Right vs. left hemispheric blood-brain barrier permeability in schizophrenia: a dynamic computed tomographic study

Dynamic computerized tomographic brain scanning was used to make determinations of mean cerebral tissue nonenhanced density and contrast-enhanced density in 10 bilateral brain regions in 10 psychotic subjects. Asymmetry of both nonenhanced and contrast-enhanced density was observed; left regional nonenhanced values were higher than right, whereas contrast-enhanced density values were higher on the right than on the left. No significant differences were observed in arterial mean transit time (AMTT) between right and left middle cerebral artery branches or in capillary or tissue mean transit time (CMTT) in the middle temporal cortex. However, corrected CMTT (CCMTT), i.e., CMTT minus AMTT, may have been prolonged in five subjects either on the left or right, or in both homologous regions. Only 2 of 10 subjects exhibited anterior-posterior (AP) gradients that resembled to some extent the hyperfrontal pattern reported in normal subjects by other investigators with different techniques.

Childhood head trauma and psychosis

The medical histories of 200 schizophrenic patients were compared to those of 203 depressed patients, 122 manic patients, and 134 surgical controls. All subjects were hospital inpatients. Charts were specifically examined to record any head injury before age 10 that had required medical attention or caused loss of consciousness. Schizophrenics had a significantly greater history of head trauma than the manics, depressives, and surgical controls. There were no significant differences between manics and depressives or between affective disorders as a group and surgical controls. Childhood trauma may be a contributing factor to the development of psychosis in some individuals.

Clinical effectiveness of oral and parenteral rapid neuroleptization

A random assignment, double-blind, placebo-controlled evaluation was used to compare the effectiveness of rapid parenteral injections of fluphenazine hydrochloride with that of oral doses of the same drug in 16 patients with acute psychotic illnesses. Doses of fluphenazine hydrochloride were much higher in the parenteral neuroleptization group than in the oral administration group during the acute phase, although oral doses were equivalent during the continuation phase. The rate of improvement was not different for the two groups, but the rate of extrapyramidal side effects was higher in the parenteral neuroleptization group. The results suggest that rapid parenteral neuroleptization for the acute treatment of psychosis offers more risks than benefits.

Perinatal insult as a risk factor in paranoid and nonparanoid schizophrenia

The medical histories of 30 paranoid schizophrenics were compared to those of 60 patients with nonparanoid schizophrenia. History of perinatal distress was more common in patients with chronic nonparanoid schizophrenia (p less than 0.005). A significant trend was noted for perinatal distress to be more common among cases with no family history of psychiatric illness (p less than 0.05). It is suggested that perinatal distress may be an organic risk factor for chronic nonparanoid schizophrenia and that this risk is independent of the genetic risk for this disease.

Perinatal distress and prognosis of psychotic illness

The medical histories of a group of 511 patients hospitalized for schizophrenia were examined for the occurrence of perinatal distress. These patients were part of a 40-year follow-up study, so that their prognostic outcome was known at the time of this study. In this way, 200 cases of chronic schizophrenia were compared with 311 cases of psychotics with good prognosis. It was found that a history of perinatal distress was much more common in the poor prognosis group than in the good prognosis group. This difference could not be accounted for by age or family history of psychiatric illness.

Organic factors in catatonia

A retrospective case-control study was performed using the records of 59 catatonics, 59 non-catatonic schizophrenics, 59 manics, 59 depressives and 59 surgical controls. The findings suggest that prior brain injury and physical illness at onset of psychosis are much more common in subjects with catatonia. While these findings do not account for all cases of catatonia, they may indicate an aetiology for some phenotypic cases of catatonia.

Opiate antagonism fails to reverse post-ECT cognitive deficits

The opiate antagonist naloxone has been reported to improve memory in animals and to produce partial improvement in Alzheimer's dementia. The usefulness of naloxone for reversing ECT-induced cognitive impairment was tested by comparing the effects of naloxone and placebo on several tests of cognitive performance in 10 patients who underwent bilateral ECT. No significant differences were found between naloxone and placebo. The results suggest that at the doses used, naloxone is not effective in reversing ECT-induced memory deficits.

Mania associated with electroconvulsive therapy

Of 94 depressed patients given electroconvulsive therapy (ECT), a manic episode developed in 6 (64%). These six patients were equally distributed across three diagnostic categories of depressive illness: primary unipolar depression, bipolar affective disorder, and schizoaffective disorder. Compared with matched controls, the patients who experienced ECT-associated mania had an earlier age of onset and a longer duration of illness. These patients also had more previous psychiatric hospitalizations. Although evidence of a direct causal relationship between the administration of ECT and the development of mania is still lacking, our data suggest that the risk of mania is higher in patients with certain clinical characteristics.

Suppression of tardive dyskinesia with amoxapine: case report

Evidence of the neuroleptic potency of amoxapine is rapidly accumulating. A case history is presented which complements the growing literature in this area. A depressed patient with persistent orofacial dyskinesia was placed on amoxapine and experienced a suppression of her involuntary movements. The therapeutic implications of this observation are discussed.

Cortical atrophy in young adults with a history of hyperactivity in childhood

A computed tomographic (CT) brain scan study was conducted in 24 young males treated and followed up for hyperactivity since childhood. Compared to 27 matched controls, adults with a history of hyperactivity had a significantly greater frequency of cerebral atrophy. No differences in cerebellar atrophy frequency or in lateral cerebral ventricle-to-brain ratio (VBR) were found. The possible associations of hyperactivity or perhaps stimulant drug treatment to atrophic brain changes are discussed.

A controlled magnetic resonance imaging study of corpus callosum thickness in schizophrenia

Two previous postmortem studies reported an increased thickness of the corpus callosum in schizophrenic patients compared to psychiatric controls. We report an in vivo study of the corpus callosum in schizophrenic patients (n = 38) and healthy controls (n = 41) using magnetic resonance (MR) brain imaging. A significant increase in mean callosal thickness was found in the middle and anterior, but not the posterior, parts of the callosal body. However, when the patients and controls were compared by gender and handedness, schizophrenic men were found not to differ from control men in callosal thickness, regardless of handedness, whereas schizophrenic women were found to have a highly significant increase in callosal middle and anterior thickness compared to control women. The data suggest that increased callosal thickness in schizophrenia is gender related, a factor that is not considered by postmortem studies. The implications of increased callosal dimensions in female schizophrenics are discussed.

Cerebral ventricular enlargement in schizophrenia. A preliminary follow-up study

Lateral cerebral ventricular enlargement is now known to occur in some schizophrenic patients. To determine whether ventriculomegaly in schizophrenia is a static vs progressive process, we conducted a follow-up computed tomographic brain scan study on 11 young male patients, three years after initial scans were obtained. No significant change was found in the mean ventricles-brain ratio of this small schizophrenic sample after three years. Four of 11 patients showed noticeable increases (greater than 50%) in individual ratio. Methodologic problems are discussed and the need for follow-up studies as a research strategy is emphasized.

Structural abnormalities in the frontal system in schizophrenia. A magnetic resonance imaging study

Thirty-eight schizophrenics and 49 normal controls underwent magnetic resonance imaging. Midline sagittal cuts indicated that the schizophrenics had significantly smaller frontal lobes, as well as smaller cerebrums and craniums. The findings are consistent with some type of early developmental abnormality that might retard brain growth and therefore skull growth. These findings are confirmed on a smaller sample of patients on whom we have coronal cuts. Decreased cerebral and cranial size are associated with prominent negative symptoms, although decreased frontal size is not. Decreased cranial and cerebral size was also associated with impairment on some cognitive tests. These findings are consistent with the hypothesis that some schizophrenics may have a type of early developmental abnormality associated with prominent negative symptoms and cognitive impairment. Further, the results suggest that schizophrenics may have a type of structural frontal system impairment. Thus, they provide anatomic evidence for the "hypofrontality hypothesis."

Pharmacologic probes of neurotransmitter systems in tardive dyskinesia: implications for clinical management

Despite the plethora of clinical drug trials in tardive dyskinesia, few consistent findings have emerged. One possible reason for this is that there have been no serious attempts to define the role of major neurotransmitter systems (dopamine, norepinephrine, acetylcholine, serotonin, GABA) in one specific population of tardive dyskinesia patients. This study reports a series of five controlled drug trials in a population of patients with persistent tardive dyskinesia; each drug probed one of four neurotransmitter systems. The intra- and interpatient responses are analyzed and the implications of the pharmacologic response profiles for the clinical management of tardive dyskinesia are discussed.

Sydenham's chorea and psychosis

The medical histories of 600 psychotic and 369 nonpsychotic subjects were examined for the occurrence of rheumatic chorea. There was significantly more rheumatic chorea in the histories of psychotic patients than in nonpsychotics (p less than 0.01, chi-square). Neuropathological associations are discussed.

Depression, cortisol metabolism and lymphocytopenia

Depression is often associated with hypercortisolemia. Because high levels of cortisol influence the distribution of different types of leukocytes in the blood stream, we examined the percentages and absolute numbers of circulating neutrophils and lymphocytes in 29 depressed patients who were nonsuppressors on the Dexamethasone Suppression Test (DST), 28 depressed patients who were suppressors on the DST, and 52 schizophrenic controls. We found no significant differences in either RBC or WBC counts in the 3 groups. There were, however, significant differences in the percentages of both neutrophils and lymphocytes as well as the absolute number of lymphocytes among the groups. These differences were mostly due to significantly lower lymphocyte percentages and absolute counts in the depression-nonsuppressor group. We also found a significant negative association between post-dexamethasone plasma cortisol concentrations and blood lymphocyte counts. These data suggest a close interaction between cortisol metabolism and lymphocyte regulation in major depression.

Major depression and carbon monoxide-induced parkinsonism: diagnosis, computerized axial tomography, and response to L-dopa

A case of major depressive disorder complicated by carbon monoxide (CO)-induced Parkinson's syndrome is reported. Computerized axial tomography (CAT) revealed bilateral globus pallidus necrosis. Clinical, CAT, and neuropathological findings in other cases of CO encephalopathy with and without parkinsonism are reviewed. The utility of CAT in the diagnostic workup and in following clinical course is discussed, as are the difficulties of making a diagnosis of an antecedent primary psychiatric disorder in the presence of neurological and psychiatric sequelae of CO intoxication. There was no clinical response to a tricyclic antidepressant, but both the mood and movement disorders responded fully to L-dopa. The implications of these findings with regard to the central neurochemical pathophysiology in this patient and in major depressive disorder in general are discussed.

Relationships between brain density, cortical atrophy and ventriculomegaly in schizophrenia and mania

A number of parameters assessed by computed tomography have been shown to differentiate between populations of psychiatric patients and normal controls. Changes in these parameters have been felt to result from atrophic processes. We hypothesized that changes in one parameter ought to result in related changes in another if they result from the same process. We tested this hypothesis by comparing CT scan results of density measurement with area and linear measurements of ventricular size and radiological assessments of cortical and cerebellar atrophy. Our results indicate that few statistically significant relationships appear to be present, the only such relationship being found between increased third ventricular size and cerebellar atrophy. We conclude that regional changes in brain density are not necessarily correlated with local changes in CSF volume, which suggests the involvement of disparate processes in their causation.

Third ventricular enlargement on CT scans in schizophrenia: association with cerebellar atrophy

The width, length, and ventricle-to-brain area ratio (VBR) of the third ventricle were measured in 55 consecutive young male schizophrenic patients and 27 matched control subjects. No differences in third ventricular dimensions were found between the two groups. However, schizophrenic patients with cerebellar atrophy had a significantly greater mean third ventricular length. Correlations of third ventricular VBR with lateral ventricular VBR, but not with sulcal widening, were found. The possible existence of a subset of schizophrenic patients defined by cerebellar atrophy and third ventricular enlargement is discussed.

Echocardiographic assessment of schizophrenics and manics: a reexamination of early necropsy findings

Postmortem evaluation of schizophrenic patients earlier this century demonstrated relatively consistent findings of hypoplasia of the heart and great vessels. No recent attempts have been made, to our knowledge, to replicate these results. In vivo assessment of the left heart and aorta by M-mode echocardiographic examination seemed likely to provide an opportunity to investigate the relationship of major psychiatric illness to heart size and aortic diameter. Twenty-two chronic schizophrenics (mean age 31.5 years), 17 manics (mean age 30.9 years), and 14 normal volunteers (mean age 29.1 years) consented to echocardiographic examination. Patients were diagnosed by DSM-III criteria. Individuals with any history of cardiovascular disease or alcohol abuse were excluded. No statistically significant differences emerged among the groups in measures of left atrial, aortic root, or end-diastolic left ventricular diameters. Our results did not support previously reported autopsy findings. Implications of the relationship of chronic institutionalization and chronic neuroleptic treatment to heart and great vessel dimensions are discussed.

Cerebral asymmetry in subtypes of schizophrenia

CT scans of 26 nonparanoid and 10 paranoid right-handed male schizophrenics were examined. Multiple measurements were made of each region of the brain and a standard error of measurement with a confidence level of p less than .01 was used to define significant asymmetry. Three aspects of cerebral asymmetry, i.e., local hemispheric width, local hemispheric protrusion, and regional hemispheric size, were examined. Paranoid and nonparanoid patients were similar in their patterns of frontal asymmetries. However, a substantial proportion of nonparanoid schizophrenics had wider, longer, and larger right parieto-occipital lobes compared to paranoid patients.