Brain structure, function, and neurochemistry in schizophrenia and bipolar disorder—a systematic review of the magnetic resonance neuroimaging literature
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Since Emil Kraepelin’s conceptualization of endogenous psychoses as dementia praecox and manic depression, the separation between primary psychotic disorders and primary affective disorders has been much debated. We conducted a systematic review of case–control studies contrasting magnetic resonance imaging studies in schizophrenia and bipolar disorder. A literature search in PubMed of studies published between January 2005 and December 2016 was conducted, and 50 structural, 29 functional, 7 magnetic resonance spectroscopy, and 8 combined imaging and genetic studies were deemed eligible for systematic review. Structural neuroimaging studies suggest white matter integrity deficits that are consistent across the illnesses, while gray matter reductions appear more widespread in schizophrenia compared to bipolar disorder. Spectroscopy studies in cortical gray matter report evidence of decreased neuronal integrity in both disorders. Functional neuroimaging studies typically report similar functional architecture of brain networks in healthy controls and patients across the psychosis spectrum, but find differential extent of alterations in task related activation and resting state connectivity between illnesses. The very limited imaging-genetic literature suggests a relationship between psychosis risk genes and brain structure, and possible gene by diagnosis interaction effects on functional imaging markers. While the existing literature suggests some shared and some distinct neural markers in schizophrenia and bipolar disorder, it will be imperative to conduct large, well designed, multi-modal neuroimaging studies in medication-naïve first episode patients that will be followed longitudinally over the course of their illness in an effort to advance our understanding of disease mechanisms.
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Diffusion studies of the uncinate fasciculus and anterior and posterior thalamic radiations have shown decreased fractional anisotropy in both BD and schizophrenia.
“Diffusion studies of the uncinate fasciculus (79) (connecting the amygdala with the medial- and orbitofrontal cortices) and anterior and posterior thalamic radiations (192) have shown decreased fractional anistrophy (a marker of white matter microstructural abnormality) in both BD and schizophrenia.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [192]
Structural abnormalities common to both BD and schizophrenia have been observed on neuroimaging.
“Structural abnormalities common to both BD and schizophrenia have also been observed on neuroimaging.”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [192]
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- Authors
- Birur, B., Kraguljac, N. V., Shelton, R. C., & Lahti, A. C.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Lahti, Adrienne Carol
- Venue
- npj Schizophrenia
- Published
- 2017-04-03
- Volume
- 3
- Issue
- 1
- Pages
- 15-15
- ISSN
- 2334-265X (ISSN-L)
- PMC
- PMC5441538
- OpenAlex
- W2603262402
- Cited by
- 203
- References
- 144
- Citations by year
- 2026: 4 · 2025: 21 · 2024: 12 · 2023: 18 · 2022: 27 · 2021: 31 · 2020: 34 · 2019: 24 · 2018: 25 · 2017: 7
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Schizophrenia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Mental Health (R01MH102951, K23MH106683)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- bipolar disorder, psychosis spectrum, brain structure, white matter integrity, gray matter reduction, resting-state functional connectivity, task-related brain activation, brain networks, neurochemistry, magnetic resonance spectroscopy, imaging genetics, first-episode psychosis, neuroimaging biomarkers
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