Abstract
BackgroundMore severe and persistent forms of affective disorders are accompanied by grey matter loss in key frontal and temporal structures. It is unclear whether such changes precede the onset of illness, occur early in the course or develop gradually with persistence or recurrence of illness. A total of 47 young people presenting with admixtures of depressive and psychotic symptoms were recruited from specialist early intervention services along with 33 age matched healthy control subjects. All participants underwent magnetic resonance imaging and patients were rated clinically as to current stage of illness. Twenty-three patients were identified as being at an early 'attenuated syndrome' stage, while the remaining were rated as having already reached the 'discrete disorder' or 'persistent or recurrent illness' stage. Contrasts were carried out between controls subjects and patients cohorts with attenuated syndromes and discrete disorders, separately.ResultsThe patients that were identified as having a discrete or persisting disorder demonstrated decreased grey matter volumes within distributed frontal brain regions when contrasted to both the control subjects as well as those patients in the attenuated syndrome stage. Overall, patients who were diagnosed as more advanced in terms of the clinical stage of their illness, exhibited the greatest grey matter volume loss of all groups.ConclusionsThis study suggests that, in terms of frontal grey matter changes, a major transition point may occur in the course of affective illness between early attenuated syndromes and later discrete illness stages.
Highlights
More severe and persistent forms of affective disorders are accompanied by grey matter loss in key frontal and temporal structures
Sample characteristics Whilst the various clinical stages did not differ in terms of the education they did differ in terms of age [t = -2.4, p=.023], with the help-seeking/attenuated syndrome group being approximately 3 years younger than the discrete disorder/persistent illness group
For symptoms potentially indicative of more severe syndromes, 35% of the help-seeking/attenuated syndrome group reported bipolar-like symptoms compared to 30% of the discrete disorder/persistent illness group; whereas only 9% of the help-seeking/attenuated syndrome group reported psychotic symptoms compared to 54% of the discrete disorder/persistent illness group
Summary
More severe and persistent forms of affective disorders are accompanied by grey matter loss in key frontal and temporal structures. It is unclear whether such changes precede the onset of illness, occur early in the course or develop gradually with persistence or recurrence of illness. Structural neuroimaging studies in patients with established affective and psychotic disorders have emphasised the extent to which discrete regions of fronto-temporal grey matter are selectively diminished [1,2,3]. As compared with studies related to psychosis onset [2,8] little is known about potential grey matter changes that occur when patients transition from earlier to later phases of illness
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