Oral Presentation 2
Brain network dysfunction - a candidate predictive biomarker for outcome of first episode psychosis?
Zhang Jie
Shantou University
Dr Jie Zhang earned his Ph.D. in Medical Imaging in 2013 and his M.B.B.S. degree in 2004. He completed his resident training at Shantou University Mental Health Centre (SUMHC). He finished the China Scholarship sponsored Neuroscience Training Program at Department of Psychiatry, Yale University as well as the Dr Cheng Yu Tung Fellowships funded Clinical Research Fellow Program at Department of Psychiatry, The University of Hong Kong. He is currently an psychiatrist and Associate Director of Department of Science & Education at SUMHC. Dr Zhang's clinical research is concentrated largely on exploring the brain biomarkers for strategies of intervention and prevention associated with major mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder. Moreover, much of his basic research has focused on identifying the contributions of the amino acid neurotransmitter systems (GABA and Glutamate) to the neurobiology of behavioral disorders related with Early Life Adversity (ELA) and the potential mechanism of drug intervention. Specifically, he employed ELA rodent model to explore the effects of early life stress on cellular and molecular biology, and examined the molecular and behavioral effects of drug intervention strategies targeting these affected systems. In addition, he is interested in the research to evaluate the clinical efficacy of brain stimulation technologies applied for treatment of mental disorders.
醫學博士，碩士研究生導師，主治醫師，心理治療師。現工作于汕頭大學精神衛生中心。中國醫師協會會員（2016-2017）、廣東省健康教育專家庫成員（2015-）、廣東省醫學會精神醫學分會青年委員（2017-）、廣東省預防醫學會精神衛生專業委員會委員兼秘書（2016-）、汕頭大學醫學院-加拿大曼尼托巴大學醫學院生物精神病學聯合實驗室學術秘書（2015-）。2011年-2013年美國耶魯大學醫學院精神病學系postgraduate fellow；2016-2017香港大學醫學院鄭裕彤博士獎學金獲得者。主持廣東省自然科學基金專案（2014A030310456）和廣東省醫學科研基金專案（A2014024），參與了國家自然科學基金重點專案（30930027）和國家自然科學基金面上專案（30670756）研究工作，發表專業論文10餘篇及科普文章5篇。專業特長：抑鬱/焦慮障礙、睡眠障礙、認知功能康復、青少年心理問題；研究方向：1.精神疾病的早期干預和優化治療；2.精神疾病的認知功能研究。
Abstract
Introduction
Since the chronic, recurrent and disabling course for schizophrenia (SCH), first episode of psychosis (FEP), considered as early stage SCZ, is classically viewed as a critical period for determining the outcome of the illness. Duration of untreated psychosis (DUP), one of the few potentially modifiable factors, is able to predict the short- and long-term outcomes of psychosis. The emerging evidence indicated resting-state functional connectivity (rs-fcMRI), reflecting the intrinsic fluctuations in neural activity, was impaired in the FEP, however, it is unclear whether the impairment in the functional connectivity is due to the effects of untreated psychosis. We systematically reviewed the literature on the association between the length of DUP and brain functional connectivity, determined with rs-fcMRI, in the FEP.
Methods
We searched five electronic databases and conducted forward and backward citation searching to identify relevant papers. Studies were included if they: (1) included FEP patients who were treatment naive or minimally treated; and (2) had correlated measures of DUP with resting brain network/connectivity measures.
Results
We identified ten studies that met the inclusion criteria. Seven examined the correlation between DUP and brain functional connectivity. There was evidence of associations in brain network considered important in FEP; however, the findings were inconsistent across studies. The majority of included studies were not primarily designed to examine whether DUP is correlated with brain network, and there were a limitations in methodology and sample size within most studies included.
Conclusion
Current available evidence suggest that there is little evidence of an association between untreated psychosis and brain network dysfunction in FEP. Although the limitations in design and methodology were found within the studies, there are few outcome-oriented studies support the dysfunctional brain network mediate the relationship between longer DUP and worsened outcome for intervention. Future studies, specifically designed to examine relation between DUP and brain functional network in FEP are necessary.
介紹
精神分裂症是一組以慢性、復發性和致殘性為特徵的重性精神疾病。處於首次發作階段的精神病患者，因是精神分裂症的早期階段，而被看做是影響該疾病預後的關鍵時期。精神病的未治療時間被看做有限的幾個能夠預測精神病短期和長期結局的影響因素。靜息狀態下功能磁共振能夠反映腦神經在生理和疾病狀態下的內在活動和連接。目前，越來越多的證據表明，首發精神病患者靜息狀態下腦神經網路連接受損，但這種神經連接障礙和精神病的起病時間長短是否有關尚不十分清楚。因此，我們對目前發表的關於首次發作精神病患者靜息態腦神經連接和精神病未治時間之間的關係進行系統綜述。
方法
我們在包括Pubmed，Medline，Web of Science等在內的5個主要英文資料庫中進行選擇性搜索。將符合下列條件的文獻作為分析物件。1）研究物件必須是首次發作和幾乎沒有接受治療的精神病患者；2）必須包括精神病未治時間和靜息態腦神經連接的直接相關性分析。
結果
本次系統綜述共納入10項符合分析條件的公開發表文獻，其中7篇文獻直接分析了精神病未治時間和腦神經連接之間的關係。綜述文章的結果顯示，首發精神病未治療時間的長短和腦神經連接指標間存在聯繫，但是研究結果並不一致。目前多數公開發表的文獻存在以下兩個問題：1）研究目的並非主要探討首發精神病未治療時間和腦神經連接的相關關係；2）各項研究中的研究物件和研究手段存在較大差異。
結論
目前的研究結論提示，首發精神病患者的精神病未治時間和腦神經連接障礙間的關聯性較小。較少的研究結果支援，腦神經網路障礙可能介導了長時間未治療的精神病患者對抗精神病藥物的治療反應性，儘管這些研究在研究方法和研究物件上存在較多差異。將來需要設計更多以療效為目的的研究來進一步闡明腦神經功能連接在精神病未治時間對首發精神病患者短期和長期治療效果和康復結果的影響。