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Cerebral volumetric changes in first-episode schizophrenic-like psychotic patients: A quantitative magnetic resonance imaging study
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VI. Structural Imaging STRUCTURAL IMAGING IN SUBJECTS AT HIGH RISK FOR SCHIZOPHRENIA S.M. Lawrie, H. Whalley, A. Hodges, S. AbukrneiL J.J.K. Best, E.C. J o h n s t o n e
Department o! Psychiato', Royal Edinburgh Hospital, Edinburgh, EHIO 5HF. UK Aim: To test the hypothesis that the structural abnormalities of the brain in schizophrenia are also found in subjects at high risk of developing the disorder. Methods. 100 high risk subjects (with at least two affected first degree relatives), 20 patients in their first episode and 30 healthy controls received a three-dimensional MRI scan covering the whole brain ( 128 × 1.9 mm slices). After inhomogeneity correction, a priori regions of interest were traced with 'Analyze', by three group-blind raters with good inter-rater reliability, on serial slices using conventional anatomical landmarks. Between group comparisons were made by analysis of variance and co-variance. Results: The volume of the left amygdala-hippocampal complex (AHC) in high risk subjects (4.6 cc) was intermediate between that in healthy controls (4.8 cc) and first episode cases (4.3 cc). These differences were statistically significant, whether taking AHC volumes as a proportion of whole brain volume or by co-varying for whole brain and other potential confounders. Third ventricle volume was largest in first episode cases, and both thalamic nuclei were smaller in high risk than healthy controls. Coneh~sions: Subjects at high risk of developing schizophrenia for genetic reasons have reduced AHC volumes that are akin to those in schizophrenia and are likely to be genetically mediated. Our other findings suggest possible differential brain structure effects as the disease develops. It may be that high risk subjects with smaller AHCs are most likely to develop schizophrenia, which could assist in early detection and treatment.
CEREBRAL
VOLUMETRIC
FIRST-EPISODE
CHANGES
IN
SCHIZOPHRENIC-LIKE
PSYCHOTIC
PATIENTS: A QUANTITATIVE
MAGNETIC STUDY
RESONANCE
IMAGING
S. Bachmann, D. Weimer, J. Schr6der, M. Essig, K. Baudendistel, J. Pantel, H. Herre, C. Mfiller, L.R. Schad, M.V. K n o p p , F. Resch, C. M u n d t
Department ~/ Psychiatry, University c~/'Heidelberg, Vo,6stra[~e 4, D-69115 Heidelberg, Germany Brain abnormalities in schizophrenia have been reported by several neuroimaging studies. To date an unresolved question
is whether anatomic changes precede the onset or whether they develop during the course of the disease. To address this question we include neuroleptic-naive patients meeting DSM-IV criteria for schizophrenia-like disorder in a longitudinal study. The duration of the illness before the first hospital admission was examined with the standardized interview for the retrospective assessment of the onset of schizophrenia (IRAOS). 3D MRI sequences of ten patients and six age-matched healthy subjects were obtained using a 1.5 T Siemens Magnetom. Whole brain volume, total intracranial volume and CSF volume were assessed using the semiautomated segmentation software NMRWin. No differences were detected when comparing morphometric data of patients and healthy controls. However, there was a positive association between duration of illness and the total CSF volume in patients (r=0.51). Our results are in line with recent studies and indicate that loss of brain tissue is related to the disease process in schizophrenia, and that it is not attributable to an effect of neuroleptic treatment. In order to further test this hypothesis larger patient samples will be studied longitudinally. Also, cerebral structures such as frontal lobe, temporal lobe and hippocampal area will be measured to specify our preliminary findings.
A CT STUDY OF VENTRICULAR FIRST EPISODE PSYCHOSIS
SIZE IN
J. Danckert, D. Velakoulis, P. M c G o r r y , N. Bridle, A. Kelman, A. H o b e r t o n , C. Pantelis
Applied Schizophrenia Division. Mental Health Research Institute ~f' Victoria, Locked Bag 11, Parkville, Victoria 3052 & School ~f Po,chologieal Scienee, FaculO' ~[ Science & Technology La Trohe UniversiO,, Bundoora, Victoria 3083. Australia The finding of ventricular enlargement in patients with chronic schizophrenia has been replicated in a large number of computerised tomography (CT) and magnetic resonance imaging (MRI) studies. Relatively few studies have investigated ventricular size in patients with first episode psychosis. Even fewer investigations have examined the specificity of ventricular enlargement to schizophrenic psychoses. In the current study, ventricular to brain ratios (VBR) were calculated in 54 first episode psychosis patients. Patients with schizophrenia/schizophreniform psychosis (n-32, mean age=23.1, SD=4.99: M : F = 2 4 : 8 ) , were compared to patients with nonschizophrenic psychoses (n=22, mean age=24.73, SD=5.4: M : F = 13 : 9) who had had a CT scan during their first presentation. Two independent tracers measured the third and lateral ventricles (inter-rater reliability, r=0.9). There was no difference in VBR between the two first episode groups (mean VBR: schizophrenia= 1.62; non-schizophrenia= 1.85: p-0.42). However, male patients with schizophrenia had smaller VBRs than male non-schizophrenic patients (means: schizophrenia = 1.51 ; non-schizophrenia= 2.26; t = - 2.17, p < 0.05). The two female patient groups did not differ. These results suggest that ventricular enlargement may not be specific to patients with schizophrenic psychoses and that ventricular enlargement may be present at the onset of non-schizophrenic psychoses.
VI. Structural Imaging STRUCTURAL IMAGING IN SUBJECTS AT HIGH RISK FOR SCHIZOPHRENIA S.M. Lawrie, H. Whalley, A. Hodges, S. AbukrneiL J.J.K. Best, E.C. J o h n s t o n e
Department o! Psychiato', Royal Edinburgh Hospital, Edinburgh, EHIO 5HF. UK Aim: To test the hypothesis that the structural abnormalities of the brain in schizophrenia are also found in subjects at high risk of developing the disorder. Methods. 100 high risk subjects (with at least two affected first degree relatives), 20 patients in their first episode and 30 healthy controls received a three-dimensional MRI scan covering the whole brain ( 128 × 1.9 mm slices). After inhomogeneity correction, a priori regions of interest were traced with 'Analyze', by three group-blind raters with good inter-rater reliability, on serial slices using conventional anatomical landmarks. Between group comparisons were made by analysis of variance and co-variance. Results: The volume of the left amygdala-hippocampal complex (AHC) in high risk subjects (4.6 cc) was intermediate between that in healthy controls (4.8 cc) and first episode cases (4.3 cc). These differences were statistically significant, whether taking AHC volumes as a proportion of whole brain volume or by co-varying for whole brain and other potential confounders. Third ventricle volume was largest in first episode cases, and both thalamic nuclei were smaller in high risk than healthy controls. Coneh~sions: Subjects at high risk of developing schizophrenia for genetic reasons have reduced AHC volumes that are akin to those in schizophrenia and are likely to be genetically mediated. Our other findings suggest possible differential brain structure effects as the disease develops. It may be that high risk subjects with smaller AHCs are most likely to develop schizophrenia, which could assist in early detection and treatment.
CEREBRAL
VOLUMETRIC
FIRST-EPISODE
CHANGES
IN
SCHIZOPHRENIC-LIKE
PSYCHOTIC
PATIENTS: A QUANTITATIVE
MAGNETIC STUDY
RESONANCE
IMAGING
S. Bachmann, D. Weimer, J. Schr6der, M. Essig, K. Baudendistel, J. Pantel, H. Herre, C. Mfiller, L.R. Schad, M.V. K n o p p , F. Resch, C. M u n d t
Department ~/ Psychiatry, University c~/'Heidelberg, Vo,6stra[~e 4, D-69115 Heidelberg, Germany Brain abnormalities in schizophrenia have been reported by several neuroimaging studies. To date an unresolved question
is whether anatomic changes precede the onset or whether they develop during the course of the disease. To address this question we include neuroleptic-naive patients meeting DSM-IV criteria for schizophrenia-like disorder in a longitudinal study. The duration of the illness before the first hospital admission was examined with the standardized interview for the retrospective assessment of the onset of schizophrenia (IRAOS). 3D MRI sequences of ten patients and six age-matched healthy subjects were obtained using a 1.5 T Siemens Magnetom. Whole brain volume, total intracranial volume and CSF volume were assessed using the semiautomated segmentation software NMRWin. No differences were detected when comparing morphometric data of patients and healthy controls. However, there was a positive association between duration of illness and the total CSF volume in patients (r=0.51). Our results are in line with recent studies and indicate that loss of brain tissue is related to the disease process in schizophrenia, and that it is not attributable to an effect of neuroleptic treatment. In order to further test this hypothesis larger patient samples will be studied longitudinally. Also, cerebral structures such as frontal lobe, temporal lobe and hippocampal area will be measured to specify our preliminary findings.
A CT STUDY OF VENTRICULAR FIRST EPISODE PSYCHOSIS
SIZE IN
J. Danckert, D. Velakoulis, P. M c G o r r y , N. Bridle, A. Kelman, A. H o b e r t o n , C. Pantelis
Applied Schizophrenia Division. Mental Health Research Institute ~f' Victoria, Locked Bag 11, Parkville, Victoria 3052 & School ~f Po,chologieal Scienee, FaculO' ~[ Science & Technology La Trohe UniversiO,, Bundoora, Victoria 3083. Australia The finding of ventricular enlargement in patients with chronic schizophrenia has been replicated in a large number of computerised tomography (CT) and magnetic resonance imaging (MRI) studies. Relatively few studies have investigated ventricular size in patients with first episode psychosis. Even fewer investigations have examined the specificity of ventricular enlargement to schizophrenic psychoses. In the current study, ventricular to brain ratios (VBR) were calculated in 54 first episode psychosis patients. Patients with schizophrenia/schizophreniform psychosis (n-32, mean age=23.1, SD=4.99: M : F = 2 4 : 8 ) , were compared to patients with nonschizophrenic psychoses (n=22, mean age=24.73, SD=5.4: M : F = 13 : 9) who had had a CT scan during their first presentation. Two independent tracers measured the third and lateral ventricles (inter-rater reliability, r=0.9). There was no difference in VBR between the two first episode groups (mean VBR: schizophrenia= 1.62; non-schizophrenia= 1.85: p-0.42). However, male patients with schizophrenia had smaller VBRs than male non-schizophrenic patients (means: schizophrenia = 1.51 ; non-schizophrenia= 2.26; t = - 2.17, p < 0.05). The two female patient groups did not differ. These results suggest that ventricular enlargement may not be specific to patients with schizophrenic psychoses and that ventricular enlargement may be present at the onset of non-schizophrenic psychoses.