Postmortem evidence of structural brain changes in schizophrenia. Differences in brain weight, temporal horn area, and parahippocampal gyrus compared with affective disorder

MRI in schizophrenia: basal ganglia and white matter T1 times

The T1 relaxation time of the basal ganglia (putamen, globus pallidus and head of caudate) and of the frontoparietal centrum semiovale was compared between 49 schizophrenic patients and 36 healthy controls. Previous reports of increased T1 time in the basal ganglia were not confirmed, and group differences were not detected within the white matter. Within patients T1 values could not be related to tardive dyskinesia or other clinical features. Normal variation seen in basal ganglia T1 times is described for the first time: lowest values occur in the globus pallidus and highest in the caudate, and values within the putamen increase rostrally.

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.

Olfactory acuity in the positive and negative syndromes of schizophrenia

The olfactory thresholds of 46 schizophrenic subjects were measured. This group yielded 11 patients with a stringently defined positive syndrome and 12 with a negative syndrome when rated with the Positive and Negative Syndrome Scale. The negative group had a significantly (p less than 0.01) higher olfactory threshold than the positive group although neither of the groups differed significantly from a control group. Implications of this finding are discussed.

Cortex, white matter, and basal ganglia in schizophrenia: a volumetric postmortem study

Postmortem volumetry of cortex, white matter, and basal ganglia was performed in 23 brains of schizophrenic patients and 23 brains of controls closely matched for gender, age, and hemisphere. Stereological methods were applied to serial coronal sections of complete hemispheres. We found no significant volume changes of cortex and white matter in schizophrenics. Striatal volume of schizophrenics was increased bilaterally reaching a significant level on the left side. Volumes of the globus pallidus were increased in both hemispheres reaching a significant level on the right side. After psychopathological differentiation, basal ganglia volume increase was also found in the subgroup of paranoid-hallucinatory schizophrenics.

Event-related potentials in schizophrenia: their biological and clinical correlates and a new model of schizophrenic pathophysiology

Evidence is growing that schizophrenic patients show significant structural damage in the temporal lobe limbic system. We review event-related potentials abnormalities (ERPs) in schizophrenia that may be related to dysfunction in this brain region or its inputs; ERPs discussed include the N100/P200, P300 and N400 components. Additional CT and clinical data have led our laboratory to a unifying working hypothesis of the presence of temporal lobe damage in schizophrenics that is evinced electrophysiologically as ERP alterations, structurally as tissue loss/derangement, and clinically as positive symptoms. The final section of this paper presents a new model of at least one form of schizophrenic pathology that, while speculative, incorporates experimentally based data from both our ERP work and from basic cellular physiology and pharmacology. The model proposes that positive symptoms of schizophrenia are related to limbic system pathology and in particular to a dysregulation of the NMDA form of excitatory amino acid transmission, potentiated by stress, and leading to cell damage and death due to 'excitotoxicity'.

G proteins (Gi, Go) in the medial temporal lobe in schizophrenia: preliminary report of a neurochemical correlate of structural change

We have measured the amount of Gi (the inhibitory G-protein) or Go (a similar G-protein of unknown function) in 5 areas of the medial temporal lobe of control and schizophrenic brains utilizing pertussis toxin-catalyzed ADP ribosylation. The material used has previously been shown to have asymmetrical structural abnormalities of the ventricular system. The amount of Gi or Go was reduced on the left side in the hippocampus, amygdala and parahippocampal gyrus, the difference reaching significance in the hippocampus. This data is the first report of a neurochemical correlate of the structural change in the brains of patients with schizophrenia. Decreased Gi or Go in hippocampus may relate to other reported neurochemical deficits or other transmembrane signalling abnormalities. Further investigations of these indices of secondary messenger function in relation to structural changes are indicated.

A magnetic resonance imaging study of schizophrenia: brain structure and clinical symptoms

Thirty-one patients with schizophrenia and 33 normal control subjects underwent MRI. The BPRS was used to rate clinical symptoms and the NART to estimate pre-morbid IQ. All were right handed. The temporal lobe was significantly smaller on the left than the right in both the control and schizophrenic groups. The amygdala was smaller on the left than the right in controls but not in schizophrenics. The parahippocampal gyrus was smaller on the left side in the schizophrenic group but not in controls. In the schizophrenic group, ventricular enlargement and cerebral atrophy were significantly related to severity of symptoms. Patients with marked negative symptoms had a bilateral reduction in the size of the head of caudate and the two measures were significantly correlated. Patients with marked positive symptoms had larger VBRs and again the clinical and morphometric changes were significantly correlated. There were no morphometric differences between patients with short duration (two years or less) and chronic symptoms.

Analysis of laminar distribution of kappa opiate receptor in human cortex: comparison between schizophrenia and normal

Quantitative receptor autoradiography using the ligand [3H]U 69593 and tritium sensitive film was used to visualize the kappa subtype of opiate receptor in sections from 4 normal human postmortem brains. Data obtained from cortical scans, which measured receptor densities across the left and right parahippocampal gyri, were subject to Fourier analysis. This revealed that the kappa receptor distribution was described by a curve having significant first and second component harmonics. This analysis method can be used to describe a binding pattern mathematically, thus enabling a comparison to be made between normal and diseased brains. The same analysis was applied to [3H]U 69593 autoradiograms prepared from sections of 4 schizophrenic postmortem brains. The kappa receptor distribution in the schizophrenic group not only failed to produce the same pattern as the controls, but also showed no consistent pattern within the group. The method described can be used to investigate alterations in receptor distribution which occur in neuropsychiatric diseases involving neuronal dysplasia or atrophy.

Computed tomography of the brain in unipolar depression

Several authors have reported enlarged lateral brain ventricles in major depressive patients as compared to healthy controls. Also, the enlargement of brain lateral ventricles has been related to delusions, psychomotor retardation and some biochemical data such as cortisol secretion and L-tryptophan serum levels. The present study was undertaken to investigate if melancholic depressives are characterised by a higher degree of brain atrophy than normal controls and minor depressives, the origin of any brain atrophy, and whether measures of brain atrophy are related to cortisol secretion and L-tryptophan serum levels. We investigated 10 healthy controls and 35 depressive patients categorised according to DSM-III. In contrast to previous studies, we determined a combination of indices which makes it possible to differentiate between central and cortical diffuse atrophy. We found no evidence for the existence of abnormal atrophy of the brain in melancholics; nor did we find any correlation between CT scan measurements and cortisol or tryptophan.

Enkephalin, dynorphin and substance P in postmortem substantia nigra from normals and schizophrenic patients

Three peptide neuromodulators that are found in high concentration in the substantia nigra: dynorphin A 1-8, met5-enkephalin-arg6-gly7-leu8 and substance P, were measured by specific radioimmunoassays in nigral tissue from normals and schizophrenics postmortem. Substance P and dynorphin were unchanged between the two groups. However, the proenkephalin-derived peptide was significantly elevated in the schizophrenic group. The immunoreactivity was identified as authentic met5-enkephalin-arg6-gly7-leu8 by high pressure liquid chromatography. The data suggest that a different set of regulatory controls exists for nigral enkephalin peptides as compared to dynorphin and substance P, and that the former system may be disordered in schizophrenia.

Carbachol infusion into the dentate gyrus disrupts sensorimotor gating of startle in the rat

Prepulse inhibition (PPI) is the decrease in a startle response that occurs when the startling stimulus is preceded by a weaker stimulus or "prepulse". Schizophrenic patients exhibit abnormally low levels of PPI when the prepulse precedes the startle stimulus by less than 500 ms. A similar deficit in sensorimotor gating can be demonstrated in rats after stimulation of D2 dopamine (DA) receptors by systemic administration of DA agonists or by infusion of DA directly into the nucleus accumbens. We now demonstrate that carbachol infusion into the dentate gyrus of the hippocampal formation disrupts PPI in the rat. This disruption of sensorimotor gating occurs when the startling stimulus is either acoustic or tactile. Carbachol infusion into the neocortex has no effect on PPI. While pretreatment with the D2 DA receptor antagonist spiperone reverses the disruption of PPI caused by systemic administration of apomorphine, this pretreatment fails to reverse the disruption of PPI induced by carbachol infusion into the hippocampus. These results demonstrate that pharmacologic stimulation of the hippocampus disrupts sensorimotor gating in the rat by a mechanism distinct from that of DA agonists. Prepulse inhibition of the startle reflex is an animal model in which pharmacologic stimulation of the hippocampus mimics the deficits in sensorimotor gating observed in schizophrenic patients.

Selective loss of cerebral cortical sigma, but not PCP binding sites in schizophrenia

Drugs such as phencyclidine (PCP) that interact with PCP and sigma binding sites can produce psychotomimetic effects that resemble some symptoms of schizophrenia. Therefore, it has been suggested that PCP and sigma receptors may be important in the clinical manifestations of schizophrenia. Assays of these two binding sites in human postmortem brains showed consistent significant reductions in the density of sigma, but not PCP sites, in schizophrenics as compared with age-matched and postmortem interval-matched normal and suicide controls. Reductions in the density of sigma binding sites in schizophrenia were most prominent in temporal cerebral cortex, and were accompanied by a small increase in affinity for the ligand [3H]haloperidol. These data provide the first evidence for alterations in sigma binding sites in schizophrenia, and suggest that selective sigma ligands may be useful in the treatment of the disorder.

Schizophrenia: a neuropathological perspective

It is probable that all schizophrenics have abnormalities in the medial temporal lobe, which differ in degree but not in kind. The structures of the medial temporal lobe are believed to have a crucial role in the integration and processing of the output from the association cortex. Dysfunction of this system could result in the clinical symptoms that form the core of the schizophrenia syndrome. The structural differences appear to fit the profile of a disturbance in the normal pattern of brain development. The asymmetrical patterns of normal brain development explain how such a disturbance simultaneously affecting both hemispheres could, disproportionately, affect the left (dominant) hemisphere. Epidemiological and pathological evidence points to aberrant genetic mechanisms as being the cause of the developmental anomaly in the majority of cases; environmental factors probably play a minor role. Despite the great progress made in solving the enigma of the structural changes in the brains of schizophrenics, the cause(s) of the changes--the aberrant genetic mechanism controlling brain development--may prove difficult to define.

Astrocytosis in the molecular layer of the dentate gyrus: a study in Alzheimer's disease and schizophrenia

Recently, several authors have claimed prominent abnormalities in the entorhinal cortex of both patients with Alzheimer's disease (AD) and schizophrenia. The entorhinal cortex is the origin of the perforant pathway, a major input to granule cells of the dentate gyrus of the hippocampus. The present study explored the possibility of a lesion in the entorhinal cortex of both AD and schizophrenic patients by quantitating astrocytic markers within the terminal fields of the perforant pathway. An increase in fibrillary astrocytes was found in half (3/6) of the AD patients while none of the schizophrenic (n = 6) or control (n = 7) brains exhibited gliosis. Since the redistribution and hyperplasia of astrocytes within the molecular layer of the partially deafferented dentate gyrus depend on the chronicity of the entorhinal lesion, the abnormalities observed in AD patients are consistent with the progressive course of the illness. Furthermore, the presence of gliosis in the subiculum of three out of six AD patients suggested pathology secondary to projections from the entorhinal region, amygdala, or prepyriform cortex. The absence of similar changes in schizophrenic patients does not disprove previous claims of entorhinal pathology but suggests that the lesion, if it exists, is either static in nature or occurred long before death.

A genotype-phenotype research strategy for schizophrenia

A research strategy which integrates known biological aspects of schizophrenia is proposed. The strategy includes genotype and phenotype components and emphasizes interactions. Its central feature is the comprehensive diagnostic assessment of patients with schizophrenia. Clinical and laboratory based methodologies are applied within the genotype and phenotype components of the strategy. Examples of research from each area and the potential interactions with other aspects of the strategy are presented. The expectation is that a greater understanding of the pathophysiology of schizophrenia will result from the application of the genotype-phenotype strategy and that consequently more efficacious treatments will ultimately be developed.

Psychosis associated with demonstrable brain disease

Sixty-five psychotic patients with unequivocal evidence of brain pathology and a variety of neurological disorders were assessed with respect to phenomenology and outcome. No relationship was found between site of brain pathology and type of psychotic disorder. A majority of patients had a syndrome indistinguishable from schizophrenia without coarse brain involvement and shared similar variables predicting outcome of psychosis, thus raising important issues concerning their nosological status.

MRI findings in medial temporal lobe structures in schizophrenia

In an MRI volumetric study of 10 young male schizophrenics (DSM-III-R 295.9x) a temporal lobe segment, corresponding hippocampal formation and parahippocampal gyrus were found smaller as compared with healthy controls while temporal horn was enlarged. Temporal lobe segment and parahippocampal gyrus were larger on the right in patients and controls, reversed asymmetry was found for the hippocampus.

Increased forskolin binding in the left parahippocampal gyrus and CA1 region in post mortem schizophrenic brain determined by quantitative autoradiography

Using quantitative autoradiography of [3H]forskolin we have visualized the activated states of adenylate cyclase in the hippocampal formation bilaterally in sections from schizophrenic brain and age-matched controls. There is a generalized increase in binding in schizophrenic hippocampi, particularly in the CA1 region and parahippocampal gyrus. The effect is particularly marked in the left parahippocampal gyrus. These findings add some support to the notion of schizophrenia as a medial temporal lobe disorder and suggest novel substrates as therapeutic targets in schizophrenia.

Post-mortem volume measurements of limbic system and basal ganglia structures in chronic schizophrenics. Initial results from a new brain collection

Volumes of the hippocampal formation, external and internal pallidum, caudate, putamen, and nucleus accumbens were measured in both hemispheres of recently collected post-mortem brains of 18 chronically ill schizophrenics and 21 control subjects. In the schizophrenic group, the hippocampal formation and the internal pallidum were significantly smaller in the right and left hemisphere, whereas external pallidum, putamen, caudate and accumbens were not significantly changed. Volumes of the hippocampus and of all evaluated parts of the basal ganglia were in the male schizophrenics more reduced than in the female patients. The right and left hemispheres were equally affected in both sexes. Since the mean brain weight was in patients and controls nearly identical, the volume differences can not be explained by a general brain atrophy or hypoplasia but rather indicate a more focal lack of brain tissue, by which some clinical features of the disease might be explained.

A possible role of hippocampal dysfunction in schizophrenic symptomatology

The author proposes a pathogenesis for the bizarre, repetitive behaviors frequently seen in deteriorated schizophrenics, i.e., polydipsia, hoarding, pacing, etc. It is argued that such behaviors may have a neurobiology similar to schedule-induced behaviors or incentive-conditioned behaviors described in animal models, which involve the hippocampus, nucleus accumbens, and the neurotransmitter dopamine. Such behaviors are augmented by hippocampal lesions, stress, increased drive state, or dopaminergic agents, and reduced by 6-OH dopamine lesions to nucleus accumbens or antipsychotic agents. These repetitive behaviors may reflect the failure of hippocampus to modulate the impact of mesolimbic dopaminergic activity on the nucleus accumbens and thus on motor behavior. Such a hypothesis is consistent with a growing body of neuropathological and brain imaging results demonstrating hippocampal lesions in chronic schizophrenics.

A "mock up" of schizophrenia: temporal lobe epilepsy and schizophrenia-like psychosis

Schizophrenia-like psychoses occur more frequently than expected in patients with chronic temporal lobe epilepsy. We have analyzed pathological and clinical data from a series (n = 249) of temporal lobectomies to determine the factors that may relate to the development of schizophrenia-like psychosis. Schizophrenia-like psychoses did not occur at random; they were significantly associated with lesions that (1) originated in the fetus or perinatally, (2) affected neurons in the medial temporal lobe, and (3) gave an early age of first fit. Gangliogliomas--developmental lesions of the medial temporal lobe containing aberrant neurons--were disproportionately (p less than 0.001) associated with risk of psychosis. Schizophrenia-like psychoses arising preoperatively occurred more often (p = 0.1) with left-sided lesions. Asymmetry of lesion was not present in cases with postoperative psychoses. These findings are of interest in relation to recent studies suggesting that the structural abnormalities found in the brains of schizophrenics arise during fetal brain development.

Morphometry of the parahippocampal gyrus in schizophrenics and controls. Some anatomical considerations

Volumetry of the parahippocampal gyrus was performed applying stereological methods. No difference was found comparing 18 schizophrenic brains with 18 sex- and age-matched controls. Variable sulcal pattern may contribute to inconsistency with previous findings.

Schizophrenia: the cellular biology of a functional psychosis

Structural abnormalities are found in the brains of schizophrenics. They affect preferentially, but not exclusively, medial temporal lobe structures (parahippocampal gyrus, hippocampus and amygdala), and can be found in all sub-types of schizophrenia. The structures of the medial temporal lobe are believed to have a crucial role in the integration and processing of the output from association cortex. It is probable that all schizophrenics have abnormalities in the medial temporal lobe that differ in degree but not in kind. Dysfunction of this system could result in the clinical symptoms that form the core of the schizophrenia syndrome. The changes in brain structure are not the result of neurodegenerative processes or destructive lesions but suggest a disturbance in the normal pattern of brain development.

The continuum of psychosis and its genetic origins. The sixty-fifth Maudsley lecture

Attempts to draw a line of genetic demarcation between schizophrenic and affective illnesses have failed. It must be assumed that these diseases are genetically related. A postmortem study has demonstrated that enlargement of the temporal horn of the lateral ventricle in schizophrenia but not in Alzheimer-type dementia is selective to the left side of the brain. This suggest that the gene for psychosis is the 'cerebral dominance gene', the factor that determines the asymmetrical development of the human brain. That the psychosis gene is located in the pseudoautosomal region of the sex chromosomes is consistent with observations that sibling pairs with schizophrenia are more often than would be expected of the same sex and share alleles of a polymorphic marker at the short-arm telomeres of the X and Y chromosomes above chance expectation. That the cerebral dominance gene also is pseudoautosomal is suggested by the pattern of verbal and performance deficits associated with sex-chromosome aneuploidies. The psychoses may thus represent aberrations of a late evolutionary development underlying the recent and rapid increase in brain weight in the transition from Australopithecus through Homo habilis and Homo erectus to Homo sapiens.

Morphometry of the corpus callosum in monozygotic twins discordant for schizophrenia: a magnetic resonance imaging study

The corpus callosum (CC) has been the focus of several morphometric studies of patients with schizophrenia, but the results of these studies have been contradictory. In an attempt to improve the reliability of morphometric measurements of the corpus callosum, a computerised image analysis system was used to measure the shape, area, thickness and length of the CC on magnetic resonance imaging (MRI) in 12 pairs of monozygotic twins discordant for schizophrenia (SC). No differences in CC area (anterior, middle, posterior thirds and total), length or vertical thickness of the CC body (at three levels) were demonstrated by t test comparisons of the affected SC and unaffected twins. Statistical analysis of a Fourier expansion series suggested differences in shape between normal and SC cotwins in the second harmonic of the anterior and middle segments and effects of gender on posterior CC shape. These results fail to replicate previous findings of altered length, thickness and area in the schizophrenic CC, but implicate disease-related shape differences in the anterior and middle segment of the corpus callosum and gender-related differences in splenium shape. The disease-related shape distortion suggest ventriculomegaly rather than an intrinsic abnormality of the corpus callosum.

Nature of the genetic contribution to psychotic illness--a continuum viewpoint

The recurrent psychoses, rather than, as Kraepelin supposed, constituting 2 major entities, manic depressive illness and schizophrenia, as separate diseases, may be distributed along a continuum that extends from unipolar depressive illness through bipolar and schizoaffective psychosis to schizophrenia with increasing severities of defect state. It is proposed that this continuum rests on a genetic base, variations in the form of the gene accounting for variations in form of psychosis. The simplest interpretation of the continuum is that such variation relates to changes at a single genetic locus. Evidence from a postmortem study of brain structure in schizophrenia suggests that this is the gene that determines the development of asymmetries in the human brain, i.e., the cerebral dominance gene or right shift factor of Annett; a possible genomic location is in the pseudoautosomal region of the sex chromosomes.

Schizophrenia and the brain: a prospective clinico-neuropathological study

The neuropathological results from a prospective, systematically assessed, series of 56 schizophrenic patients and 56 age- and sex-matched normal controls have been presented. When compared with the normal controls, the brains of the schizophrenic subjects showed a significant reduction in brain weight and brain length with a concomitant increase in ventricular size. (All findings relate to measurements made after formalin fixation). In addition, the brains of the schizophrenic patients contained significantly more non-specific focal pathology and fibrillary gliosis than the controls. After exclusion of cases with moderate and severe Alzheimer-type change, cerebro-vascular disease and all forms of focal pathology, the structural brain changes (i.e. decrease in brain weight and brain length) continued to distinguish the schizophrenia group from the controls. Furthermore, an analysis of the clinical data showed that the structural brain changes were correlated in the schizophrenic patients with a measurement of pre-morbid function. The findings and their possible aetiological implications have been discussed.

Deficit and hemispheric asymmetry of GABA uptake sites in the hippocampus in schizophrenia

There is increasing evidence of a deficit or disturbance of neurons in the brains of schizophrenic patients--evidence that particularly implicates the frontal or temporal lobes. As yet there is no direct neurochemical correlate of the transmitter systems involved, although changes in some neurotransmitters in the temporal lobe have been reported. Radiolabeled nipecotic acid, a specific inhibitor of uptake sites to gamma-aminobutyric acid (GABA), has provided a marker of GABAergic neurons. The binding of this ligand to brain tissue taken at autopsy has demonstrated a decreased density of GABA uptake sites in the hippocampus in schizophrenia. This decrease was found to correlate in the left hemisphere with increased concentration of dopamine in the amygdala, providing a link between neuropathology, evidence of laterality, and the dopamine hypothesis of the disease.

Preservation of P300 event-related potential topographic asymmetries in schizophrenia with use of either linked-ear or nose reference sites

Previous studies of the auditory P300 event-related potential (ERP) from our laboratory have reported a left- greater than right-sided attenuation in medicated chronic schizophrenics compared with normal controls. A possible confound in these studies has been the use of the linked-ear reference (LER), which has been criticized on the grounds that it might either induce or suppress topographic asymmetries. To test the effects of LER on P300 asymmetries in schizophrenia, we recorded ERPs with both LER and a nose reference (NR) in a group of 20 chronic medicated schizophrenics and in group of 20 age-matched normal controls. We here report: (1) confirmation of our previous P300 findings of left temporal scalp region deficit using both LER and NR with a 28-electrode montage; this feature was prominent in the wave form associated with the target stimulus, without the use of the wave form subtractions of our previous studies; (2) no statistically significant topographic differences between the LER and NR for either the schizophrenic or normal subjects; and (3) better performance of the LER in differentiating schizophrenics versus normal controls, due to lower wave form variability. We conclude that the LER is preferable for studies using subject groups and methodology similar to the present study.

In vivo quantification of the limbic system using MRI: effects of normal aging

Limbic system structures are of central interest in many neuropsychiatric disorders. Magnetic resonance imaging (MRI) has a unique potential for imaging limbic system structures in vivo, but methodological constraints can limit the usefulness and interpretation of the collected image data. In this article, we present approaches for the acquisition and quantification of high resolution MR images of the limbic system. We used a long TR, cardiac gated, flow compensated, spin echo sequence to collect 22, 3-mm thick contiguous sections encompassing the limbic system. The sections were oriented relative to standard internal neuroanatomical landmarks. The sequence provided good gray matter/white matter/cerebrospinal fluid (CSF) and CSF/bone contrast; the latter is necessary for quantifying intracranial size and total CSF volume. Using operationalized criteria, we achieved high interrater reliability in volumetric measurement of temporal horn and hippocampus. This technique was then used to examine the effect of normal aging by comparing eight young (mean = 24 years) and seven old (mean = 73 years) healthy community members. We were able to demonstrate a significant age-related increase in temporal horn volume and a trend toward an age-related decrease in hippocampal volume.

Reduced temporal limbic structure volumes on magnetic resonance images in first episode schizophrenia

Pathomorphology of the limbic system has been described in post-mortem studies of schizophrenia. To determine whether this could be detected in living patients and was not secondary to the treatment or the chronicity of the disease itself, we measured the volumes of the hippocampus-amygdala complex and adjoining temporal horns of 34 patients in their first episode of schizophrenia and 25 normal volunteers using T1 weighted contiguous coronal magnetic resonance images of 3.1 mm width. The results demonstrate abnormal medial temporal lobe morphology in a subgroup of patients at the onset of their illness. There were clear laterality effects and sex differences: hippocampal tissue was significantly smaller only in the left hemisphere of male patients, whereas enlargement of the whole temporal horn or its anterior portion was present on the left side in both sexes. Dysfunction of the limbic mesiotemporal structures might explain some of the clinical features of the disease.

Affect, affective disorder and schizophrenia. A neuropsychological investigation of right hemisphere function

Performance on a happy-sad chimeric face test was used to examine the role of right hemisphere activation in positive and negative affect, both normal and abnormal, as well as in schizophrenia. This test is known to elicit a left-sided perceptual bias in right-handed normal subjects. Happy and sad mood in normals did not influence the perceptual bias. Depression and mania were associated with reduced and increased biases respectively, while schizophrenics showed no bias to either side. Possible explanations are right hemisphere hyperfunction in mania, moderate relative hypofunction in depression, and severe relative hypofunction in schizophrenia. The marked difference between mania and schizophrenia supports distinct pathophysiologies underlying the two conditions.