Editing Psychosis (section)

=== Neuroimaging ===
The first brain image of an individual with psychosis was completed as far back as 1935 using a technique called [[pneumoencephalography]]<ref>{{cite journal | vauthors = Moore MT, Nathan D, Elliott AR, Laubach C |title=Encephalographic studies in mental disease |journal=American Journal of Psychiatry|volume=92|issue=1|pages=43–67|doi= 10.1176/ajp.92.1.43|year=1935 }}</ref> (a painful and now obsolete procedure where [[cerebrospinal fluid]] is drained from around the brain and replaced with air to allow the structure of the brain to show up more clearly on an [[X-ray]] picture).

Both [[Antipsychotic#First episode psychosis|first episode psychosis]], and high risk status is associated with reductions in grey matter volume (GMV). First episode psychotic and high risk populations are associated with similar but distinct abnormalities in GMV. Reductions in the right [[middle temporal gyrus]], right [[superior temporal gyrus]] (STG), right [[parahippocampus]], right [[hippocampus]], right [[middle frontal gyrus]], and left [[anterior cingulate cortex]] (ACC) are observed in high risk populations. Reductions in first episode psychosis span a region from the right STG to the right insula, left insula, and cerebellum, and are more severe in the right ACC, right STG, insula and cerebellum.<ref>{{cite journal | vauthors = Fusar-Poli P, Radua J, McGuire P, Borgwardt S | title = Neuroanatomical maps of psychosis onset: voxel-wise meta-analysis of antipsychotic-naive VBM studies | journal = Schizophrenia Bulletin | volume = 38 | issue = 6 | pages = 1297–1307 | date = November 2012 | pmid = 22080494 | pmc = 3494061 | doi = 10.1093/schbul/sbr134 }}</ref><ref>{{cite journal | vauthors = Palaniyappan L, Balain V, Liddle PF | title = The neuroanatomy of psychotic diathesis: a meta-analytic review | journal = Journal of Psychiatric Research | volume = 46 | issue = 10 | pages = 1249–1256 | date = October 2012 | pmid = 22790253 | doi = 10.1016/j.jpsychires.2012.06.007 }}</ref>

Another meta analysis reported bilateral reductions in insula, operculum, STG, medial frontal cortex, and ACC, but also reported increased GMV in the right [[lingual gyrus]] and left [[precentral gyrus]].<ref name="Radua">{{cite journal | vauthors = Radua J, Borgwardt S, Crescini A, Mataix-Cols D, Meyer-Lindenberg A, McGuire PK, Fusar-Poli P | title = Multimodal meta-analysis of structural and functional brain changes in first episode psychosis and the effects of antipsychotic medication | journal = Neuroscience and Biobehavioral Reviews | volume = 36 | issue = 10 | pages = 2325–2333 | date = November 2012 | pmid = 22910680 | doi = 10.1016/j.neubiorev.2012.07.012 | quote = Patients with an FEP showed large and robust bilateral decreases of GMV in a peri-Sylvian cluster that included the insula, operculum and the superior temporal gyrus, and in the medial frontal and anterior cingulate cortices (MeF/ACC) (Fig. 2A and Supplementary Table S2). Patients had relatively greater GMV than controls in the right lingual gyrus and left precentral gyrus. | doi-access = free }}</ref>  The [[Kraepelinian dichotomy]] is made questionable{{Clarify | date = November 2019 | reason = Non sequitur.  Also, even the provided link doesn't clarify why GMV abnormalities would make the Kraepelinian dichotomy, which also separates schizophrenia from bipolar disorder, questionable. }} by grey matter abnormalities in bipolar and schizophrenia; schizophrenia is distinguishable from bipolar in that regions of grey matter reduction are generally larger in magnitude, although adjusting for gender differences reduces the difference to the left [[dorsomedial prefrontal cortex]], and right [[dorsolateral prefrontal cortex]].<ref>{{cite journal | vauthors = Bora E, Fornito A, Yücel M, Pantelis C | title = The effects of gender on grey matter abnormalities in major psychoses: a comparative voxelwise meta-analysis of schizophrenia and bipolar disorder | journal = Psychological Medicine | volume = 42 | issue = 2 | pages = 295–307 | date = February 2012 | pmid = 21835091 | doi = 10.1017/S0033291711001450 | s2cid = 206252132 }}</ref>

During attentional tasks, first episode psychosis is associated with hypoactivation in the right middle frontal gyrus, a region generally described as encompassing the dorsolateral prefrontal cortex (dlPFC).Altered Behavioral Inhibition System functioning could possibly cause reduced sustained attention in psychosis and overall contribute to more negative reactions.<ref>{{Cite journal |last1=Osborne |first1=K. Juston |last2=Zhang |first2=Wendy |last3=Gupta |first3=Tina |last4=Farrens |first4=Jaclyn |last5=Geiger |first5=McKena |last6=Kraus |first6=Brian |last7=Krugel |first7=Chloe |last8=Nusslock |first8=Robin |last9=Kappenman |first9=Emily S. |last10=Mittal |first10=Vijay A. |date=November 2023 |title=Clinical high risk for psychosis syndrome is associated with reduced neural responding to unpleasant images. |journal=Journal of Psychopathology and Clinical Science |language=en |volume=132 |issue=8 |pages=1060–1071 |doi=10.1037/abn0000862 |pmid=37796541 |issn=2769-755X|doi-access=free |pmc=11812458 }}</ref> In congruence with studies on grey matter volume, hypoactivity in the right insula, and right inferior parietal lobe is also reported.<ref>{{cite journal | vauthors = Del Casale A, Kotzalidis GD, Rapinesi C, Sorice S, Girardi N, Ferracuti S, Girardi P | title = Functional Magnetic Resonance Imaging Correlates of First-Episode Psychoses during Attentional and Memory Task Performance | journal = Neuropsychobiology | volume = 74 | issue = 1 | pages = 22–31 | date = 2016 | pmid = 27698323 | doi = 10.1159/000448620 | s2cid = 5806628 }}</ref> During cognitive tasks, hypoactivities in the right insula, dACC, and the left precuneus, as well as reduced deactivations in the right [[basal ganglia]], right [[thalamus]], right [[Inferior frontal gyrus|inferior frontal]] and left precentral gyri are observed. These results are highly consistent and replicable possibly except the abnormalities of the right inferior frontal gyrus.<ref>{{harvnb|Radua|Borgwardt|Crescini|Mataix-Cols|2012|loc=3.3. Changes in regional brain response to cognitive tasks.}} "In the anterior part of the right insula and in the dorsal ACC there was hypoactivation relative to controls, whereas in the right basal ganglia/thalamus extending to the posterior part of the insula and in the medial frontal cortex, there was a relative reduction in deactivation... Patients also showed reductions in deactivation in the right inferior frontal and left precentral gyri, as well as hypoactivation in left precuneus. ... The analyses of robustness showed that all these results were highly replicable, with the possible exception of the abnormalities in right inferior frontal gyrus..."</ref> Decreased grey matter volume in conjunction with bilateral hypoactivity is observed in anterior insula, dorsal medial frontal cortex, and dorsal ACC. Decreased grey matter volume and bilateral hyperactivity is reported in posterior insula, ventral medial frontal cortex, and ventral ACC.<ref>{{Harvnb|Radua|Borgwardt|Crescini|Mataix-Cols|2012|loc=3.4. Multimodal analysis of grey matter volume and brain response.}} "Specifically, the anterior parts of the insulae and the dorsal part of the MeF/ACC showed hypoactivation, whereas the posterior parts of the insulae and the ventral part of the MeF/ACC showed reductions in deactivation (Fig. 3 and Table 1)."</ref>