Addressing fusiform gyrus dysfunction in schizophrenia, theory of mind, and implications for antipsychotics' response and resistance: A systematic review and critical appraisal.

In 30 seconds

This systematic review examined fMRI studies of fusiform gyrus (FG) activation and functional connectivity in people with schizophrenia compared with healthy controls. Of 2,765 records identified, 86 studies met the review criteria. Findings varied across drug-naïve samples, but reduced FG activation during visual, affective, and sensory tasks was reported more broadly. First-episode psychosis was associated with FG hypoconnectivity linked to negative symptoms and socio-cognitive impairment. The review describes partial modulation of FG measures after antipsychotic treatment in responsive patients, while abnormalities persisted in treatment-resistant schizophrenia.

Key findings

• The review included 86 eligible fMRI studies of FG activation or functional connectivity in schizophrenia.
• Reduced FG activation on visual, affective, and sensory tasks was reported broadly across schizophrenia samples.
• First-episode psychosis was characterized by FG hypoconnectivity associated with negative symptoms and socio-cognitive impairment.
• Responsive patients showed partial normalization or modulation of FG measures after antipsychotic treatment; abnormalities persisted in treatment-resistant patients.

Why it matters

The review brings together evidence linking FG dysfunction with perceptual, emotional, and social-cognitive disturbances in schizophrenia. Differences between treatment-responsive and treatment-resistant groups suggest that FG measures may vary with clinical state and treatment response, while the heterogeneous findings in drug-naïve patients caution against treating a single connectivity pattern as universal.

What to keep in mind

The review synthesizes heterogeneous fMRI studies, and the abstract reports no pooled quantitative effect estimate. Findings across drug-naïve patients were inconsistent.