RESUMO
BACKGROUND: The potential effects of antipsychotic drugs on brain structure represent a key factor in understanding neuroanatomical changes in psychosis. This review addresses two issues: (1) do antipsychotic medications induce changes in total or regional human brain volumes and (2) do such effects depend on antipsychotic type? METHOD: A systematic review of studies reporting structural brain magnetic resonance imaging (MRI) measures: (1) directly in association with antipsychotic use; and (2) in patients receiving lifetime treatment with antipsychotics in comparison with drug-naive patients or healthy controls. We searched Medline and EMBASE databases using the medical subject heading terms: 'antipsychotics' AND 'brain' AND (MRI NOT functional). The search included studies published up to 31 January 2007. Wherever possible, we reported the effect size of the difference observed. RESULTS: Thirty-three studies met our inclusion criteria. The results suggest that antipsychotics act regionally rather than globally on the brain. These volumetric changes are of a greater magnitude in association with typical than with atypical antipsychotic use. Indeed, there is evidence of a specific effect of antipsychotic type on the basal ganglia, with typicals specifically increasing the volume of these structures. Differential effects of antipsychotic type may also be present on the thalamus and the cortex, but data on these and other brain areas are more equivocal. CONCLUSIONS: Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.
Assuntos
Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Encéfalo/efeitos dos fármacos , Imageamento por Ressonância Magnética , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Gânglios da Base/efeitos dos fármacos , Gânglios da Base/patologia , Encéfalo/patologia , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/patologia , Estudos Transversais , Dominância Cerebral/efeitos dos fármacos , Relação Dose-Resposta a Droga , Esquema de Medicação , Giro do Cíngulo/efeitos dos fármacos , Giro do Cíngulo/patologia , Humanos , Estudos Longitudinais , Mesencéfalo/efeitos dos fármacos , Tamanho do Órgão/efeitos dos fármacos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/patologia , Valores de Referência , Esquizofrenia/diagnóstico , Esquizofrenia/patologia , Tálamo/efeitos dos fármacos , Tálamo/patologiaRESUMO
Short stature in adolescence may cause some medical, psychological and social concerns, in addition to specific diagnostic and therapeutical problems. Among the various causes of short stature, the present review will examine in detail some forms such as constitutional delay of growth and puberty, growth hormone deficiency and Turner's syndrome, since these forms will benefit from an appropriate medical approach in adolescence. The diagnostic and therapeutical problems these forms may present in adolescence are also discussed.
