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Brain MRI abnormalities associated with reduced antipsychotic response to clozapine in schizophrenic patients
BIOL PSYCHIATRY 1991;29:43A- 185A
43A
Abstracts PAPER SESSIONS SCHIZOPHRENIA I Thursday, May 9, 1:00-4:00 PM
Ponchartrain B
BRAIN MRI ABNORMALITIES ASSOCIATED WITH REDUCED ANTIPSYCHOTIC RESPONSE TO CLOZAPINE IN SCHIZOPHRENIC PATIENTS R. D. Jewart, Ph.D., R. R. J. Lewine, Ph.D., D. E. Manning, M.D., Emile D. Risby, M.D., S. C. Risch, M.D. Emory University School of Medicine, Atlanta, GA 30322. Twenty-nine patients with schizophrenia received MRI scans during their treatment with clozapine. Fourteen had MRI scans judged by the neuroradiologists to be notable (Abn) for such abnormalities as cortical atrophy, increased ventricular size, or white matter hyperintensities while the MRIs of the remaining 15 patients were judged clinically unremarkable (n). In the (n) MRI patients the overall antipsychotic responses measured by reduction in BPRS total scores was highly significant (53.0 --- 13 baseline versus 32.3 - I0 p = 0.000) and was accompanied by significant reductions in all BPRS subscales. In the patients with Abn MRI scans, the antipsychotic response was comparatively reduced (55.0 ± 14.7 baseline versus 43.6 ± 13.5 p = 0.05) and there was a significant reduction only in the BPRS thinking disorder subscale. These results suggest that patients with brain structural alterations may have an attenuated antipsychotic response to clozapine.
A MAGNETIC RESONANCE IMAGING STUDY IN SCHIZOPHRENIA COMPARING TREATME_NT RESPONSES Del D. Miller, Michael A. Flaum, William Coryell, Nancy C. Andreasen Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA 52242. Nur.ket'ous structural imaging studies indicate that at least some patients with schizophrenia have enlarged ventricles as well as other cerebral structural abnormalities. Studies looking at the relationship between ventricle size and response to antipsychotics have had conflica~.g conclusions. In general, they have not found differences in ventricle size when mean ventricle size was compared between responde,'s and nonresponders to acute antipsychotic treatment. Studies that have focused on the response uf ~hizophrenics who have enlarged ventricles are split--wit,h about half showing poor response and the others equal response when compared to patients with normal-sized ventricles. Using magnetic resonance imaging, we compared cerebral structures between schizophrenic patients who responded to acute antipsychotic treatment, those who did not respond to acute antipsychotic treatment, chronically antipsychotic-refractory patients, and normal age-matched controls. The two groups were comprised of schizopb~enic patients who were treated with 4 or 6 weeks of haloperidol (22 responders and 19 non-responders). The other group was made up of 22 schizophrenics who had a history of not responding to at least three antipsychotics, who were being included in a clozapine trial. The volumes of 23 separate cerebral structures including lateral ventricles, © 1991 Society of Biological Psyc!:iatry
0006-3223/91/$03.50
43A
Abstracts PAPER SESSIONS SCHIZOPHRENIA I Thursday, May 9, 1:00-4:00 PM
Ponchartrain B
BRAIN MRI ABNORMALITIES ASSOCIATED WITH REDUCED ANTIPSYCHOTIC RESPONSE TO CLOZAPINE IN SCHIZOPHRENIC PATIENTS R. D. Jewart, Ph.D., R. R. J. Lewine, Ph.D., D. E. Manning, M.D., Emile D. Risby, M.D., S. C. Risch, M.D. Emory University School of Medicine, Atlanta, GA 30322. Twenty-nine patients with schizophrenia received MRI scans during their treatment with clozapine. Fourteen had MRI scans judged by the neuroradiologists to be notable (Abn) for such abnormalities as cortical atrophy, increased ventricular size, or white matter hyperintensities while the MRIs of the remaining 15 patients were judged clinically unremarkable (n). In the (n) MRI patients the overall antipsychotic responses measured by reduction in BPRS total scores was highly significant (53.0 --- 13 baseline versus 32.3 - I0 p = 0.000) and was accompanied by significant reductions in all BPRS subscales. In the patients with Abn MRI scans, the antipsychotic response was comparatively reduced (55.0 ± 14.7 baseline versus 43.6 ± 13.5 p = 0.05) and there was a significant reduction only in the BPRS thinking disorder subscale. These results suggest that patients with brain structural alterations may have an attenuated antipsychotic response to clozapine.
A MAGNETIC RESONANCE IMAGING STUDY IN SCHIZOPHRENIA COMPARING TREATME_NT RESPONSES Del D. Miller, Michael A. Flaum, William Coryell, Nancy C. Andreasen Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA 52242. Nur.ket'ous structural imaging studies indicate that at least some patients with schizophrenia have enlarged ventricles as well as other cerebral structural abnormalities. Studies looking at the relationship between ventricle size and response to antipsychotics have had conflica~.g conclusions. In general, they have not found differences in ventricle size when mean ventricle size was compared between responde,'s and nonresponders to acute antipsychotic treatment. Studies that have focused on the response uf ~hizophrenics who have enlarged ventricles are split--wit,h about half showing poor response and the others equal response when compared to patients with normal-sized ventricles. Using magnetic resonance imaging, we compared cerebral structures between schizophrenic patients who responded to acute antipsychotic treatment, those who did not respond to acute antipsychotic treatment, chronically antipsychotic-refractory patients, and normal age-matched controls. The two groups were comprised of schizopb~enic patients who were treated with 4 or 6 weeks of haloperidol (22 responders and 19 non-responders). The other group was made up of 22 schizophrenics who had a history of not responding to at least three antipsychotics, who were being included in a clozapine trial. The volumes of 23 separate cerebral structures including lateral ventricles, © 1991 Society of Biological Psyc!:iatry
0006-3223/91/$03.50