Diseases of white matter and schizophrenia-like psychosis.
OBJECTIVE
To analyse the available data regarding the presentation of psychosis in diseases of central nervous system (CNS) white matter.


METHODS
The available neurological and psychiatric literature on developmental, neoplastic, infective, immunological and other white matter diseases was reviewed.


RESULTS
A number of diseases of the white matter can present as schizophrenia-like psychoses, including leukodystrophies, neoplasms, velocardiofacial syndrome, callosal anomalies and inflammatory diseases.


CONCLUSIONS
Production of psychotic symptoms may result from functional asynchrony of interdependent regions, due to alterations in critical circuits as a result of pathology. The nature, location and timing of white matter pathology seem to be the key factors in the development of psychosis, especially during the critical adolescent period of association area myelination. Diseases that disrupt the normal formation of myelin appear to cause psychosis at higher rates than those that disrupt mature myelinated structures. Diffuse rather than discrete lesions, in particular those affecting frontotemporal zones, are also more strongly associated with schizophrenia-like psychosis. These illnesses point to the central role that white matter plays in maintaining CNS connectivity and to how pathology of the white matter may contribute to the neurobiology of psychosis.
Walterfang
Mark
M
Melbourne Neuropsychiatry Centre, Level 2, John Cade Building, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia. mark.walterfang@mh.org.au
Wood
Stephen J
SJ
Velakoulis
Dennis
D
Copolov
David
D
Pantelis
Christos
C
D001927:Brain Diseases / Q000175:diagnosis* / Q000503:physiopathology; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000503:physiopathology; D003937:Diagnosis, Differential; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D009413:Nerve Fibers, Myelinated / Q000502:physiology*; D009415:Nerve Net / Q000503:physiopathology; D009434:Neural Pathways / Q000503:physiopathology; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology; D013702:Temporal Lobe / Q000503:physiopathology