Progressive gray matter reduction of the superior temporal gyrus during transition to psychosis.
BACKGROUND
Longitudinal magnetic resonance imaging studies have shown progressive gray matter reduction in the superior temporal gyrus during the earliest phases of schizophrenia. It is unknown whether these progressive processes predate the onset of psychosis.


OBJECTIVE
To examine gray matter reduction of the superior temporal gyrus over time in individuals at risk for psychosis and in patients with first-episode psychosis.


METHODS
Cross-sectional and longitudinal comparisons.


METHODS
Personal Assessment and Crisis Evaluation Clinic and Early Psychosis Preventions and Intervention Centre.


METHODS
Thirty-five ultrahigh-risk individuals (of whom 12 later developed psychosis [UHRP] and 23 did not [UHRNP]), 23 patients with first-episode psychosis (FEP), and 22 control subjects recruited from the community.


METHODS
Volumes of superior temporal subregions (planum polare, Heschl gyrus, planum temporale, and rostral and caudal regions) were measured at baseline and follow-up (mean, 1.8 years) and were compared across groups.


RESULTS
In cross-sectional comparisons, only the FEP group had significantly smaller planum temporale and caudal superior temporal gyrus than other groups at baseline, whereas male UHRP subjects also had a smaller planum temporale than controls at follow-up. In longitudinal comparison, UHRP and FEP patients showed significant gray matter reduction (approximately 2%-6% per year) in the planum polare, planum temporale, and caudal region compared with controls and/or UHRNP subjects. The FEP patients also exhibited progressive gray matter loss in the left Heschl gyrus (3.0% per year) and rostral region (3.8% per year), which were correlated with the severity of delusions at follow-up.


CONCLUSIONS
A progressive process in the superior temporal gyrus precedes the first expression of florid psychosis. These findings have important implications for underlying neurobiologic features of emerging psychotic disorders and emphasize the importance of early intervention during or before the first episode of psychosis.
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Australia. tsutomu@med.u-toyama.ac.jp
Tsutomu
T
Takahashi
Stephen J
SJ
Wood
Alison R
AR
Yung
Bridget
B
Soulsby
Patrick D
PD
McGorry
Michio
M
Suzuki
Yasuhiro
Y
Kawasaki
Lisa J
LJ
Phillips
Dennis
D
Velakoulis
Christos
C
Pantelis
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001284:Atrophy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000473:pathology / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003702:Delusions / Q000175:diagnosis / Q000473:pathology / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000473:pathology / Q000523:psychology / Q000628:therapy; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology / Q000628:therapy; D012307:Risk Factors; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000175:diagnosis* / Q000473:pathology; D012565:Schizophrenic Psychology; D012569:Schizotypal Personality Disorder / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012737:Sex Factors; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult
D014150:Antipsychotic Agents; D018967:Risperidone