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Subtle abnormalities in frontal white matter have been reported in
To assess whether impaired integrity of white matter tracts is associated
with bipolar disorder and genetic liability for the disorder.
A total of 19 patients with psychotic bipolar I disorder from multiply
affected families, 21 unaffected first-degree relatives and 18 comparison
individuals (controls) underwent diffusion tensor imaging. Whole brain
voxel-based analyses compared fractional anisotropy between patients and
relatives with controls, and its relationship with a quantitative measure
of genetic liability.
Patients had decreased fractional anisotropy compared with controls in
the genu of the corpus callosum, right inferior longitudinal fasciculus
and left superior longitudinal fasciculus. Increased genetic liability
for bipolar disorder was associated with reduced fractional anisotropy
across distributed regions of white matter in patients and their
Disturbed structural integrity within key intra- and interhemispheric
tracts characterises both bipolar disorder and genetic liability for this
People with prodromal symptoms have a very high risk of developing psychosis.
To use functional magnetic resonance imaging to examine the neurocognitive basis of this vulnerability.
Cross-sectional comparison of regional activation in individuals with an ‘at-risk mental state’ (at-risk group: n=17), patients with first-episode schizophreniform psychosis (psychosis group: n=10) and healthy volunteers (controls: n=15) during an overt verbal fluency task and an N-back working memory task.
A similar pattern of between-group differences in activation was evident across both tasks. Activation in the at-risk group was intermediate relative to that in controls and the psychosis group in the inferior frontal and anterior cingulate cortex during the verbal fluency task and in the inferior frontal, dorsolateral prefrontal and parietal cortex during the N-back task.
The at-risk mental state is associated with abnormalities of regional brain function that are qualitatively similar to, but less severe than, those in patients who have recently presented with psychosis.
Depersonalisation disorder is characterised by emotion suppression, but the cerebral mechanisms of this symptom are not yet fully understood.
To compare brain activation and autonomic responses of individuals with the disorder and healthy controls.
Happy and sad emotion expressions in increasing intensities (neutral to intense) were presented in an implicit event-related functional magnetic resonance imaging (fMRI) design with simultaneous measurement of autonomic responses.
Participants with depersonalisation disorder showed fMRI signal decreases, whereas the control group showed signal increases in response to emotion intensity increases in both happy and sad expressions. The analysis of evoked haemodynamic responses from regions exhibiting functional connectivity between central and autonomic nervous systems indicated that in depersonalisation disorder initial modulations of haemodynamic response occurred significantly earlier (2s post-stimulus) than in the control group (4–6s post-stimulus).
The results suggest that fMRI signal decreases are possible correlates of emotion suppression in depersonalisation disorder.
Grey matter and other structural brain abnormalities are consistently
reported in first-onset schizophrenia, but less is known about the extent
of neuroanatomical changes in first-onset affective psychosis
To determine which brain abnormalities are specific to (a) schizophrenia
and (b) affective psychosis
We obtained dual-echo (proton density/T2-weighted) magnetic resonance
images and carried out voxel-based analysis on the images of 73 patients
with first-episode psychosis (schizophrenia n=44,
affective psychosis n=29) and 58 healthy controls
Both patients with schizophrenia and patients with affective psychosis
had enlarged lateral and third ventricle volumes. Regional cortical grey
matter reductions (including bilateral anterior cingulate gyrus, left
insula and left fusiform gyrus) were evident in affective psychosis but
not in schizophrenia, although patients with schizophrenia displayed
decreased hippocampal grey matter and increased striatal grey matter at a
more liberal statistical threshold
Both schizophrenia and affective psychosis are associated with volumetric
abnormalities at the onset of frank psychosis, with some of these evident
in common brain areas
First-episode psychosis is typically preceded by a prodrome in which
there is deterioration in global and social functioning
To examine whether the duration of the prodromal phase influences grey
and white matter volumes at the onset of psychosis
Eighty-two people were scanned using magnetic resonance imaging when they
developed a first episode of psychosis. The duration of the prodromal
phase was estimated from detailed interviews and medical records.
Voxel-based morphometry was used to assess neuroanatomical
A long prodromal phase was associated with smaller grey matter volumes in
the cingulate, frontal and left insular cortex, and with less white
matter volume bilaterally in the superior longitudinal and uncinate
fasciculi and the cingulum
The severity of volumetric abnormalities in first-episode psychosis was
greater in those with a long prodrome
It is unclear whether schizophrenia and psychotic bipolar disorder are associated with similar deviations of brain morphometry.
To assess volumetric abnormalities of grey and white matter throughout the entire brain in individuals with schizophrenia or with bipolar disorder compared with the same control group.
Brain scans were obtained by magnetic resonance imaging from 25 people with schizophrenia, 37 with bipolar disorder who had experienced psychotic symptoms and 52 healthy volunteers. Regional deviation in grey and white matter volume was assessed using computational morphometry.
Individuals with schizophrenia had distributed grey matter deficit predominantly involving the fronto-temporal neocortex, medial temporal lobe, insula, thalamus and cerebellum, whereas those with bipolar disorder had no significant regions of grey matter abnormality. Both groups had anatomically overlapping white matter deficits in regions normally occupied by major longitudinal and interhemispheric tracts.
Schizophrenia and psychotic bipolar disorder are associated with distinct grey matter deficits but anatomically coincident white matter abnormalities.
Foucault commented that ‘the medical gaze … contains within a single structure, different sensorial fields. The ‘glance’ has become a complex organisation with a view to the spatial assignment of the invisible’ (Foucault 1963). During the last two decades, the structural brain image has been deconstructed using an increasing variety of analytic techniques in order to reveal previously invisible pathology.
Since the first major psychiatric computed tomography (CT) study published in 1976 (Johnstone et al. 1976), structural imaging has been utilized to investigate the major psychiatric disorders. It has become clear that many of these disorders are characterized by subtle structural brain changes. However, brain structure shows considerable variability between individuals, in terms of size, shape and composition (e.g. relative grey and white matter). Thus, the detection of a small neuropathological signal in the presence of loud noise (from neurodevelopment and other sources) has been a central problem for structural imaging studies and has provided the impetus for the development of a range of new analytic approaches. Several psychiatric and neurological disorders have been particularly important in terms of the development of structural imaging techniques, including schizophrenia, multiple sclerosis and epilepsy. In this chapter we illustrate new directions in structural imaging using research into brain changes in schizophrenia.
In addition to identifying the contributions of these new techniques, we highlight some of the problems that we believe have retarded progress in structural imaging.
Third rather than lateral ventriculomegaly may be a more specific finding in psychosis. The relevance of ventricular abnormality remains unclear.
To investigate the developmental correlates of ventricular enlargement.
Information on childhood development and magnetic resonance images in 1.5-mm contiguous sections were collected on 21 patients experiencing a first episode of psychosis.
Patients (n=21) had significantly less whole brain volume and enlarged third and lateral ventricles compared to controls (n=25). Third ventricle (r=0.48, P < 0.03) and lateral ventricle (r=0.65, P < 0.01) volumes correlated with developmental score. Patients with developmental delay had significantly larger third and lateral ventricles than those without.
Enlargement of both third and lateral ventricles is found in first-episode psychosis and is related to developmental delay in childhood. Insult to periventricular areas is relevant to the neurobiology of the disease. These findings support the view that schizophrenia involves disturbance of neurodevelopmental processes in some patients.
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