Structural impairment in superficial and deep white matter in schizophrenia

Meta‐Analysis of Brain Structure in Magnetic Resonance Imaging Studies of Adolescents With Schizophrenia

Background: Adolescence is a critical stage for neurobiological development, including the formulation of advanced cognitive functions. It is also a period of immense susceptibility to psychiatric disorders, meaning that there may be cortical structural abnormalities in adolescents with these conditions, including schizophrenia. Adolescents with schizophrenia also tend to have symptoms that are common to a variety of psychiatric disorders, leading to diagnostic challenges. Thus, we meta‐analyzed MRI data to study the structural brain characteristics of adolescent with schizophrenia.

Methods: We used “early onset schizophrenia, child/children/childhood onset schizophrenia, adolescent/adolescence onset schizophrenia, and magnetic resonance imaging (MRI)” as keywords for searches in the PubMed, Web of Science, EBSCO databases, and ClincalTrial.gov to find English‐language articles publicly available before March 31, 2023. This meta‐analysis was registered on PROSPERO (CRD42023404619) and followed the guidelines of PRISMA.

Results: Twenty‐nine publications were included in the final meta‐analysis, involving 726 patients and 1039 healthy controls. We found data available only in structural brain volume for meta‐analysis. Gray matter (GM) structures in the frontal, occipital, and parietal areas, as well as the thalamus, were significantly reduced, while the lateral ventricles were significantly increased. In patients with childhood‐onset schizophrenia (COS), total GM, frontal, parietal, and lateral ventricle volume were significantly altered. Patients with first‐episode drug‐naïve (FEDN) schizophrenia had a significant atrophy in the frontal and parietal, occipital, and thalamus, along with enlarged lateral ventricles. Additionally, in the sum of GM and white matter, total brain volume, temporal, and left temporal were significantly decreased, but putamen was increased. In COS patients, total brain volume was reduced considerably, but putamen volumes were significantly increased.

Conclusions: Our study indicates that there are extensive structural abnormalities in the brain regions of adolescent schizophrenics, especially within cortical structures. Patients with either COS or non‐first‐episode schizophrenia who may have received antipsychotic medication also exhibited extensive structural brain abnormalities. The thalamus, lateral ventricles, and putamen may be crucial biological markers of structural brain abnormalities in adolescent schizophrenia, providing a basis for exploring the pathological mechanisms underlying the disease, as well as essential targets for early diagnosis and treatments.