Cavum septum pellucidum in schizophrenia, affective disorder and healthy controls: a magnetic resonance imaging study

Many structural brain abnormalities have been described in schizophrenia, consistent with a neurodevelopmental model for this disease. We report here a study of the cavum septum pellucidum (CSP) in schizophrenia compared to control groups, as well as the clinical correlates of this congenital anomaly in schizophrenia. We conducted a magnetic resonance imaging (MRI) study to compare rates of CSP in schizophrenia (N = 67) v. psychiatric controls (bipolar and schizoaffective, N = 60) and healthy controls (N = 37). Of the controls 18.9%, and of all psychotic subjects 18.1% had a CSP of any size and there was no difference in the frequency of large CSP among the groups. Males had higher rates of CSP than females (25% v. 9.7%, P = 0.01) in all groups. Schizophrenics had higher CSP rates than affective patients (25%, v. 10%, P = 0.02). No clinical difference was found between schizophrenics with or without CSP.

Neuropsychological performance in symptomatic and asymptomatic HIV infection

OBJECTIVE

To examine cognitive function in patients at various stages of HIV infection, and to determine the nature and severity associated with stage of illness.

DESIGN

Subjects were administered an extensive battery of neuropsychological tests.

SUBJECTS

Two hundred and thirty-three HIV-1-infected homosexual/bisexual men and 77 HIV-negative control subjects who had been screened for previous neurological illness. All subjects were volunteers in a longitudinal study of neurobehavioral complications of HIV infection.

RESULTS

Patients with symptomatic infection differed from controls on a large number of measures, and asymptomatic patients had a more circumscribed pattern of deficit. On a summary measure of cognitive impairment, there was a twofold increase in the prevalence of impairment in asymptomatic patients relative to controls, and a fourfold increase in symptomatic patients. Memory and dexterity problems appear to be early features of neurobehavioral dysfunction, and frontal lobe deficits were found in patients with symptomatic infection.

CONCLUSION

These data indicate that there is a steady increase in the prevalence of neurobehavioral abnormalities associated with stage of infection. The pattern of abnormality also varies with disease stage.

Clinical correlates of valproate augmentation in refractory bipolar disorder

We examined the clinical correlates of valproate (VPA) therapy in refractory bipolar disorder. Retrospective chart review was used to collect demographic and clinical data including present diagnosis, diagnosis at illness onset, duration of illness, number of hospitalizations, VPA dose, side effects, and maximum serum concentration. Global response was rated once patients serum VPA exceeded 50 mg/dL. The charts of all inpatients admitted over a two-year period and treated with VPA for acute episodes of bipolar disorder in manic, mixed, or depressed phase were reviewed. Seventeen of these patients began VPA augmentation while hospitalized and became the cohort for review. Patients were excluded if VPA was started prior to admission or the patient was discharged less than one week after drug initiation. Patients were not excluded on the basis of EEG, CT, or neurological exam findings. Overall, 12 of 17 (71%) of the patients showed a moderate or marked improvement while 5 of 17 (29%) showed mild or no response. Responders were older and had a longer duration of illness with an increased number of hospitalizations. There was a strong trend for responders to achieve a higher serum VPA level. A significant positive correlation was found between response in acute mania and psychotic symptoms at first episode of illness.

Are controls in schizophrenia research "normal"?

The psychiatric assessment by structured interview and family history of mental disorder in normal volunteers recruited by advertisement for a study of brain structure and function in psychosis is described. Nine of 51 volunteers (17.6%) who passed a phone screen were excluded after a structured interview for major psychopathology. Of 35 completers, 10 (28.6%) had subthreshold mood or substance use but were included in the study. Only 16 subjects (45%) had a negative family history by FH-RDC. Diagnoses in family members included substance abuse (31%), mood disorder (11%), psychosis (9%), and other/undiagnosed (14%). Ventricular enlargement was evaluated by magnetic resonance imaging in two planes. Ventricular size was bimodally distributed in the males, and the group with larger ventricles was more educated and had higher scores on the 8 (Schizophrenia) scale of the MMPI (F = 5.44, p = .0099). Our results suggest that 'normal' volunteers for psychiatric research have personal or family psychopathology which motivates them to participate. As the sensitivity of biological instrumentation increases, the characteristics of the control group must be anticipated in the design and recruitment.

Developmental brain anomalies in schizophrenia and bipolar disorder: a controlled MRI study

Many of the structural brain abnormalities found in schizophrenia (SC) and bipolar disorder (BD) over the past decade are believed to represent impaired neurodevelopmental processes. The authors hypothesized that incidental developmental anomalies would be more frequently present in the brains of subjects with SC and BD compared with healthy control subjects. The authors systematically assessed the MRI scans of 167 subjects (SC = 67, BD/schizoaffective = 63, healthy control subjects = 37) for the presence of 23 developmental anomalies involving cortical and subcortical structures. No excess neurodevelopmental anomalies were found in the schizophrenic or bipolar/schizoaffective groups. These findings do not support the hypothesis that SC and BD are associated with an excess of gross neurodevelopmental brain anomalies.

Drug and alcohol use and neuropsychological performance in asymptomatic HIV infection

The effect of drug and alcohol abuse on neuropsychological performance was examined in 132 human immunodeficiency virus-seropositive gay or bisexual men. Syndromal (diagnostic) criteria of alcohol/drug abuse based on DSM-III-R were used, and quantitative estimates of alcohol consumption were obtained. Very few differences appeared between substance abuse subgroups formed on the basis of recency or severity of drug use. There were some correlations with the quantitative estimate of alcohol use, but not on the measures previously found to differentiate seronegative and asymptomatic seropositive gay men. These data indicate that alcohol use does affect neuropsychological performance but does not account for the differences observed in studies of seronegative and seropositive subjects.

Third-ventricle enlargement and neuropsychological deficit in schizophrenia

Cerebral ventricular enlargement is present in a substantial subgroup of schizophrenic patients. Most, but not all studies examining neuropsychological performance and ventricular size in schizophrenics show more severe cognitive impairment in those patients with greatest ventricular enlargement. Inconsistencies in this literature have been attributed to different neuroimaging techniques, variation in patient characteristics across studies, and the variety of neuropsychological batteries used. In the present study, schizophrenic patients (n = 49 men, n = 23 women) and normal controls (n = 13 men, n = 18 women) underwent magnetic resonance (MR) imaging of the brain and extensive neuropsychological testing including measures of frontal and temporal lobe function. A complete coronal set of MR images was used to calculate volumetric estimates of lateral and third cerebral ventricles. Highly significant associations were found between cognitive deficits and third-ventricle volume, with measures of frontal functioning, attention, and concentration showing the most robust correlations. In contrast, neuropsychological performance was not highly associated with lateral ventricular size. These findings further support the pathophysiological relevance of ventricular enlargement in schizophrenia. More specifically, third, but not lateral, ventricular enlargement was associated with greater cognitive disturbance in this sample. Results are consistent with pathological involvement of periventricular diencephalic structures resulting in dysfunctional frontal and limbic processing in a subgroup of patients.

Magnetic resonance imaging of white matter lesions in HIV infection

Previous studies of the frequency of high-signal lesions in human immunodeficiency virus (HIV) infection have had methodological weaknesses regarding lack of control groups, differing machine strengths, and biased subject selection. To obtain a more accurate estimate of prevalence, MRI scans were performed on 243 HIV-positive and HIV-negative homosexual or bisexual men with no history of intravenous drug use. Axial T2-weighted (long TR/TE, spin-echo) MRI scans were rated blindly for presence of focal white matter high-signal lesions. Incidence of hyperintensities was low in all groups, although slightly higher in patients with AIDS, and was not associated with neuropsychological performance. The lower incidence of hyperintensities appears to relate to elimination of methodological problems in previous studies.

Rate of CD4 decline and neuropsychological performance in HIV infection

This study examined the relationship between performance on a battery of neuropsychologic tasks and rate of CD4 lymphocyte decline in 47 gay or bisexual men infected with the human immunodeficiency virus type 1. Subjects were volunteers for a longitudinal study of the human immunodeficiency virus infection and were not selected because of neuropsychiatric symptoms. Subjects were at all stages of illness, although most were asymptomatic. Faster rates of decline in percent CD4 lymphocyte were related to poorer performance on measures of memory and reaction time. This relationship was independent of stage of illness and CD4 level at the time of neuropsychologic examination, and was not due to medication effects. The rate of percent CD4 lymphocyte cell loss is associated with and may represent a risk factor for the development of the human immunodeficiency virus-related neurobehavioral deficit.

Family history and brain morphology in schizophrenia: an MRI study

This study examined neuroanatomical differences between male schizophrenic patients with a family history of psychosis (n = 16) and those without such a history (n = 15). Intracranial area, cerebral area, ventricular size, and cortical atrophy were assessed using magnetic resonance imaging (MRI). Third ventricular enlargement was more prevalent in patients than controls (n = 15). Familial and nonfamilial patients differed significantly. Reduced cranial and cerebral areas without ventricular enlargement characterized familial patients, whereas nonfamilial patients showed marked lateral ventricular enlargement without a reduction in cranial/cerebral size.

Perinatal brain injury and cerebellar vermal lobules I-X in schizophrenia

Several studies, including our own, have reported atrophy of the cerebellar vermis in some schizophrenic patients. A recent report by Courchesne et al (1988) of hypoplasia of a developmentally specific region of the cerebellar vermis in autism prompted us to hypothesize that the cerebellar "atrophy" in some schizophrenic patients may also have developmental origins. We measured the area of the vermal lobules in 30 male schizophrenics. Contrary to expectation, the patients as a group had consistently larger cerebellar structures than the controls. Patients with perinatal injury had smaller structures than the nonperinatally injured group, but these measures were still larger than in the control subjects. Patients without perinatal injury differed from controls, having larger lobules VI-VII (p less than 0.03). These preliminary findings tentatively suggest a role for developmental factors for cerebellar structures in schizophrenia. Further research is needed to clarify the cerebellar vermal changes observed in some schizophrenic patients.

Cognitive impairment and cerebral structure by MRI in bipolar disorder

The distinction between bipolar disorder and schizophrenia customarily follows examination of the clinical symptomatology and course of illness. The presence of cognitive impairment has been held to be uncommon in bipolar disorder and more likely in schizophrenia. This study explored neuropsychological function in 30 ambulatory outpatients with a DSM-III-R diagnosis of bipolar affective disorder (all of whom had been psychotic during manic episodes), comparing their performance with that of controls. These bipolar patients proved to have significant levels of diffusely represented cognitive impairment when compared with controls. Further, the degree of impairment was significantly correlated with reduction in midsagittal areas of brain structures measured on magnetic resonance imaging scans. The implications of these findings in relation to bipolar disorder are discussed.

Leukoaraiosis in asymptomatic adult offspring of individuals with Alzheimer's disease

The presence of white matter changes on magnetic resonance imaging (MRI), which has been referred to by Hachinski (1987) as leukoaraiosis, is frequently noted in elderly individuals in conditions ranging from health to frank dementia. This study involved the use of MRI to document cerebral structure if 41 healthy 50-60-year-old individuals, 28 of whom were offspring of Alzheimer's disease victims. On visual inspection of spin-echo images, 13 of the 28 offspring showed white matter lesions whereas all of the controls were free of leukoaraiosis. This statistically significant difference suggests that the presence of leukoaraiosis might be of importance in understanding changes in the white matter among populations at increased risk for Alzheimer's disease.

Hypofrontality and cognitive impairment in schizophrenia: dynamic single-photon tomography and neuropsychological assessment of schizophrenic brain function

Regional cerebral blood flow (rCBF) was assessed in 40 chronic male schizophrenic patients (20 medicated, 20 unmedicated) and 31 matched normal controls with Dynamic Single-photon Emission Computed Tomography (D-SPECT). Blind analyses of normalized color-coded tomograms revealed significant bifrontal and bitemporal rCBF deficits in the patient group. Frontal flow deficits were most prominent in paranoid patients (n = 21) and right temporal deficits were most prominent in nonparanoid patients (n = 19). These relative regional declines were observed within the context of significantly elevated hemispheric blood flow in schizophrenics compared with controls. Reduced left frontal rCBF was associated with neuropsychological impairment on the Wisconsin Card Sorting Test and Luria-Nebraska Battery. Increased hemispheric CBF was correlated with the presence of positive schizophrenic symptoms. Medication status was unrelated to rCBF. These findings demonstrate that hypofrontality has important implications for cognitive function in some schizophrenic individuals.

Visual evoked potential correlates of positive/negative symptoms in schizophrenia

Previous studies of schizophrenic patients have found evoked potential (EP) correlates of clinical symptomatology, including EP differences between subtypes of schizophrenia. In the current study, 14 medicated male schizophrenics underwent flash visual evoked potentials (VEP) and were clinically rated for positive and negative symptoms. We tested the hypothesis that positive symptoms would be associated with VEP latency reduction and negative symptoms with latency prolongation. Patients were divided into predominantly positive symptom and predominantly negative symptom groups using a combination of positive and negative symptom ratings. Patients with predominantly positive symptoms exhibited reduced latencies when compared with predominantly negative symptom patients. Similarly, significant negative correlations between positive symptom ratings and P200 latency variables were found. Correlations between negative symptom measures and P200 latencies (in the opposite direction) were also noted, but were less significant. These relationships persisted when confounders were statistically controlled for. The results are consistent with previous findings of evoked potential correlates of clinical symptomatology, especially those finding EP latency correlates of psychosis severity and affective blunting. The findings are discussed in relationship to concepts relevant to psychosis, including arousal, sensory gating, and the dopamine hypothesis.

Gender differences in schizophrenia on MRI brain scans

There are many reports of clinical and biological gender differences in schizophrenia. Gender differences in structural brain abnormalities in schizophrenia have been reported on both computed tomographic (CT) and magnetic resonance imaging (MRI) scans. We present here a new MRI study of cerebral structures in schizophrenia. On the basis of previous findings, we hypothesized that schizophrenic males are more likely than females to show smaller brains and larger ventricles compared to their control counterparts. Our results indicated that the opposite was true: schizophrenic females, but not schizophrenic males, had smaller craniums and brains and larger lateral and third ventricles on MRI scans. The possible significance and implications of these data are discussed.

Neuropsychological deficit in schizophrenic subtypes: paranoid, nonparanoid, and schizoaffective subgroups

Schizophrenic patients were carefully diagnosed and screened for a history of neurological disorders. Diagnosis and subtyping was based on DSM-III-R criteria, using the Structured Clinical Interview for DSM-III-R, which was administered by trained interviewers and confirmed by a research psychiatrist. The schizophrenic patients were compared with an age-matched control group on an extensive battery of neuropsychological measures. The undifferentiated/disorganized schizophrenic patients were consistently the most impaired on a broad range of tasks. When the effect of symptom severity and drug level were statistically controlled (analysis of covariance), however, the magnitude and number of differences were substantially reduced. The perseverative error score from the Wisconsin Card Sort Test showed the greatest difference between the groups. However, the strongest and most consistent effects were observed in relation to symptom ratings. These data indicate the importance of controlling for medication and symptom severity, and suggest that current diagnostic classifications may not be the most useful factors for studies of the cognitive correlates of schizophrenia.

Midsagittal cerebral anatomy by magnetic resonance imaging. The importance of slice position and thickness

Several recent studies of psychiatric patients have relied upon magnetic resonance imaging (MRI) to demonstrate features of cerebral anatomy in the midsagittal plane. Methodologies have varied somewhat in relation to thickness and position of planes of view. Due to concerns over the effects of slice thickness and position on measurements, the authors used a multislice thin plane method to assess these effects in 143 individuals (34 controls, 58 schizophrenics, and 51 with bipolar or schizoaffective disorder). Substantial variance in area measurements attributable to slice position emerged, especially in ventricular, cerebral and cerebellar area. Of greater importance would be the demonstrated interaction of position with diagnosis and sex in measures of several regions. The implications of these findings for MRI studies are discussed.

Perinatal complications and genetic loading in schizophrenia: preliminary findings

History of perinatal complications (PCs) and first degree family history (FH) of psychiatric illness were examined in groups of schizophrenic/schizoaffective (n = 21) and bipolar (n = 10) patients. PCs were significantly more frequent in the schizophrenic and schizoaffective patients than in bipolar patients. An inverse relationship was found between PCs and FH status, with FH-positive patients having significantly fewer PCs than the FH-negative group. This relationship persisted when the bipolar patients were excluded. Findings emphasize the etiological importance of genetics and perinatal events in the psychoses, and support the validity of a familial/sporadic distinction.

Structural brain-imaging findings in affective disorders: an overview

In recent years, numerous reports of structural brain abnormalities found with computerized tomography (CT) scans in affective disorders (e.g., major depression, bipolar disorder) have been published. More currently, magnetic resonance imaging (MRI) studies have provided additional data on brain structure in affective disorders. In this article, the various CT and MRI findings in affective disorders are reviewed, and the clinical and research relevance of those neuroanatomical findings are presented and discussed.

Higher frequency of neuroleptic-induced dystonia in mania than in schizophrenia

In a study of 135 schizophrenic and 46 manic male patients treated with neuroleptics, a significantly higher proportion of the manic patients (26.1%) than of the schizophrenic patients (5.9%) developed acute dystonia. This suggests a higher vulnerability to acute extrapyramidal symptoms in mania.