Brain Structural Abnormalities at the Onset of Schizophrenia and Bipolar Disorder: A Meta-analysis of Controlled Magnetic Resonance Imaging Studies

Abstract

A number of structural brain imaging studies and meta-analytic reviews have shown that multiple subtle brain abnormalities are consistently found in schizophrenia and bipolar disorder. Several studies suggest that schizophrenia and affective psychoses share a largely common pattern of brain abnormalities. Aim of the present study was to compare, by means of a meta-analytic approach, brain structural abnormalities, as detected by Magnetic Resonance Imaging (MRI), found at the onset of schizophrenia and bipolar disorder in order to address the question of the specificity of brain abnormalities across diagnostic groups. Forty-five studies were identified as suitable for analysis. In both schizophrenic and bipolar patients significant overall effect sizes were demonstrated for intracranial, whole brain, total grey and white matter volume reduction as well as for an increase of lateral ventricular volume at disease onset. Thus, the available literature data strongly indicate that some brain abnormalities are already present in first-episode schizophrenia or bipolar disorder and that there is a significant overlap of brain abnormalities in affective and non-affective psychotic disorders at the onset of the disease. However, whole grey matter volume deficits and lateral ventricular enlargement appear to be more prominent in first-episode schizophrenia whereas white matter volume reduction seems more prominent in bipolar disorder. The common vs specific trajectories of brain pathomorphology in schizophrenia and bipolar disorder are discussed.

Brain structural changes in schizoaffective disorder compared to schizophrenia and bipolar disorder

“…De Peri et al. 37 also found largely similar whole‐brain volume reductions in first‐episode patients with schizophrenia and bipolar disorder in a meta‐analysis of conventional MRI studies, although gray matter reductions were somewhat more pronounced in the former and white matter reductions in the latter.…”

Shared intermediate phenotypes for schizophrenia and bipolar disorder: neuroanatomical features of subtypes distinguished by executive dysfunction

“…These results were revealed in the context of a lack of grey matter volume differences between the traditional diagnostic categories of BD-I and schizophrenia (including schizoaffective disorder). Substantial evidence has highlighted common brain aberrations, including both global and regional deficits, 10,12,29,30 in addition to selected diagnosis-specific findings 9,11 among patients with these disorders relative to controls. However, the regions identified as "distinguishing" the diagnoses vary across studies, and our results appear consistent with those of recent investigations demonstrating a lack of substantial diagnostic specificity in neuroanatomical profile.…”

“…Both disorders have been associated with volume deficits of the frontal lobes, particularly precentral, inferior frontal, orbitofrontal and anterior cingulate gyri, and the insula. [9][10][11][12] In addition to frontal lobe deficits, bipolar disorder has been uniquely associated with enlarged amygdala volume. [29][30][31] Typically, schizophrenia is characterized by a larger magnitude and broader range of volume reductions, 10,29,30 with grey matter volume deficits additionally encompassing superior, inferior and medial temporal lobe gyri, hippocampus/ amygdala and thalamus, in addition to reduced global brain volume and ventricular enlargement.…”

“…[9][10][11][12] In addition to frontal lobe deficits, bipolar disorder has been uniquely associated with enlarged amygdala volume. [29][30][31] Typically, schizophrenia is characterized by a larger magnitude and broader range of volume reductions, 10,29,30 with grey matter volume deficits additionally encompassing superior, inferior and medial temporal lobe gyri, hippocampus/ amygdala and thalamus, in addition to reduced global brain volume and ventricular enlargement. 26,32 However, this literature is potentially confounded by a myriad of illness-related features (e.g., symptom profile, medication); not surprisingly, the structural imaging literature on both disorders shows high variability with generally poor levels of replication.…”

Depressive symptom in the first-episode schizophrenic patients is related to the reduction of grey matter volume in the subgenual anterior cingulate cortex - a pilot study

“…These studies have acquired important and useful information that has improved our understanding of the biological basis of schizophrenia and have provided many indices to aid psychiatrists in improving the rates of accurate diagnoses and treatment efficacies [9][10][11][12][13][14][15][16][17]. However, most of these previous studies have focused on exploring the common brain features shared by patients with schizophrenia and depression, these previous studies have provided evidence that structural or functional impairments in some brain regions in patients with schizophrenia overlap with impairments observed in patients with MDD to some extent, The temporal lobe and anterior cingulate are the main affected regions [7,[18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”