RESUMO
OBJECTIVES: The extent to which psychotic disorders fall into distinct diagnostic categories or can be regarded as lying on a single continuum is controversial. We compared lateral ventricle volumes between a large sample of patients with first-episode schizophrenia or bipolar disorder and a healthy control group from the same neighbourhood. METHODS: Population-based MRI study with 88 first-episode psychosis (FEP) patients, grouped into those with schizophrenia/schizophreniform disorder (N=62), bipolar disorder (N=26) and 94 controls. RESULTS: Right and left lateral ventricular and right temporal horn volumes were larger in FEP subjects than controls. Within the FEP sample, post-hoc tests revealed larger left lateral ventricles and larger right and left temporal horns in schizophrenia subjects relative to controls, while there was no difference between patients with bipolar disorder and controls. None of the findings was attributable to effects of antipsychotics. CONCLUSIONS: This large-sample population-based MRI study showed that neuroanatomical abnormalities in subjects with schizophrenia relative to controls from the same neighbourhood are evident at the first episode of illness, but are not detectable in bipolar disorder patients. These data are consistent with a model of psychosis in which early brain insults of neurodevelopmental origin are more relevant to schizophrenia than to bipolar disorder.
Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/patologia , Processamento de Imagem Assistida por Computador , Ventrículos Laterais/patologia , Imageamento por Ressonância Magnética , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/patologia , Esquizofrenia/diagnóstico , Esquizofrenia/patologia , Psicologia do Esquizofrênico , Adulto , Encéfalo/patologia , Dominância Cerebral/fisiologia , Feminino , Humanos , Masculino , Tamanho do Órgão/fisiologia , Transtornos Psicóticos/psicologia , Recidiva , Valores de Referência , Adulto JovemRESUMO
BACKGROUND: In low- and middle-income countries people with schizophrenia are reported to experience better outcomes than those in high-income countries. AIMS: To examine structural brain differences in people with first-episode psychosis and controls in Brazil. METHOD: Magnetic resonance imaging using voxel-based morphometry was performed on 122 people with first-episode psychosis and 94 controls. RESULTS: There were significant decreases in grey matter in the left superior temporal and inferior prefrontal cortices, insula bilaterally and the right hippocampal region in first-episode psychosis (P<0.05, corrected for multiple comparisons). The subgroup of people with schizophrenia (n=62) exhibited a similar pattern of decrease in grey matter relative to controls. CONCLUSIONS: Structural abnormalities reported in psychosis in high-income countries are also present in first-episode psychosis in Brazil.
Assuntos
Encéfalo/patologia , Transtornos Psicóticos/patologia , Esquizofrenia/patologia , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Mapeamento Encefálico/métodos , Brasil , Córtex Cerebral/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/patologiaRESUMO
BACKGROUND: There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis. METHOD: All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. Data relating to duration of untreated psychosis (DUP) and clinical and sociodemographic characteristics were collected from patients, relatives and case-notes. RESULTS: There was no evidence that African-Caribbean or Black African patients experienced longer periods of untreated psychosis than White British patients prior to first contact with services. There was evidence that Black African patients experienced shorter periods of untreated psychosis than White British patients. CONCLUSIONS: Contrary to what is commonly assumed, our study suggests that Black patients with a psychotic mental illness do not experience longer treatment delays prior to first contact with services than White British patients. This suggests that strategies to reduce treatment delays targeted specifically at Black patients will be of limited value.