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. 2014 Oct;59(10):513-7.
doi: 10.1177/070674371405901003.

The role of untreated psychosis in neurodegeneration: a review of hypothesized mechanisms of neurotoxicity in first-episode psychosis

Kelly K Anderson  1 , Aristotle Voineskos  2 , Benoit H Mulsant  3 , Tony P George  4 , Kwame J Mckenzie  5
Affiliations

The role of untreated psychosis in neurodegeneration: a review of hypothesized mechanisms of neurotoxicity in first-episode psychosis

Kelly K Anderson et al. Can J Psychiatry. 2014 Oct.

Abstract
in English, French

For over 20 years, studies have tried to measure the association between the duration of untreated psychosis (DUP) and changes in brain morphology. A hypothesis that untreated psychosis is neurotoxic has been postulated, but the mechanisms of that toxicity have not been described. We re-analyzed papers collected for a systematic review to extract data on the hypotheses that have been generated on the potential mechanisms by which DUP could impact brain morphology in first-episode psychosis. Dopaminergic hyperactivity, prolonged hypothalamic-pituitary-adrenal activation, and persistent activity of catecholamines have been hypothesized as mechanisms to explain these associations. However, the question remains as to whether the observed structural changes are permanent or may be reversed via antipsychotic treatment.

Depuis plus de 20 ans, les études tentent de mesurer l’association entre la durée de la psychose non traitée (DPNT) et les changements de la morphologie du cerveau. Une hypothèse a été émise selon laquelle la psychose non traitée est neurotoxique, mais les mécanismes de cette toxicité n’ont pas été décrits. Nous avons ré-analysé les articles recueillis pour une revue systématique afin d’extraire des données sur les hypothèses générées sur les mécanismes potentiels par lesquels la DPNT pourrait avoir une influence sur la morphologie du cerveau dans un premier épisode de psychose. L’hyperactivité dopaminergique, l’activation hypothalamo-hypophyso-surrénalienne prolongée, et l’activité persistante des catécholamines ont été supposées être des mécanismes pour expliquer ces associations. Cependant, il reste à savoir si les changements structurels observés sont permanents ou s’ils peuvent être inversés par un traitement antipsychotique.

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