A magnetic resonance imaging study of putamen nuclei in major depression

Structural abnormalities in brain magnetic resonance images of depressed children

OBJECTIVE

Brain magnetic resonance images (MRIs) of 65 children and adolescents who were hospitalized with depressive disorders (DD) were compared with the brain MRIs of 18 hospitalized psychiatric controls (PC) without a depressive disorder.

METHOD

Volumetric analyses were used to measure frontal lobe volumes (FLV), lateral ventricular volumes (VV), and total cerebral volumes (CV) for all subjects. To correct for differences in absolute cerebral volume associated with different body and head size, the ratios of FLV/CV and VV/CV were used to compare differences between the two groups. A multivariate analysis was used to control for the effects of several independent variables (age, sex, diagnosis).

RESULTS

Significant differences were seen in the FLV/CV ratio and the VV/CV ratio when the results were compared between the two groups (DD versus PC). The DD group had a significantly smaller FLV/CV ratio (t = 2.148, df = 79, p = .035) and a significantly larger VV/CV ratio (t = -2.093, df = 79, p = .040).

CONCLUSION

The findings are consistent with previous reports in depressed adults and may implicate the frontal lobes in the pathogenesis of early-onset depressive disorders.

Silent cerebral infarctions in patients with late-onset mania

BACKGROUND AND PURPOSE

Previously we have studied the relationship between senile depression and silent cerebral infarctions (SCIs). The goal of this study was to clarify the relationship between late-onset mania and SCIs using MR imaging.

METHODS

Twenty manic patients who developed a bipolar disorder after 50 years of age (late-onset mania) were selected prospectively. These patients were compared with 20 age- and sex-matched patients who developed an affective disorder while younger than 50 years of age (early-onset affective disorder) and with 20 patients who developed major depression after 50 years of age (late-onset major depression). Patients with focal neurological symptoms were excluded from the study. All patients underwent MR imaging to assess the incidence of SCIs. Patients diagnosed with SCIs were subclassified according to whether the infarction type was perforating, cortical, or mixed.

RESULTS

The incidence of SCIs in patients with late-onset mania was 65.0%; this incidence was significantly higher than that of patients with early-onset affective disorders (P < .05). The incidence of the mixed type of SCI was 50.0% in patients with late-onset mania; this was significantly higher than that in patients with late-onset major depression (P < .05).

CONCLUSIONS

Our findings suggest that approximately half of the cases of late-onset mania might be secondary mania related to SCIs. Because the mixed type of SCI is more prevalent in the patients with late-onset mania than in those with late-onset major depression, mania may be associated with the larger areas of brain damage and hence may be a more serious form of affective illness than major depression.

A comparison of stereology and segmentation techniques for volumetric measurements of lateral ventricles in magnetic resonance imaging

Lateral ventricular volumes were measured on magnetic resonance imaging (MRI) scans by independent raters in 18 subjects (11 psychotic patients and 7 healthy control subjects) with two different approaches: a point-counting stereological (PCS) technique and a computerized technique based on segmentation algorithms. The correlation between the two techniques was very high (r = 0.96), and phantom studies showed good validity for both approaches. These findings and the technical simplicity of the PCS technique support its potential use for MRI morphometric measurements.

Anxiety in Geriatric Depression: Effects of Age and Cognitive Impairment

The authors investigated the occurrence of anxiety symptomatology in a clinical sample of geriatric depressed patients and examined the effect of age and cognitive impairment on the experience of anxiety symptoms. Subjects were psychiatric patients consecutively admitted to a longitudinal study of geriatric depression. Severity of depression, antidepressant treatment, cognitive impairment, medical illness, social support, and physical environment were systematically assessed at entry and approximately every 6 months afterwards. Symptoms of anxiety and phobic anxiety were similar in older (n = 52) and younger (n = 15) subjects, although older subjects had significantly lower scores of subjectively experienced depression, interpersonal sensitivity, anger, hostility, and psychoticism. Older depressed patients with cognitive impairment corresponding to mild or moderate dementia had less anxiety than geriatric depressed patients without dementia. Findings of this study suggest the absence of an age effect on the expression of anxiety during depressive states. Although there is no age effect on anxiety, mild-to-moderate dementia appears to be associated with lower anxiety.

Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression

In 39 hospital inpatients with severe primary depressive disorders, we evaluated the relationships between subcortical hyperintensities on magnetic resonance imaging (MRI) and clinical features, neuropsychological impairment and response to standard therapies. Both white matter and gray nuclei lesions were associated with older age and the absence of a family history of affective disorder. White matter hyperintensities were also associated with onset of first affective episode after the age of 50 years and impaired psychomotor speed. Most importantly, the severity of white matter hyperintensities predicted a poorer response to treatment (r = -0.44, p < .01). Negative correlations of the same order were detected in those (n = 20) who received electroconvulsive therapy (r = -0.42, p = .06) and those (n = 19) who received pharmacotherapy alone (r = -.49, p < .05). This study provides preliminary evidence supporting the clinical and prognostic significance of extensive white matter hyperintensities in patients with severe depression.

Ipsilateral subcortical atrophy associated with temporal lobectomy

Stereologic methods for determining the volume of cerebral structures in vivo via magnetic resonance imaging have identified unilateral hippocampal atrophy among patients with complex partial epilepsy of temporal lobe origin. Metabolic imaging has also identified altered metabolism in temporal as well as extratemporal regions among these patients. As the temporal cortex and subcortical nuclei of the limbic system are reciprocally connected with striatal projection fields, we examined the putamen nuclei for evidence of associated extratemporal volume asymmetry in patients before and after temporal lobectomy. There was no evidence of preoperative putamen volume asymmetry, but a significant postoperative decrement in ipsilateral putamen volume was observed. The magnitude of postsurgical putamen volume asymmetry was correlated with the duration of time since resection. Progressive degeneration of extratemporal projections of the temporal lobe may occur in association with temporal lobectomy.

Relative accuracy and reproducibility of regional MRI brain volumes for point-counting methods

Volumetric magnetic resonance imaging (MRI) methods for the measurement of various neuroanatomical regions are of great interest in studies of neuropsychiatric disorders. Both manual and semiautomated methods have been developed. Manual methods include tracing and point counting. Point counting methods are widely used in post-mortem and microscopy studies. Point counting has been well validated for these purposes. In this article, we report in a series of separate studies the accuracy and reproducibility of point-counting methods. Absolute accuracy was evaluated with a spherical phantom. Accuracy and time efficiency were subsequently assessed with an anatomically realistic phantom and various size grids. The point-counting method was also compared to a tracing method. Finally, the reproducibility of the point-counting method for the caudate and putamen was evaluated on four subjects in a test-retest experiment. These studies provide an estimate of the accuracy and time efficiency of point-counting methods. The test-retest reliability was also high for both caudate and putamen. Findings suggest that point counting is a reliable and efficient method for estimating volumes.

Volumetric MRI measurements in bipolars compared with schizophrenics and healthy controls

Twenty-six patients with RDC bipolar disorder were compared with a previously reported group of 48 RDC schizophrenics and 34 healthy controls, using volumetric MRI measurements of cerebral, cortical and sulcal volumes. The bipolar group appeared no different from the controls, and both of these groups had significantly larger cerebral and cortical volumes than the schizophrenics. Our previous report of a significantly reduced cortical volume in the schizophrenic group, with a corresponding increase in the volume of sulcal fluid is, therefore, not a generalized feature of psychotic illness but may be more specific to schizophrenia.

Echogenicity of the brainstem raphe in patients with major depression

A novel transcranial ultrasound technique was used to detect differences in the echogenicity and echotexture of the brainstem dorsal raphe nucleus in 20 patients with major depression compared with 20 age- and sex-matched healthy adults. Transcranial color-coded real-time sonography visualized the mesencephalic and pontine brainstem and its midline structure. The echogenicity of the raphe was classified in a four-point scale. Compared with healthy subjects, the depressed patients were characterized by a significant decrease in the echogenicity of the brainstem raphe. The echogenicity score was not correlated, however, with measures of psychopathology such as the Hamilton Rating Scale for Depression, the Clinical Global Impression Scale, the Global Assessment Scale, or the Depression Scale of von Zerssen. These preliminary findings suggest that the brainstem raphe may be involved in the etiopathogenesis of major depression. The echogenicity score should be further evaluated as a possible trait marker in different types of affective disorders.

The Prince Henry Hospital Mood Disorders Unit

In 1985 a Mood Disorders Unit (MDU) was established at Prince Henry Hospital in Sydney as a clinical research module, linked with the psychiatric department of the University of New South Wales. There were three general objectives: first, to provide a specialized state-wide clinical service for the assessment and management of those with affective disorders, particularly treatment-resistant depression; secondly, to make a research contribution; and thirdly, to serve as an academic centre for teaching and training of undergraduate and postgraduate students from a variety of disciplines.

Hypercortisolemia and hippocampal changes in depression

Hypercortisolemia is a frequently observed abnormality in patients with major depression. It has been hypothesized that the hippocampus, as a major feedback site for glucocorticoids, is involved in the pathophysiology of hypercortisolemia. Some have in fact posited that the hippocampus is marked by diminished size in depressed patients with hypercortisolemia. We tested this hypothesis by examining the relationship between hippocampal volume, assessed with magnetic resonance imaging, and hypercortisolemia using the dexamethasone suppression test (DST) in a group of 19 depressed patients. No differences in hippocampal volume were observed between patients and control subjects (n = 30). Within the patient group, DST suppressors did not differ from DST nonsuppressors in hippocampal volume. However, a relationship between hippocampal volume and 11 p.m. cortisol concentration was observed after covariance adjustment for age and sex. Furthermore, significant negative correlations were observed between hippocampal volume and both age of depressive onset and number of hospitalizations. The results of this study therefore provide limited support for the hypothesis regarding an essential role of the hippocampus in the neuroendocrine elevation of glucocorticoids in depression.

Neuroanatomic substrates of depression in the elderly

The causes of depression in the elderly are poorly understood. The concept that psychological and social factors are the primary contributors to the occurrence of depression in later life, though intuitively appealing, is not supported by available evidence. In addition, genetic factors are less significant in patients presenting with depression for the first time in later life. In this article, the following hypotheses are examined: (1) the aging process facilitates emergence of depression in later life; (2) cerebrovascular pathology plays a role in the etiology of depression in the elderly; and (3) the site and location of changes in the brain provide a basis for understanding neuroanatomic substrates of depression in the elderly. The role of the basal ganglia and different basal ganglia circuits in the pathophysiology of depression is discussed. The clinical significance of the findings of structural changes in the brain are also discussed.

Magnetic resonance in patients with affective illness

Magnetic resonance imaging is presently being utilized to understand the neuropathology of affective disorders. Present research has demonstrated brain changes in affective disorders that correlate with neuroendocrine findings and are similar to changes noted in normal aging.