Contribución de la neuroimagen al diagnóstico y seguimiento de la esquizofrenia: una breve revisión sistemática / The neuroimaging contribution to the schizophrenia diagnosis and monitoring: a brief systematic review

RESUMEN: Introducción: La neuroimagen estructural y funcional en la esquizofrenia ha tomado fuerza en los últimos años, por lo que esta revisión tiene por objetivo describir hallazgos de esta técnica que contribuyen a la fisiopatología, diagnóstico y pronóstico de esta patología. Métodos: Se realizó una búsqueda en PubMed/Medline de estudios clínicos que abordan el estudio con neuroimágenes en la esquizofrenia. Resultados: La búsqueda arrojó 2200 resultados, de los cuales fueron incluidos 13 estudios, los que arrojaron hallazgos que se tradujeron en alteraciones neurocognitivas, tales como alteraciones funcionales y estructurales de la amígdala asociada a síntomas negativos, reducción morfométrica de la región frontal, alteraciones en la perfusión del giro del cíngulo anterior y la corteza parietal inferior izquierda, desregulación de la enzima histona deacetilasa, entre otros. Conclusiones: Esta revisión brinda una visión actualizada sobre los hallazgos de la neuroimagenología que pueden aportar a la comprensión de los mecanismos patológicos detrás de este trastorno psicótico, así como su utilidad diagnóstica y potencial contribución al seguimiento de esta enfermedad.

ABSTRACT Introduction: Structural and functional neuroimaging in schizophrenia has gained strength in recent years, so this review aims to describe neuroimaging findings that contribute to the physiopathological understanding, monitoring, and diagnosis of this pathology. Methods: A PubMed/Medline search was conducted for clinical studies addressing neuroimaging in schizophrenia. Results: The search yielded 2200 results, from which 13 studies were included, which provided findings, such as functional and structural alterations of the amygdala, which have shown to be associated with negative symptoms; morphometric reduction of the frontal region, alterations in the perfusion of the anterior cingulate gyrus and the lower-left parietal cortex, deregulation of the histone deacetylase enzyme, among others which translate clinically in neurocognitive deficits. Conclusions: This review provides an updated view on the findings of neuroimaging that can contribute to the understanding of the pathological mechanisms behind this psychotic disorder, its diagnostic usefulness, and its potential contribution to the prognosis and follow-up of this disease.

Frontal lobe alterations in schizophrenia: a review / Alterações no lobo frontal na esquizofrenia: uma revisão

Abstract Objective: To highlight the changes in the frontal lobe of the human brain in people with schizophrenia. Methods: This was a qualitative review of the literature. Results: Many schizophrenic patients exhibit functional, structural, and metabolic abnormalities in the frontal lobe. Some patients have few or no alterations, while some have more functional and structural changes than others. Magnetic resonance imaging (MRI) shows structural and functional changes in volume, gray matter, white matter, and functional activity in the frontal lobe, but the mechanisms underlying these changes are not yet fully understood. Conclusion: When schizophrenia is studied as an essential topic in the field of neuropsychiatry, neuroscientists find that the frontal lobe is the most commonly involved area of the human brain. A clear picture of how this lobe is affected in schizophrenia is still lacking. We therefore recommend that further research be conducted to improve understanding of the pathophysiology of this psychiatric dilemma.

Resumo Objetivo: Descrever as alterações no lobo frontal do cérebro humano em indivíduos com esquizofrenia. Métodos: Esta foi uma revisão qualitativa da literatura. Resultados: Muitos pacientes esquizofrênicos exibem anormalidades funcionais, estruturais e metabólicas no lobo frontal. Alguns pacientes apresentam poucas ou nenhuma alteração, ao passo que outros apresentam mais alterações funcionais e estruturais quando comparados com seus pares. A ressonância magnética é capaz de demonstrar alterações estruturais e funcionais em volume, substância cinzenta, substância branca e atividade funcional do lobo frontal, porém os mecanismos subjacentes a essas alterações ainda não são completamente compreendidos. Conclusão: Quando a esquizofrenia é estudada como um tópico central na área da neuropsiquiatria, os neurocientistas observam que o lobo frontal é a área do cérebro humano mais comumente envolvida. Uma imagem clara de como esse lobo é afetado na esquizofrenia permanece inexistente. Portanto, recomendamos que mais pesquisas sejam conduzidas para melhorar nosso entendimento sobre a fisiopatologia desse dilema psiquiátrico.

study on computerized tomography in schizophrenia

The aim of this work is [1] to find out CT changes in schizophrenia and look for the different factors that may affect such changes e. g. duration of illness, family history, type of symptoms [positive vs. negative ones] and ECT. [2] to verify whether CT changes in schizophrenia are associated with some cognitive deficits. The material of this study included sixty schizophrenics and twenty controls. The methods used entitled: [1] CT study e.g. ventricular dilatation, cortical atrophy, brain tissue density, [2] Organicity testing [Bender Gestalt test]. The results revealed the following: 1- Schizophrenics had significant enlargement of the third ventricle [central atrophy] compared to controls. 2- Schizophrenics with longer duration of illness [more than 2 years] showed more significant central atrophy. 3- Factors like family history, type of symptoms and ECT had no significant relation to the presence of central atrophy. 4- Cortical atrophy was not significantly different in patients compared to controls. 5- The density of grey and white matter showed significant decrease in schizophrenics compared to controls. 6- In Bender Gestalt test, two thirds of schizophrenics gave organic scores while one third gave functional scores. Impairment of cognitive function is more likely to occur in patients with central atrophy [enlargement of the third ventricle]