根据1月份Archives of General Psychiatry上的一篇报道，与无精神病诊断的健康青少年相比，具精神分裂症与其他精神病诊断的青少年灰白质体积减少更多，额叶中的脑脊液增加更多。
"在儿童期首发精神分裂症中已报道了大脑灰质（GM）逐步丧失，然而，目前尚不能确定这些变化是否是不同的精神病小儿患者所共有的"，"作者在这项研究的背景信息中这样写道。
西班牙马德里Gregorio Marañón医科大学的Celso Arango博士和同事在西班牙的6岁与青少年精神病患者中，检查了首发早发性精神病大脑变化的进展和后续两年的诊断及预后的关系。作者对61例患者（25例精神分裂症患者，16例双相性精神障碍和20例其他精神病）和71例健康对照者进行大脑磁共振成像（MRI）检查。磁共振成像扫描作为研究基线，并在随后两年继续进行。
与对照组相比，在随后的两年内，那些精神分裂症患者的额叶表现出更大的灰质体积损失。精神分裂症患者左侧额叶还显示出脑脊液增加。另外，精神分裂症患者的全脑灰质和左顶叶灰质变化明显不同于对照组患者。
在精神分裂症患者中，某些区域的脑体积进展性变化与预后较差的标志有关，如随访期间的数周住院治疗和改善阴性症状更少改善。更大的左侧额叶灰质体积损失与数周住院治疗相关，而与阴性症状严重性不相关，其中阴性症状严重性与精神分裂症患者脑脊液增加相关。
在双相性精神障碍患者中，作者没有发现任何比对照组患者更重大的变化，对照组纵向脑变化与描绘健康青少年的预期模式相符合。
"总之，在随访患者两年后，与健康对照组相比，我们在最后诊断为精神分裂症而不是双相性精神障碍的患者中发现进展性灰质体积损失"，作者写道，"这些病理生理过程中的一些似乎标志着预后较差。为制定阻止这些病理性进展性大脑变化的治疗策略，将来的研究应侧重于他们的神经生物学基础。"（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.
