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Poster #S54 BRAIN STRUCTURAL ABNORMALITIES IN POSTPARTUM PSYCHOSIS: AN MRI STUDY
S108
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Methods: 33 SCZ, 18 with DoI shorter than 10 years (SCZ≤10y), 15 longer than 10 years (SCZ>10y), and 24 healthy controls (HC) were enrolled. T1 structural images were collected using 3T MRI scanner. Participants performed a WCST at the time of the scanning. The number of completed categories (CAT), perseverative responses (PR) and of perseverative errors (PE) were considered performance measures. An ANCOVA was run entering as a nuisance covariate the age of subject to analyse the difference in the WCST performance between the three groups. The effect size was computed using the Cohen’s d. Group-related differences in gray matter volume (GMV) were examined using VBM, as implemented in SPM8. An ANOVA was performed in SPM8, entering gender, age and years of education as nuisance covariates, to compare in a whole brain analysis the three groups. The eigenvariates (radius=8 mm) were extracted for each cluster of interest and correlated (Pearson’s r) with WCST performance. Results: There were no significant differences in gender, level of education, number of admissions and antipsychotic dose at the time of the scanning. The SCZ>10y group was significantly older than the other two groups (p<0.001). There were significant between-group differences in the three WCST performance measures. Post hoc analyses showed significant difference in CAT between the HC and the SCZ>10y (p=0.02, Cohen’s d=1.21). HC and SCZ≤10y groups performed better on PR scores than SCZ>10y (respectively p=0.001, Cohen’s d=1.56, and p=0.013, Cohen’s d=0.98). HC performed better on PE as compared to SCZ>10y (p=0.047, Cohen’s d=1.01); there were no PE differences between SCZ>10y and SCZ≤10y. At whole brain level, there was a significant difference in the left medial frontal gyrus (LMFG) GMV (19 voxels, peak in x=−9, y=30, z=36) across the three groups (t=5.48 p=0.009 FWE corrected). Post hoc analyses identified a linear trend in this region, with greater GMV reduction in patients with a longer DoI compared to patients with a shorter DoI. There were not significant group by WCST performance interactions surviving multiple comparions correction. Discussion: The present study supports the hypothesis that medial frontal gyrus alterations in schizophrenia are sensitive to DoI but not associated to executive functioning. Patients with shorter DoI appeared to be less cognitively impaired, with no significant differences relative to HC and with a better performance on PR compared to patients with longer DoI. This is partially in line with previous findings. We found GMV reduction in the LMFG in SCZ. There was a linear trend across the three groups, with the shorter DoI patients in an intermediate position between the longer DoI patients (greater GMV reduction) and controls. Literature data showed that medial prefrontal cortex is affected by the illness but there are still not convergence on the relationship with illness duration or with the illness onset. We did not find any significant between-group DoI by executive functioning interaction in the medial prefrontal gyrus but more longitudinal studies are required to clarify this issue.
Poster #S54 BRAIN STRUCTURAL ABNORMALITIES IN POSTPARTUM PSYCHOSIS: AN MRI STUDY Montserrat Fusté 1,2 , Astrid Pauls 3 , Simone Reinders 4 , Mitul Mehta 5 , Andy Simmons 6 , Steve Williams 5 , Josep Maria Haro 7 , Carmine Pariante 8 , Paola Dazzan 8 1 Department of Psychosis Studies, Institute of Psychiatry - King’s College London; 2 Department of Psychosis Studies, Institute of Psychiatry - King’s College London, Parc Sanitari Sant Joan de Déu, Barcelona, Spain; 3 Department of Psychosis Studies. Institute of Psychiatry, King’s College of London, De Crespigny Park, London, UK; 4 Institute of Psychiatry, King’s College London; 5 Centre for Neuroimaging Sciences. Institute of Psychiatry, King’s College London, De Crespigny Park, London, UK; 6 Institute of Psychiatry; 7 Parc Sanitari Sant Joan de Déu; 8 Psychological Medicine, Institute of Psychiatry, King’s College London Background: Postpartum Psychosis (PP) is the most severe psychiatric disorder associated with childbirth with an incidence of about one per 1000 deliveries (1). This clinical entity takes the form of mania, severe depression symptoms, or acute polymorphic (cycloid) psychosis. Recent family and longitudinal studies linked the Postpartum Psychosis to the manic depressive psychosis (2). The aims of our study are: 1) to examine whether alterations in brain regions involved in psychoses in the affective spectrum such as the amygdala and the anterior cingulate cortex (3) are
also present in Postpartum Psychosis; 2) to explore whether there is an association between stressful life events, symptomatology and specific brain areas mentioned above in postpartum psychosis group. Methods: This is a cross-sectional study of 21 healthy postpartum women and 24 women at risk of postpartum psychosis. Within this group, 12 developed postpartum psychosis ((PE) n=8, Bipolar Disorder n=4) and 12 did not develop postpartum psychosis ((NPE) Bipolar Disorder n= 10, Schizoaffective Disorder n=1, First-degree family history of PP n=1). After delivery all participants underwent an MRI scan and assessment of symptoms using Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS) and Beck Depression Inventory (BDI) as well as Intrusive Life Events scale (ILE). We examined Gray Matter Volume using Voxel Based Morphometry (VBM) and Freesurfer methods of image analysis. Results: The subgroup that developed postpartum psychosis (PE) showed a reduction in the Anterior Cingulate Cortex (ACC) volume compared to those who did not develop PP (NPE), whereas we found at trend level, a reduction in right precuneus cortex in the at risk group ((PE+NPE) n=24) when comparing with postpartum control group (n=21). In this study the reduction in ACC volumes in PE compared to the NPE are not associated to symptomatology or life events. Discussion: These preliminary findings suggest that women with posptartum psychotic disorders show specific volumetric abnormalities in areas relevant to the pathophysiology of affective psychosis. References: [1] Munk-Olsen T, et al. JAMA 2006;296:2582-2589. [2] Chaudron LH, Pies RW. J Clin Psychiary. 2003;64 (11):1284-1292. [3] Morgan KD, et al. BrJPsychiatry Suppl 2007;51:s111-s116.
Poster #S55 PREFRONTAL CORTEX VOLUME IN PATIENTS WITH SCHIZOPHRENIA IS CORRELATED WITH VERBAL MEMORY PERFORMANCE Clarissa S. Gama 1 , Leticia Czepielewski 2 , Mariana Pedrini 2 , Juliana Sartori 3 , Marina Londero 3 , Sandra Polita 4 , Juliana Duarte 2 , Pedro Goi 5 , Mireia Vianna-Sulzbach 2 , Paulo Belmonte-de-Abreu 1 , Raffael Massuda 5 1 Universidade Federal do Rio Grande do Sul; 2 Programa de Pos Graduação em Ciencias Medicas: Psiquiatria., Universidade Federal do Rio Grande do Sul (UFRGS); 3 Department of Psychiatry, Hospital de Clinicas de Porto Alegre; 4 Hospital de Clinicas de Porto Alegre; 5 UFRGS Background: Several studies have shown brain volume changes in schizophrenia (SZ). Volume reduction of areas such as prefrontal cortex is particularly of interest regarding cognitive performance. Verbal memory (VM) is one of the most impaired cognitive domains in SZ and is linked to daily life functioning. Prefrontal cortex is one of the target areas in VM performance. The aims of this pilot study were: (1) to compare total and prefrontal cortex volumes in individuals at recent onset (RO) and chronic patients (CP) with SZ; (2) to correlate the volumes with Hopkins Verbal Learning Test-Revised (HVLT-R) total immediate free recall scores. Methods: The double case-control design included 21 RO patients (within first 5 years of SZ diagnosis), 19 CP (minimum of 20 years after the diagnosis of SZ) and their respective matched controls for age, gender and level of education (19 and 18 subjects). Images were acquired at Philips Achieva 1.5T MRI scanner at the Hospital de Clinicas de Porto Alegre, Brazil. Images were processed using the automated pipeline of FreeSurfer v5.1. Intracranial volume and years of disease (only in the patients group) were regressed out from prefrontal and total cortex volumes. Results: Either total (p<0.0001, F=21.695, RO controls = RO patients = CP controls > CP) or prefrontal (p<0.0001, F=18.775, RO controls = RO patients = CP controls > CP) cortices were different between groups. In patients, HVLT-R total immediate free recall scores were positively correlated with total cortex (r=0.434; p=0.008); a correlation trend with prefrontal cortex (r=0.322; p=0.055) was found. In controls, there were no significant correlations (p=0.490 for total and p=0.697 for prefrontal cortex volumes). Discussion: Although preliminary and on a secondary prevention level perspective, these findings give us insights on therapeutic strategies to reduce the cortex atrophy and cognitive impairment at the first five years after diagnosis of SZ.
Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384
Methods: 33 SCZ, 18 with DoI shorter than 10 years (SCZ≤10y), 15 longer than 10 years (SCZ>10y), and 24 healthy controls (HC) were enrolled. T1 structural images were collected using 3T MRI scanner. Participants performed a WCST at the time of the scanning. The number of completed categories (CAT), perseverative responses (PR) and of perseverative errors (PE) were considered performance measures. An ANCOVA was run entering as a nuisance covariate the age of subject to analyse the difference in the WCST performance between the three groups. The effect size was computed using the Cohen’s d. Group-related differences in gray matter volume (GMV) were examined using VBM, as implemented in SPM8. An ANOVA was performed in SPM8, entering gender, age and years of education as nuisance covariates, to compare in a whole brain analysis the three groups. The eigenvariates (radius=8 mm) were extracted for each cluster of interest and correlated (Pearson’s r) with WCST performance. Results: There were no significant differences in gender, level of education, number of admissions and antipsychotic dose at the time of the scanning. The SCZ>10y group was significantly older than the other two groups (p<0.001). There were significant between-group differences in the three WCST performance measures. Post hoc analyses showed significant difference in CAT between the HC and the SCZ>10y (p=0.02, Cohen’s d=1.21). HC and SCZ≤10y groups performed better on PR scores than SCZ>10y (respectively p=0.001, Cohen’s d=1.56, and p=0.013, Cohen’s d=0.98). HC performed better on PE as compared to SCZ>10y (p=0.047, Cohen’s d=1.01); there were no PE differences between SCZ>10y and SCZ≤10y. At whole brain level, there was a significant difference in the left medial frontal gyrus (LMFG) GMV (19 voxels, peak in x=−9, y=30, z=36) across the three groups (t=5.48 p=0.009 FWE corrected). Post hoc analyses identified a linear trend in this region, with greater GMV reduction in patients with a longer DoI compared to patients with a shorter DoI. There were not significant group by WCST performance interactions surviving multiple comparions correction. Discussion: The present study supports the hypothesis that medial frontal gyrus alterations in schizophrenia are sensitive to DoI but not associated to executive functioning. Patients with shorter DoI appeared to be less cognitively impaired, with no significant differences relative to HC and with a better performance on PR compared to patients with longer DoI. This is partially in line with previous findings. We found GMV reduction in the LMFG in SCZ. There was a linear trend across the three groups, with the shorter DoI patients in an intermediate position between the longer DoI patients (greater GMV reduction) and controls. Literature data showed that medial prefrontal cortex is affected by the illness but there are still not convergence on the relationship with illness duration or with the illness onset. We did not find any significant between-group DoI by executive functioning interaction in the medial prefrontal gyrus but more longitudinal studies are required to clarify this issue.
Poster #S54 BRAIN STRUCTURAL ABNORMALITIES IN POSTPARTUM PSYCHOSIS: AN MRI STUDY Montserrat Fusté 1,2 , Astrid Pauls 3 , Simone Reinders 4 , Mitul Mehta 5 , Andy Simmons 6 , Steve Williams 5 , Josep Maria Haro 7 , Carmine Pariante 8 , Paola Dazzan 8 1 Department of Psychosis Studies, Institute of Psychiatry - King’s College London; 2 Department of Psychosis Studies, Institute of Psychiatry - King’s College London, Parc Sanitari Sant Joan de Déu, Barcelona, Spain; 3 Department of Psychosis Studies. Institute of Psychiatry, King’s College of London, De Crespigny Park, London, UK; 4 Institute of Psychiatry, King’s College London; 5 Centre for Neuroimaging Sciences. Institute of Psychiatry, King’s College London, De Crespigny Park, London, UK; 6 Institute of Psychiatry; 7 Parc Sanitari Sant Joan de Déu; 8 Psychological Medicine, Institute of Psychiatry, King’s College London Background: Postpartum Psychosis (PP) is the most severe psychiatric disorder associated with childbirth with an incidence of about one per 1000 deliveries (1). This clinical entity takes the form of mania, severe depression symptoms, or acute polymorphic (cycloid) psychosis. Recent family and longitudinal studies linked the Postpartum Psychosis to the manic depressive psychosis (2). The aims of our study are: 1) to examine whether alterations in brain regions involved in psychoses in the affective spectrum such as the amygdala and the anterior cingulate cortex (3) are
also present in Postpartum Psychosis; 2) to explore whether there is an association between stressful life events, symptomatology and specific brain areas mentioned above in postpartum psychosis group. Methods: This is a cross-sectional study of 21 healthy postpartum women and 24 women at risk of postpartum psychosis. Within this group, 12 developed postpartum psychosis ((PE) n=8, Bipolar Disorder n=4) and 12 did not develop postpartum psychosis ((NPE) Bipolar Disorder n= 10, Schizoaffective Disorder n=1, First-degree family history of PP n=1). After delivery all participants underwent an MRI scan and assessment of symptoms using Positive and Negative Syndrome Scale (PANSS), Young Mania Rating Scale (YMRS) and Beck Depression Inventory (BDI) as well as Intrusive Life Events scale (ILE). We examined Gray Matter Volume using Voxel Based Morphometry (VBM) and Freesurfer methods of image analysis. Results: The subgroup that developed postpartum psychosis (PE) showed a reduction in the Anterior Cingulate Cortex (ACC) volume compared to those who did not develop PP (NPE), whereas we found at trend level, a reduction in right precuneus cortex in the at risk group ((PE+NPE) n=24) when comparing with postpartum control group (n=21). In this study the reduction in ACC volumes in PE compared to the NPE are not associated to symptomatology or life events. Discussion: These preliminary findings suggest that women with posptartum psychotic disorders show specific volumetric abnormalities in areas relevant to the pathophysiology of affective psychosis. References: [1] Munk-Olsen T, et al. JAMA 2006;296:2582-2589. [2] Chaudron LH, Pies RW. J Clin Psychiary. 2003;64 (11):1284-1292. [3] Morgan KD, et al. BrJPsychiatry Suppl 2007;51:s111-s116.
Poster #S55 PREFRONTAL CORTEX VOLUME IN PATIENTS WITH SCHIZOPHRENIA IS CORRELATED WITH VERBAL MEMORY PERFORMANCE Clarissa S. Gama 1 , Leticia Czepielewski 2 , Mariana Pedrini 2 , Juliana Sartori 3 , Marina Londero 3 , Sandra Polita 4 , Juliana Duarte 2 , Pedro Goi 5 , Mireia Vianna-Sulzbach 2 , Paulo Belmonte-de-Abreu 1 , Raffael Massuda 5 1 Universidade Federal do Rio Grande do Sul; 2 Programa de Pos Graduação em Ciencias Medicas: Psiquiatria., Universidade Federal do Rio Grande do Sul (UFRGS); 3 Department of Psychiatry, Hospital de Clinicas de Porto Alegre; 4 Hospital de Clinicas de Porto Alegre; 5 UFRGS Background: Several studies have shown brain volume changes in schizophrenia (SZ). Volume reduction of areas such as prefrontal cortex is particularly of interest regarding cognitive performance. Verbal memory (VM) is one of the most impaired cognitive domains in SZ and is linked to daily life functioning. Prefrontal cortex is one of the target areas in VM performance. The aims of this pilot study were: (1) to compare total and prefrontal cortex volumes in individuals at recent onset (RO) and chronic patients (CP) with SZ; (2) to correlate the volumes with Hopkins Verbal Learning Test-Revised (HVLT-R) total immediate free recall scores. Methods: The double case-control design included 21 RO patients (within first 5 years of SZ diagnosis), 19 CP (minimum of 20 years after the diagnosis of SZ) and their respective matched controls for age, gender and level of education (19 and 18 subjects). Images were acquired at Philips Achieva 1.5T MRI scanner at the Hospital de Clinicas de Porto Alegre, Brazil. Images were processed using the automated pipeline of FreeSurfer v5.1. Intracranial volume and years of disease (only in the patients group) were regressed out from prefrontal and total cortex volumes. Results: Either total (p<0.0001, F=21.695, RO controls = RO patients = CP controls > CP) or prefrontal (p<0.0001, F=18.775, RO controls = RO patients = CP controls > CP) cortices were different between groups. In patients, HVLT-R total immediate free recall scores were positively correlated with total cortex (r=0.434; p=0.008); a correlation trend with prefrontal cortex (r=0.322; p=0.055) was found. In controls, there were no significant correlations (p=0.490 for total and p=0.697 for prefrontal cortex volumes). Discussion: Although preliminary and on a secondary prevention level perspective, these findings give us insights on therapeutic strategies to reduce the cortex atrophy and cognitive impairment at the first five years after diagnosis of SZ.