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A follow-up study of basal ganglia volumes and extrapyramidal symptoms in schizophrenia patients treated with risperidone or olanzapine
200 (patients versus controls) and region type (temporal-frontal ROls versus control ROIs). Cortical thickness mean and statistical difference maps revealed thinning in the orbitofrontal, inferior frontal, anterior cingulate cortices and, to a lesser degree, in the dorsolateral prefi'ontal cortex. In the temporal lobe, thinning affected the lateral, inferior and medial temporal cortices, extending anteriorly towards the temporal poles. Thinning was also observed around the left occipital-temporal j unction and in the left insula. Superior parietal and primary somatosensory and motor cortices were relatively spared. These findings suggest that chronic medicated patients with schizophrenia show widespread cortical thinning that particularly affects the prefrontal and temporal cortices. This thinning might reflect underlying neuropathological abnormalities in cortical structure.
GRAY MATTER-ABNORMALITIES AND CLINICAL SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA USING A VOXEL BASED MORPHOMETRY J. K w o n , * J. J. K i m , T. Youn, T. H. Ha, M. S. K i m
Psychiatry, Seoul National University College of Medicine, Seoul, South Korea Many imaging studies have shown structural abnormalities and especially changes in gray matter(GM) in schizophrenics. However, these studies have focused mainly on some regions in the brain. Recently voxel-based morphometry has been used to detect GM volume changes, as this method allows whole brain analysis of large samples. To investigate GM abnormalities in schizophrenics we employed a novel voxel-based analysis of magnetic resonance images. High resolution magnetic resonance images were acquired using a 1.5-T GE Signa scanner from 59 schizophrenic patients(male 35, female 24, mean age 26.0 6.35) and 67 controls(male 47, female 20, mean age 27.9 6.37). hnages were resampled to 1.0 mm3 voxels, reoriented and spatially normalized using ANALYZE. Anisotropic diffusion method and the fuzzy C-means algorithm were employed to yield extracted brain images and GM images respectively. Processing of GM images for the regional analysis was performed using SPM99. Clinical symptom severity was measured using PANSS(positive and negative syndrome scale). GM density reductions were found in schizophrenic patients in anterior cingulate, superior temporal(esp, left superior temporal) and dorsolateral prefrontal regions bilaterally(p<0.01, corrected, extent threshold=100). The implications of these findings and of some areas which were correlated with clinical symptom severity will be discussed.
A FOLLOW-UP STUDY OF BASAL GANGLIA VOLUMES AND EXTRAPYRAMIDAL SYMPTOMS IN SCHIZOPHRENIA PATIENTS TREATED WITH RISPERIDONE OR OLANZAPINE D. J. L a n g , * L. C. Kopala, R. A. Vandorpe, Q. Rui, G. N. Smith, V. M. Goghari, W. G. H o n e r
Psychiatry, University of British Columbia, Vancouvez BC, Canada A follow-up study of schizophrenia patients was conducted to examine change in striatat volumes and extrapyramidal symptoms (EPS) with change in treatment. 37 schizophrenia patients and 22 compar-
13. Neuroimaging, Structural ison subjects (recruited for an earlier study) were included. MRIs and clinical assessments were done at entry and repeated a mean of 45.6 weeks later. All patients on typical antipsychotics at baseline (N=10) were switched to olanzapine. 13 patients with a limited response to risperidone were switched to olanzapine. 14 patients remained on risperidone. Basal ganglia volumes were assessed from MRIs. The PANSS and ESRS were used to assess clinical symptoms. At baseline, patients treated with typical antipsychotics had larger pallidal volumes than other groups. (p.=0.001). At follow-up, no changes in basal ganglia volumes were observed in healthy comparison subjects or patients maintained on risperidone. Caudate volumes were reduced in patients switched from risperidone to olanzapine (3.37% reduction, p.=0.03). Putamen volumes were reduced in patients switched to olanzapine from risperidone (5.49% reduction: p.=0.004) or typical antipsychotics (10.17% reduction: p.=0.001). Pallidal volumes were significantly reduced in the typical antipsychotic to olanzapine group at follow-up (9.85% reduction: p.=0.05). At baseline patients treated with typical antipsychotics had the most severe EPS (p.<0.001). Switching medications reduced ESRS scores in the typical antipsychotic-olanzapine group, however, the decrease was not statistically significant (p.=0.06). Improvements in EPS severity may have been obscured by adjunctive anticholinergic medications at baseline. Olanzapine reverses striatal hypertrophy induced by typical antipsychotics, a result also reported for clozapine. Risperidone did not appear to be associated with striatal enlargement. However, in a subgroup of patients with poor risperidone response, switching to olanzapine was associated with a reduction in striatal volume. Changes in striatal volumes related to typical and atypical antipsychotics may represent an interactive effect between individual medications and illness subtypes. We gratefully acknowledge the support of the Canadian Institute or Health Research, The Dr. Norma Calder Schizophrenia Research Foundation and OthoJanssen of Canada.
COMPARING HIPPOCAMPAL AND AMYGDALA VOLUMES OF CHRONICALLY TREATED PATIENTS WITH SCHIZOPHRENIA TO EARLY SCHIZOPHRENIA PATIENTS UTILIZING MRI: EXAMINING A POSSIBLE CONTRIBUTION OF ANTIPSYCHOTIC TREATMENT J. Lauriello,* A. M y e r s - G u t i e n ' e z , R. Barrow, L. M. Rowland, R. E. Jung, H. Petropoulos, W. M. Brooks, J. R. Bustillo
Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA MRI research has consistently implicated limbic regions in the pathophysiology of schizophrenia (SZ). Studies have showed reduction of gray matter in chronic patients that may or may not progress with time. The impact of antipsychotic treatment or the course of disease on hippocampal and amygdala volumes has not been determined. We studied hippocampal and amygdala volumes in chronic patients taking either haloperidol (n=16) or clozapine (n=16), and minimally treated,patients with early SZ(n=17). The chronic group had received haloperidol or clozapine for at least two years (stable dose 2 months) while the early SZ patients were either medication free or minimally treated (<3 weeks total). Normal subjects are currently being collected to serve as a control group. T1 axial images were acquired using a 1.5 Tesla GE clinical MR scanner, fast SPGR,
International Congress on Schizophrenia Research 2003
GRAY MATTER-ABNORMALITIES AND CLINICAL SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA USING A VOXEL BASED MORPHOMETRY J. K w o n , * J. J. K i m , T. Youn, T. H. Ha, M. S. K i m
Psychiatry, Seoul National University College of Medicine, Seoul, South Korea Many imaging studies have shown structural abnormalities and especially changes in gray matter(GM) in schizophrenics. However, these studies have focused mainly on some regions in the brain. Recently voxel-based morphometry has been used to detect GM volume changes, as this method allows whole brain analysis of large samples. To investigate GM abnormalities in schizophrenics we employed a novel voxel-based analysis of magnetic resonance images. High resolution magnetic resonance images were acquired using a 1.5-T GE Signa scanner from 59 schizophrenic patients(male 35, female 24, mean age 26.0 6.35) and 67 controls(male 47, female 20, mean age 27.9 6.37). hnages were resampled to 1.0 mm3 voxels, reoriented and spatially normalized using ANALYZE. Anisotropic diffusion method and the fuzzy C-means algorithm were employed to yield extracted brain images and GM images respectively. Processing of GM images for the regional analysis was performed using SPM99. Clinical symptom severity was measured using PANSS(positive and negative syndrome scale). GM density reductions were found in schizophrenic patients in anterior cingulate, superior temporal(esp, left superior temporal) and dorsolateral prefrontal regions bilaterally(p<0.01, corrected, extent threshold=100). The implications of these findings and of some areas which were correlated with clinical symptom severity will be discussed.
A FOLLOW-UP STUDY OF BASAL GANGLIA VOLUMES AND EXTRAPYRAMIDAL SYMPTOMS IN SCHIZOPHRENIA PATIENTS TREATED WITH RISPERIDONE OR OLANZAPINE D. J. L a n g , * L. C. Kopala, R. A. Vandorpe, Q. Rui, G. N. Smith, V. M. Goghari, W. G. H o n e r
Psychiatry, University of British Columbia, Vancouvez BC, Canada A follow-up study of schizophrenia patients was conducted to examine change in striatat volumes and extrapyramidal symptoms (EPS) with change in treatment. 37 schizophrenia patients and 22 compar-
13. Neuroimaging, Structural ison subjects (recruited for an earlier study) were included. MRIs and clinical assessments were done at entry and repeated a mean of 45.6 weeks later. All patients on typical antipsychotics at baseline (N=10) were switched to olanzapine. 13 patients with a limited response to risperidone were switched to olanzapine. 14 patients remained on risperidone. Basal ganglia volumes were assessed from MRIs. The PANSS and ESRS were used to assess clinical symptoms. At baseline, patients treated with typical antipsychotics had larger pallidal volumes than other groups. (p.=0.001). At follow-up, no changes in basal ganglia volumes were observed in healthy comparison subjects or patients maintained on risperidone. Caudate volumes were reduced in patients switched from risperidone to olanzapine (3.37% reduction, p.=0.03). Putamen volumes were reduced in patients switched to olanzapine from risperidone (5.49% reduction: p.=0.004) or typical antipsychotics (10.17% reduction: p.=0.001). Pallidal volumes were significantly reduced in the typical antipsychotic to olanzapine group at follow-up (9.85% reduction: p.=0.05). At baseline patients treated with typical antipsychotics had the most severe EPS (p.<0.001). Switching medications reduced ESRS scores in the typical antipsychotic-olanzapine group, however, the decrease was not statistically significant (p.=0.06). Improvements in EPS severity may have been obscured by adjunctive anticholinergic medications at baseline. Olanzapine reverses striatal hypertrophy induced by typical antipsychotics, a result also reported for clozapine. Risperidone did not appear to be associated with striatal enlargement. However, in a subgroup of patients with poor risperidone response, switching to olanzapine was associated with a reduction in striatal volume. Changes in striatal volumes related to typical and atypical antipsychotics may represent an interactive effect between individual medications and illness subtypes. We gratefully acknowledge the support of the Canadian Institute or Health Research, The Dr. Norma Calder Schizophrenia Research Foundation and OthoJanssen of Canada.
COMPARING HIPPOCAMPAL AND AMYGDALA VOLUMES OF CHRONICALLY TREATED PATIENTS WITH SCHIZOPHRENIA TO EARLY SCHIZOPHRENIA PATIENTS UTILIZING MRI: EXAMINING A POSSIBLE CONTRIBUTION OF ANTIPSYCHOTIC TREATMENT J. Lauriello,* A. M y e r s - G u t i e n ' e z , R. Barrow, L. M. Rowland, R. E. Jung, H. Petropoulos, W. M. Brooks, J. R. Bustillo
Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA MRI research has consistently implicated limbic regions in the pathophysiology of schizophrenia (SZ). Studies have showed reduction of gray matter in chronic patients that may or may not progress with time. The impact of antipsychotic treatment or the course of disease on hippocampal and amygdala volumes has not been determined. We studied hippocampal and amygdala volumes in chronic patients taking either haloperidol (n=16) or clozapine (n=16), and minimally treated,patients with early SZ(n=17). The chronic group had received haloperidol or clozapine for at least two years (stable dose 2 months) while the early SZ patients were either medication free or minimally treated (<3 weeks total). Normal subjects are currently being collected to serve as a control group. T1 axial images were acquired using a 1.5 Tesla GE clinical MR scanner, fast SPGR,
International Congress on Schizophrenia Research 2003