Brain anomalies in early psychosis: From secondary to primary psychosis

Neurosci Biobehav Rev. 2022 Jul:138:104716. doi: 10.1016/j.neubiorev.2022.104716. Epub 2022 Jun 1.

Abstract

Brain anomalies are frequently found in early psychoses. Although they may remain undetected for many years, their interpretation is critical for differential diagnosis. In secondary psychoses, their identification may allow specific management. They may also shed light on various pathophysiological aspects of primary psychoses. Here we reviewed cases of secondary psychoses associated with brain anomalies, reported over a 20-year period in adolescents and young adults aged 13-30 years old. We considered age at first psychotic symptoms, relevant medical history, the nature of psychiatric symptoms, clinical red flags, the nature of the brain anomaly reported, and the underlying disease. We discuss the relevance of each brain area in light of normal brain function, recent case-control studies, and postulated pathophysiology. We show that anomalies in all regions, whether diffuse, multifocal, or highly localized, may lead to psychosis, without necessarily being associated with non-psychiatric symptoms. This underlines the interest of neuroimaging in the initial workup, and supports the hypothesis of psychosis as a global network dysfunction that involves many different regions.

Keywords: Brain anomalies; Neuroimaging; Pathophysiology; Primary and secondary early psychoses.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Brain / diagnostic imaging
  • Brain Diseases*
  • Case-Control Studies
  • Humans
  • Neuroimaging
  • Psychotic Disorders* / diagnostic imaging
  • Psychotic Disorders* / etiology
  • Young Adult