Revisión sistemática: cambios de volúmenes corticales y subcorticales en pacientes adultos con un primer episodio psicótico

Abstract

Background

The clinical presentation of the first psychotic episode presents difficulties for differential diagnosis, and the establishment of the prognosis. To identify regular patterns could be useful for supporting clinical criteria, and also to be biological markers, and allow an appropriate treatment for each category. This review has as the main objective to summarize the main structural changes, evaluated with magnetic resonance imaging, reported in patients with first psychotic episode.

Methods

We made a systematic review, including articles published during the last 5 years, reporting findings in magnetic resonance imaging, in patients with a first psychotic episode. We analyzed and compared the findings in cortical and subcortical brain structures.

Results

From a total of 6,882 articles, we review 59. Reports included five categories: schizophrenia, schizophrenia spectrum, bipolar affective disorder, affective spectrum, and toxic psychosis. In schizophrenia, there were greater alterations in cerebral cortex, at level of anterior cingulate, parahippocampus, and insula. Regarding hippocampus, there was more decrease in CA1, while in thalamus there was a marked decrease in anterior nuclei, and in basal ganglia there was a decrease in striatum and caudate, and increase in putamen. In affective disorders, changes are located in temporal lobe, and in toxic psychosis, there was an increase in putamen and thalamus.

Conclusions

We described structural brain changes, cortical and subcortical, in patients with a first psychotic episode. These changes could be differential markers, so it is important to make studies with more patients, and make a follow up to determine if these changes are present after the diagnosis is established.