title: Systematic meta-review and quality assessment of the structural brain alterations in schizophrenia.
abstract: BACKGROUND
  The large quantity of systematic reviews of magnetic resonance imaging studies in schizophrenia challenges their meaningful interpretation. This meta-review synthesises the available information from systematic reviews of structural alteration in both chronic and first-episode schizophrenia.
  
  
  METHODS
  Systematic reviews were identified using electronic databases. Review methodological quality was assessed according to the Assessment of Multiple Systematic Reviews checklist. Data were extracted in duplicate and quality assessed for consistency and precision, guided by Grading of Recommendations Assessment, Development and Evaluation recommendations.
  
  
  RESULTS
  Integration of volumetric and voxel-based estimates allowed critical assessment of the magnitude and location of anatomical differences. There is evidence for grey matter reductions of anterior cingulate, frontal (particularly medial and inferior) and temporal lobes, hippocampus/amygdala, thalamus, and insula that may be magnified over time. Other regional alterations appear specific to illness stage or medication status.
  
  
  CONCLUSIONS
  There is limited high quality evidence supporting grey or white matter changes in schizophrenia, which has previously been obscured by a large volume of conflicting lower quality evidence.
authors.affiliation: University of New South Wales Research Unit for Schizophrenia Epidemiology, O'Brien Centre at St. Vincent's Hospital, 394-404 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia. alana.shepherd@unsw.edu.au
authors.forename: Alana M
authors.initials: AM
authors.lastname: Shepherd
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Laurens
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Matheson
authors.forename: Vaughan J
authors.initials: VJ
authors.lastname: Carr
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Green
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D012559:Schizophrenia / Q000188:drug therapy / Q000473:pathology*; D012565:Schizophrenic Psychology
chemical_list: D014150:Antipsychotic Agents