Gray matter involvement in schizophrenia: Evidence from magnetic resonance imaging studies

It is established that schizophrenia represents an important public health challenge as it contributes to significant psychosocial disability worldwide (Whiteford et al., Lancet 382(9904):1575-86, 2013). Although its fundamental pathobiology remains elusive, neuroimaging studies provide compelling evidence that schizophrenia is associated with alterations in brain gray matter morphometry, which may be one mechanism that underpins the emergence and maintenance of the clinical symptoms of this disorder. This chapter reviews current evidence on the nature and extent of cross-sectional and longitudinal gray matter changes in patients with syndromal schizophrenia. We then identify the most consistent links between such alterations with psychopathology and highlight key potential pathogenetic and moderating mechanisms. The relevant neuroimaging literature is substantial and substantive. We focus on evidence from large-scale, multisite, magnetic resonance imaging (MRI) studies and meta-analyses as they have the advantage of greater power and precision in identifying and quantifying schizophrenia-related alterations in gray matter morphometry.