Neuropsychiatric Disorders Schizophrenia Affective Disorders Anxiety Disorders.
A CT scan follow-up study of cerebral ventricular size in schizophrenia and major affective disorder
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165 remaining seven were withdrawn from all medications for a period of two weeks. Negative symptoms and a measure of premorbid functioning were obtained by using the Iager negative symptom rating scale and the Cannon-Spoor Premorbid Adjustment Scale, respectively. CT scans without contrast were obtained for calculation of Ventricular Brain Ratio (VBR) by standardized planimetry. Our results show that Stage-4 percent is correlated negatively with VBR (r-=0.76, p=O.O05), premorbid functioning (r=0.69, p=O.O09) and negative symptoms (r=0.67, p=O.Ol). There was no association between age and VBR or age and Stage-4 percent in our sample. Our results suggest that decreased Stage-4 sleep may be an added dimension to Type II schizophrenia. Decreased Stage-4 sleep may be a trait variable secondary to brain atrophy in a subgroup of patients. A CT SCAN FOLLOW-UP STUDY OF CEREBRAL VENTRICULAR SIZE IN SCHIZO- PHRENIA AND MAJOR AFFECTIVE DISORDER Antonio Vita, Emilio Sacchetti and Carlo L. Cazzullo Institute of Psychiatry, University of Milan, via F. Sforza 35, 20122 Milan, Italy Enlargement of the cerebral ventricles (VE), as assessed by com- puterized tomographic (CT) scans, has been consistently reported in a proportion of patients with schizophrenia (1,2) and affective disorders (3,4), but the biological significance of this abnormality is still an open question. The definition of the time course of the CT alteration would much improve our knowledge about the nature, whether neurodevelopmental or neurodegenerative, of the underlying neuropathological process. Indirect data, such as the lack of definite relationships between ventricular size and duration of schizophrenia and its occurrence in first episode schizophreniform disorder suggest that VE is not likely to be the end product of schizophrenic illness or factors related to its evolution. Only a few preliminary studies, however, have directly addressed the issue of the evolution of ventricular size in schizo- phrenia, reporting no change of ventricular brain ratio (VBR) over time (2,5,6). On the other hand, no information is yet available on the stability of ventricular size in major affective disorders. In this study, we analyzed the variation of cerebral ventricular dimensions of 15 patients with schizophrenia (8 men, 7 women; age range: 18-41 years) and of 21 patients with major affective disorders (8 men, 13 women: age range: 31-70 years), diagnosed according to the DSM III criteria (7). The first and second CT scans were mixed and analyzed by two rates, blind to the subject's diagnosis and time of execution, and ventricular size was measured on the CT slice showing the lateral ventricles at the largest and expressed as VBR (8). The mean time interval between the scans was 35.0+9-l months for schizophrenics and 35.2f10.4 months for affective patients. In schizophrenia, the mean VBR at follow-up was 5.62k4.4, not any
Transcript of A CT scan follow-up study of cerebral ventricular size in schizophrenia and major affective disorder
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remaining seven were withdrawn from all medications for a period of two weeks. Negative symptoms and a measure of premorbid functioning were obtained by using the Iager negative symptom rating scale and the Cannon-Spoor Premorbid Adjustment Scale, respectively. CT scans without contrast were obtained for calculation of Ventricular Brain Ratio (VBR) by standardized planimetry.
Our results show that Stage-4 percent is correlated negatively with VBR (r-=0.76, p=O.O05), premorbid functioning (r=0.69, p=O.O09) and negative symptoms (r=0.67, p=O.Ol). There was no association between age and VBR or age and Stage-4 percent in our sample.
Our results suggest that decreased Stage-4 sleep may be an added dimension to Type II schizophrenia. Decreased Stage-4 sleep may be a trait variable secondary to brain atrophy in a subgroup of patients.
A CT SCAN FOLLOW-UP STUDY OF CEREBRAL VENTRICULAR SIZE IN SCHIZO- PHRENIA AND MAJOR AFFECTIVE DISORDER
Antonio Vita, Emilio Sacchetti and Carlo L. Cazzullo
Institute of Psychiatry, University of Milan, via F. Sforza 35, 20122 Milan, Italy
Enlargement of the cerebral ventricles (VE), as assessed by com- puterized tomographic (CT) scans, has been consistently reported in a proportion of patients with schizophrenia (1,2) and affective disorders (3,4), but the biological significance of this abnormality is still an open question. The definition of the time course of the CT alteration would much improve our knowledge about the nature, whether neurodevelopmental or neurodegenerative, of the underlying neuropathological process.
Indirect data, such as the lack of definite relationships between ventricular size and duration of schizophrenia and its occurrence in first episode schizophreniform disorder suggest that VE is not likely to be the end product of schizophrenic illness or factors related to its evolution. Only a few preliminary studies, however, have directly addressed the issue of the evolution of ventricular size in schizo- phrenia, reporting no change of ventricular brain ratio (VBR) over time (2,5,6). On the other hand, no information is yet available on the stability of ventricular size in major affective disorders.
In this study, we analyzed the variation of cerebral ventricular dimensions of 15 patients with schizophrenia (8 men, 7 women; age range: 18-41 years) and of 21 patients with major affective disorders (8 men, 13 women: age range: 31-70 years), diagnosed according to the DSM III criteria (7). The first and second CT scans were mixed and analyzed by two rates, blind to the subject's diagnosis and time of execution, and ventricular size was measured on the CT slice showing the lateral ventricles at the largest and expressed as VBR (8).
The mean time interval between the scans was 35.0+9-l months for schizophrenics and 35.2f10.4 months for affective patients. In schizophrenia, the mean VBR at follow-up was 5.62k4.4, not any
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different from the baseline value (5.65k4.3) (paired t=0.08; p=NS), with a highly significant correlation between the two VBR measures (r=0.95). On the other hand, the mean VBR of patients with affective disorders did significantly increase over time: from 5.8k3.8 in the 1st scan to 7.354.1 at follow-up (paired t=5.7; p<O.OOOl).
This difference was not merely attributable to the effect of aging on ventricular size: the mean increase of VBR in patients (1.5 units) was, in fact, much higher than that expected (0.3 VBR units) for normal subjects of the same age as patients and during the same interval between the initial and final evaluations (data from 132 healthy controls aged 15-80 years).
These results indicate that cerebral ventricular size is a stable neuromorphological characteristic in schizophrenic patients, thus confirming the hypothesis that VE is a static abnormality preceding the onset of the disease and probably appearing in an early develop- mental stage. On the contrary, ventricular size seems to progress in major affective disorder, suggesting an ongoing alteration of the cerebral structures during the course of the illness. The causative factors of such progressivity and its relevance to the clinical expression of affective illness await clarification.
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