Schizophrenia Bulletin Advance Access originally published online on June 4, 2007
Schizophrenia Bulletin 2007 33(4):921-931; doi:10.1093/schbul/sbm045
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Deconstructing Psychosis With Human Brain Imaging
2 Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
3 Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
4 Division of Psychiatry, University of Edinburgh, Scotland, UK
1 To whom correspondence should be addressed; Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania 10 Gates, 3400 Spruce Philadelphia, PA 19104, tel: 215-662-2915, e-mail: raquel{at}bbl.med.upenn.edu.
This review synthesizes our current knowledge on the neurobiology of psychosis from an array of in vivo brain-imaging studies. The evidence base consists of hundreds of studies of patients with schizophrenia and fewer on bipolar disorder but rarely providing direct comparisons between the disorders or integration across methods. Replicated findings in schizophrenia include reduced whole-brain and hippocampal volume as potential vulnerability markers, with further progression at onset; reduced N-acetyl aspartate concentrations in hippocampus and prefrontal cortex; striatal dopamine D2 receptors upregulation; and alteration in the relation between frontal and temporal activation. These findings are not attributable to medication effects but are of unclear specificity and may apply across the psychosis spectrum. There are consistently replicated associations of psychotic symptoms and cognitive impairment in both structural and functional imaging in schizophrenia but not, as yet, in bipolar disorder. Therefore, it would be premature to dispense with current diagnostic categories because direct comparisons among them are rare, insufficient studies have examined longitudinal changes, and long-term imaging outcome studies in first-episode psychosis have not yet been done. To address these issues and make neuroimaging "clinically relevant," investigators will need to standardize their approaches to data acquisition and analysis, and construct the necessary range of "human brain maps," to implement studies that are sufficiently powered to provide reliable data pertinent to deconstructing psychosis.
Keywords: neuroimaging / schizophrenia / psychosis / brain structure / brain function
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