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Nervenheilkunde 2014; 33(01/02): 64-74
DOI: 10.1055/s-0038-1627662
Übersichtsartikel
Schattauer GmbH

Neuronale Korrelate des Psychoserisikosyndroms

Funktionelles Neuroimaging bei Personen mit erhöhtem PsychoserisikoFunctional neuroimaging in individuals with ultrahigh risk conditions for developing psychosis
D. Hirjak
1   Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universitätsklinik Heidelberg
,
P. A. Thomann
1   Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universitätsklinik Heidelberg
,
M. S. Depping
1   Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universitätsklinik Heidelberg
,
S. D. Bienentreu
2   Fachklinik für Psychiatrie und Psychotherapie der MARIENBORN GmbH, Zülpich
,
R. C. Wolf
1   Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universitätsklinik Heidelberg
› Author Affiliations
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Publication History

eingegangen am: 10 April 2013

angenommen am: 19 April 2013

Publication Date:
23 January 2018 (online)

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Zusammenfassung

Ein erhöhtes Psychoserisiko wird durch das Vorhandensein klinisch prädiktiver Symptome operationalisiert. Eine objektive Charakterisierung von Personen mit erhöhtem Psychoserisiko könnte durch funktionell bildgebende Verfahren gelingen, da diese Verfahren eine In-vivo-Darstellung früher neuronaler Veränderungen bei Personen mit erhöhtem Psychoserisiko ermöglichen. Veränderungen der Gehirnfunktion vor dem Beginn einer manifesten Psychose könnten als Marker der klinischen Transition und als prognostische Marker präventiver Interventionen genutzt werden. In den vergangenen Jahren wurden Personen mit erhöhtem Psychoserisiko mithilfe der funktionellen Magnetresonanztomografie (fMRT) untersucht, begünstigt durch die Verfügbarkeit, die Non-Invasivität und die hohe räumliche und zeitliche Auflösung des Verfahrens. In dieser Übersichtsarbeit soll die fMRT-Datenlage bei Personen mit erhöhtem Psychoserisiko zusammengefasst und im Hinblick auf ihre klinische Relevanz diskutiert werden. In der Literatur konnten anhand einer systematischen Literaturrecherche via PubMed und MEDLINE (Schlüsselwörter: „psychosis”, „ultra-high risk” und „functional mri”) und einer erweiterten Literatursuche 17 funktionell bildgebende Untersuchungen, eine Übersichtsarbeit und drei Metaanalysen identifiziert werden. In der Gesamtwertung der fMRT-Daten gibt es erste Hinweise darauf, dass bei Personen mit erhöhtem Psychoserisiko Veränderungen der Gehirnfunktion in frontalen, insulären und somatosensorischen Arealen vorliegen könnten. Die klinische Relevanz und der prädiktive Wert dieser Befunde für klinische Transition und Therapieoutcome sind jedoch unklar.

Summary

At present, ultra-high risk (UHR) conditions for developing psychosis are clinically operationalized syndromes. Early recognition of UHR individuals by means of functional neuroimaging techniques may be successful, since modern neuroimaging account for in-vivo characterization of early neuronal changes among these subjects. Alterations of the brain function before manifest psychosis may be used as neuroimaging indicators for clinical transition into full-blown psychosis and prognostic markers of early interventions. Over the last years, UHR individuals have been increasingly investigated by means of functional MR-imaging (fMRI). The aim of this article was to systematically review the extant fMRI data in UHR individuals and to discuss the clinical relevance of this evidence. Based on a systematic literature search using electronic databases PubMed and MEDLINE (keywords „psychosis”, „prodrome OR high risk” and “functional mri”), we identified 17 whole-brain fMRI studies, one systematic review and three meta-analyses. Considering the extant data, there is some evidence for functional alterations of frontal, insular and somatosensory brain regions. However, the clinical significance and the predictive value of functional neuroimaging findings for clinical transition and therapeutic outcome still remain unclear.

Schlüsselwörter

Psychoserisikosyndrom - MRT - UHR-Kriterien - Psychose - funktionelle Bildgebung

Keywords

Clinical at-risk mental state - MRI - UHR criteria - psychosis - functional neuroimaging
 

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