence from structural imaging and other studies supporting the popular notion that schizophrenia arises as a consequence of an "early neurodevelopmental" lesion, more recent findings challenge this notion. Evidence, including our own data, suggests that dynamic brain changes occur during the earliest stages of a psychotic illness, including around the time of transition to illness. In this article we review the available longitudinal and relevant cross-sectional structural neuroimaging studies focusing on both the very early neurodevelopmental markers (pre- or perinatal origin) and the later markers (late neurodevelopmental) around the period of transition to illness. Based on our review of recent findings, we suggest that the onset of psychosis is a time of active brain changes, wherein, for a proportion of individuals, (i) an early (pre- and perinatal) neurodevelopmental lesion renders the brain vulnerable to anomalous late (particularly postpubertal) neurodevelopmental processes, as indicated by evidence for accelerated loss of gray matter and aberrant connectivity particularly in prefrontal regions; and (ii) these anomalous neurodevelopmental processes interact with other causative factors associated with the onset of psychosis (e.g., substance use, stress, and dysregulation of the hypothalamic-pituitary-adrenal axis function), which together have neuroprogressive sequelae involving medial temporal and orbital prefrontal regions, as suggested by imaging studies around transition to active illness. However, the pathological processes underlying such progressive changes during "late neurodevelopment" remain unclear but may reflect anomalies of synaptic plasticity, abnormal brain maturation, the adverse effects of stress, or other environmental factors. In this context, the features of schizophrenia, including the neuropsychological deficits and behavioral manifestations, can be understood as direct effects of these multiple pathological processes at various neurodevelopmental stages, including genetic and nongenetic etiological factors.

Keywords: schizophrenia / longitudinal / neurodevelopment / neurodegeneration / brain changes / psychosis / prodrome / cognition / neuroimaging / stress / HPA axis


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