Presentation on Grey Matter and First Episode Psychosis

A new study has shown there are grey matter deficits in the brains of children ages 7 - 18 with early onset first episode psychosis (FEP).  The study featured patients with schizophrenia, bipolar I disorder, and other psychoses.

Grey Matter

Grey matter is a component of the central nervous system, and contains neural cell bodies.  The density of grey matter in a particular area corresponds with various abilities.  

The top image shows a T1 MRI differentiating between grey and white matter while the bottom image from the New York Times shows the distinction.

Various diseases and disorders have been traced to a lack or atrophy of grey matter, including schizophrenia, bipolar disorder, dyslexia, and MS.   These all show decreased amounts of grey matter in specific areas of the brain.  In diseases like schizophrenia atrophy occurs over time and affects various areas of the brain.

Schizophrenia and Bipolar I Disorder

Schizophrenia is a mental disorder characterized by abnormalities in perceptions of reality.   There are several characteristics of schizophrenia including delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms such as attempted flattening (DSM-IV).   In general two of these characteristics, which can not be attributed to any other disease or disorder, must be present for 6 months in order for diagnosis.

Bipolar I disorder is a sub-classification of bipolar disorder.  Bipolar disorder is characterized by episodes of either mania, an abnormally elevated mood, or depression.  Some sufferers may also have mixed episodes, where both symptoms of mania and depression are present at the same time.  Bipolar I disorder is characterized by the presence of a manic episode, whether or not the patient has has a depressive or mixed episode (although these are common in bipolar I patients).   This is in contrast to bipolar II sufferers who have only had hypomanic (less severe mania) or depressive episodes.  The DSM-IV considers there to be a spectrum of bipolar disorders including, bipolar I and II as well as cyclothomia and bipolar n.o.s. (not otherwise specified).

About this study/Why is it important

While past studies have shown grey matter deficits in older patients and people with later onset FEP this was the first study to look specifically at young patients upon first onset.  In addition this study focused on a variety of FEP patients, instead of just schizophrenics, a disease where most of this research is concentrated.  The study focused on 121 children and adolescents ages 7 - 18, 70 with early onset FEP and 51 control subjects.  The subjects' brains were imaged using MRI technology.  Follow up care was provided and the patients were diagnosed.  Of these diagnoses 25 patients presented with schizophrenia, 20 with bipolar I disorder, and 25 with other psychoses.  While all of these patients showed a decrease in grey matter, patients with schizophrenia and bipolar I disorder showed a specific atrophy in the left medial frontal gyrus.  In contrast patients with other psychoses showed smaller bilateral grey matter volumes in the insula and right middle occipital gyrus.  The shared pathology between schizophrenia and bipolar I disorder may lead to further investigation into the similarities in the diseases as well as the development of new, more targeted medicines that may prevent future grey matter atrophy.

Bibliography

Jansen, J., Reig, S., Parellada, M., et all. (2008). Regional Grey Matter Volume Deficits in Adolescents with First-Episode Psychosis. Journal of the American Academy of Child and Adolescent Psychology. Vol 47 Issue 11, 1311-1320.

Zipursky, R., Lambe, E., Kapur, S., Mikulis, D. (1998). Cerebral Grey Matter Volume Deficits in First Episode Psychosis. Arch Gen Psychiatry, 55, 540-546.

Gur, R., Turestsky, B., Bilker, W., Gur, R. (1999). Reduced Grey Matter Volume in Schizophrenia. Arch Gen Psychiatry, 56, 905-911.

Harrison, P. (1999). The neuropathology of schizophrenia. Brain, Vol 122, No. 4, 593-624.

Steen, R., Mull C. , McClure, R., Hammer, R., Liebermann, J. (2006).  Brain Volume in First Episode Schizophrenia. British Journal of Psychiatry, 188, 510-518.