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Lancet Psychiatry. 2014 Dec;1(7):549-58. doi: 10.1016/S2215-0366(14)00081-9. Epub 2014 Dec 3.

Changes in the adolescent brain and the pathophysiology of psychotic disorders.

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Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA. Electronic address:
Brain Imaging Section, Child Psychiatry Branch, NIMH, Bethesda, MD, USA.
Department of Psychology, Institute of Psychiatry, London, UK.
Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA.
Rotman Research Institute and Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada.


Adolescence is a time of extensive neuroanatomical, functional, and chemical reorganisation of the brain which parallels substantial maturational changes in cognition and affect regulation. This period is characterised by stabilisation of synapses to diminish redundancy and increase efficiency of neural function, fine-tuning of excitatory and inhibitory neurotransmitter systems, beginning of integration between late maturing and early maturing brain structures, and development of effective connections. In effect, these so-called moving parts create a state of dynamic change that might underlie adolescent behaviours. Imbalances or changes in timing of these developmental processes clearly increase the risk for psychiatric disorders. Genetic, environmental, and epigenetic factors that shape brain development and hormonal changes that affect stress reactivity could be reasons why some, but not all, adolescents are at a heightened risk of developing a psychopathological disorder. In this Series paper, we assess the neurobiology of the changing adolescent brain, implications of this knowledge, and future research in major psychiatric disorders, particularly for psychotic disorders.

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