Abstract
Patients with psychosis display structural brain abnormalities in multiple brain regions. The disorder is characterized by a putative prodromal period called ultra-high-risk (UHR) status, which precedes the onset of full-blown psychotic symptoms. Recent studies on psychosis have focused on this period. Neuroimaging studies of UHR individuals for psychosis have revealed that the structural brain changes observed during the established phases of the disorder are already evident prior to the onset of the illness. Moreover, certain brain regions show extremely dynamic changes during the transition to psychosis. These neurobiological features may be used as prognostic and predictive biomarkers for psychosis. With advances in neuroimaging techniques, neuroimaging studies focusing on gray matter abnormalities provide new insights into the pathophysiology of psychosis, as well as new treatment strategies. Some of these novel approaches involve antioxidants administration, because it is suggested that this treatment may delay the progression of UHR to a full-blown psychosis and prevent progressive structural changes. The present review includes an update on the most recent developments in early intervention strategies for psychosis and potential therapeutic treatments for schizophrenia. First, we provide the basic knowledge of the brain regions associated with structural abnormalities in individuals at UHR. Next, we discuss the feasibility on the use of magnetic resonance imaging (MRI)-biomarkers in clinical practice. Then, we describe potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis. Finally, we discuss the potentials and limitations related to neuroimaging studies in individuals at UHR.
Highlights
Schizophrenia is the most disabling psychotic illness that affects approximately 1% of individuals worldwide
This review (i) provides basic knowledge of the brain regions associated with structural abnormalities in UHR patients; (ii) focuses on the use of magnetic resonance imaging (MRI)-biomarkers in clinical practice; (iii) suggests potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis; and (iv) discusses the potentials and limitations related to neuroimaging studies in individuals at UHR
Over the past generation, MRI studies in prodromal psychosis have exposed a “smoking gun” with respect to whether there are brain abnormalities and what brain regions are involved in the pathophysiology of psychosis
Summary
Schizophrenia is the most disabling psychotic illness that affects approximately 1% of individuals worldwide. Recent MRI findings of UHR patients are critically reviewed along with multiple structural brain measures (regional brain volume and cortical thickness) suggesting that gray matter volume (GMV) abnormalities are associated with the onset of psychosis. This review (i) provides basic knowledge of the brain regions associated with structural abnormalities in UHR patients; (ii) focuses on the use of MRI-biomarkers in clinical practice; (iii) suggests potential etiopathological mechanisms underlying structural brain abnormalities in prodromal psychosis; and (iv) discusses the potentials and limitations related to neuroimaging studies in individuals at UHR. CROSS-SECTIONAL COMPARISON BETWEEN INDIVIDUALS AT UHR AND HEALTHY CONTROLS Magnetic resonance imaging studies of patients with established psychosis have revealed brain structural abnormalities associated with the disorder.
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