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Abstract
Childhood-onset schizophrenia is a rare pediatric onset psychiatric disorder continuous with and typically more severe than its adult counterpart. Neuroimaging research conducted on this population has revealed similarly severe neural abnormalities. When taken as a whole, neuroimaging research in this population shows generally decreased cortical gray matter coupled with white matter connectivity abnormalities, suggesting an anatomical basis for deficits in executive function. Subcortical abnormalities are pronounced in limbic structures, where volumetric deficits are likely related to social skill deficits, and cerebellar deficits that have been correlated to cognitive abnormalities. Structures relevant to motor processing also show a significant alteration, with volumetric increase in basal ganglia structures likely due to antipsychotic administration. Neuroimaging of this disorder shows an important clinical image of exaggerated cortical loss, altered white matter connectivity, and differences in structural development of subcortical areas during the course of development and provides important background to the disease state.
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Brent BK, Thermenos HW, Keshavan MS, Seidman LJ. Gray Matter Alterations in Schizophrenia High-Risk Youth and Early-Onset Schizophrenia: A Review of Structural MRI Findings. Child Adolesc Psychiatr Clin N Am 2013; 22:689-714. [PMID: 24012081 PMCID: PMC3767930 DOI: 10.1016/j.chc.2013.06.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article reviews the literature on structural magnetic resonance imaging findings in pediatric and young adult populations at clinical or genetic high-risk for schizophrenia and early-onset schizophrenia. The implications of this research are discussed for understanding the pathophysiology of schizophrenia and for early intervention strategies. The evidence linking brain structural changes in prepsychosis development and early-onset schizophrenia with disruptions of normal neurodevelopmental processes during childhood or adolescence is described. Future directions are outlined for research to address knowledge gaps regarding the neurobiological basis of brain structural abnormalities in schizophrenia and to improve the usefulness of these abnormalities for preventative interventions.
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Affiliation(s)
- Benjamin K Brent
- Harvard Medical School, Boston, MA 02115, USA; Division of Public Psychiatry, Massachusetts Mental Health Center, 75 Fenwood Road, Boston, MA 02115, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Lopez-Larson M, Breeze JL, Kennedy DN, Hodge SM, Tang L, Moore C, Giuliano AJ, Makris N, Caviness VS, Frazier JA. Age-related changes in the corpus callosum in early-onset bipolar disorder assessed using volumetric and cross-sectional measurements. Brain Imaging Behav 2011; 4:220-31. [PMID: 20686873 DOI: 10.1007/s11682-010-9101-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Corpus callosum (CC) area abnormalities have been reported in magnetic resonance imaging (MRI) studies of adults and youths with bipolar disorder (BPD), suggesting interhemispheric communication may be abnormal in BPD and may be present early in the course of illness and affect normal neuromaturation of this structure throughout the lifecycle. Neuroimaging scans from 44 youths with DSM-IV BPD and 22 healthy controls (HC) were analyzed using cross-sectional area measurements and a novel method of volumetric parcellation. Univariate analyses of variance were conducted on CC subregions using both volume and traditional area measurements. Youths with BPD had smaller middle and posterior callosal regions, and reduced typical age-related increases in CC size. The cross-sectional area and novel volumetric methodologies resulted in similar findings. Future longitudinal assessments of CC development would track the evolution of callosal abnormalities in youths with BPD and allow exploration of the functional significance of these findings.
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Abstract
AIM Early-onset schizophrenia (onset before adulthood) is a rare and severe form of the disorder that shows phenotypic and neurobiological continuity with adult-onset schizophrenia. Here, we provide a synthesis of keynote findings in this enriched population to understand better the neurobiology and pathophysiology of early-onset schizophrenia. METHODS A synthetic and integrative approach is applied to review studies stemming from epidemiology, phenomenology, cognition, genetics and neuroimaging data. We provide conclusions and future directions of research on early-onset schizophrenia. RESULTS Childhood and adolescent-onset schizophrenia is associated with severe clinical course, greater rates of premorbid abnormalities, poor psychosocial functioning and increased severity of brain abnormalities. Early-onset cases show similar neurobiological correlates and phenotypic deficits to adult-onset schizophrenia, but show worse long-term psychopathological outcome. Emerging technological advances have provided important insights into the genomic architecture of early-onset schizophrenia, suggesting that some genetic variations may occur more frequently and at a higher rate in young-onset than adult-onset cases. CONCLUSIONS Clinical, cognitive, genetic and imaging data suggest increased severity in early-onset schizophrenia. Studying younger-onset cases can provide useful insights into the neurobiological mechanisms of schizophrenia and the complexity of gene-environment interactions leading to the emergence of this debilitating disorder.
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Affiliation(s)
- Nora S Vyas
- Child Psychiatry Branch, National Institute of Mental Health, NIH, Bethesda, Maryland, USA.
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Micoulaud-Franchi JA, Bat-Pitault F, Da Fonseca D, Rufo M. [Early onset schizophrenia and partial agenesis of corpus callosum]. Arch Pediatr 2011; 18:189-92. [PMID: 21215603 DOI: 10.1016/j.arcped.2010.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 08/16/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
We report a case of schizophrenia with partial agenesis of the corpus callosum in a 14-year-old girl. Diagnosis of schizophrenia was confirmed in the longitudinal follow-up and partial agenesis of the corpus callosum was found on brain MRI at the prodromal stage of disease. The prodromal symptom was progressive deterioration of social and academic adjustment in a context of non-specified psychotic disorder in the father. We found no abnormality in the development but a history of seizures that did not require specific treatment. Follow-up at 8 months showed an increase in negative symptoms and the onset of delusional symptoms and disorganization leading to the prescription of antipsychotic treatment. A review of the literature shows that agenesis of corpus callosum is the most reliable brain morphology abnormality in schizophrenia and is related to the neurodevelopmental and abnormal brain connectivity hypothesis in schizophrenia. Although this abnormality may be a marker of disease severity, our case report highlights the lack of longitudinal follow-up to allow the characterization of a specific outcome pattern of schizophrenic adolescents with partial agenesis of the corpus callosum.
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Affiliation(s)
- J-A Micoulaud-Franchi
- Solaris, pôle universitaire de psychiatrie, hôpital Sainte-Marguerite, Marseille, France.
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Bersani G, Quartini A, Iannitelli A, Paolemili M, Ratti F, Di Biasi C, Gualdi G. Corpus callosum abnormalities and potential age effect in men with schizophrenia: an MRI comparative study. Psychiatry Res 2010; 183:119-25. [PMID: 20599365 DOI: 10.1016/j.pscychresns.2010.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 04/08/2010] [Accepted: 04/14/2010] [Indexed: 12/27/2022]
Abstract
The goal of this investigation was to evaluate corpus callosum (CC) morphometry in schizophrenia. In consideration of possible confounders such as age, gender and handedness, our study sample was restricted to right-handed male subjects, aged 18-55 years. In addition, we controlled for age at onset, illness duration and exposure to antipsychotic medication. Midsagittal CC linear and area Magnetic Resonance Imaging (MRI) measurements were performed on 50 subjects with schizophrenia and 50 healthy controls. After controlling for midsagittal cortical brain area and age, Analysis of Covariance (ANCOVA) revealed an overall effect of diagnosis on CC splenium width and CC anterior midbody area and a diagnosis by age interaction. Independent Student t tests revealed a smaller CC splenium width in the 36- to 45-year-old age group among the patients with schizophrenia and a smaller CC anterior midbody area in the 18- to 25-year-old age group among the patients with schizophrenia compared with controls. Age, age at onset, illness duration and psychopathology ratings did not show any significant correlations with the whole CC MRI measurements. A negative correlation was found between CC rostrum area and the estimated lifetime neuroleptic consumption. The results are discussed in terms of the possibility that CC structural changes may underlie the functional impairments, frequently reported in schizophrenia, of the associated cortical regions.
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Affiliation(s)
- Giuseppe Bersani
- Department of Psychiatric Sciences and Psychological Medicine, Sapienza University of Rome, Polo Pontino, A. Fiorini Hospital, Terracina (LT), Italy.
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7
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Abstract
Schizophrenia is conceptualized as a disorder of aberrant neurodevelopment, with evident stigmata such as minor physical anomalies (MPA), neurological soft signs (NSS), and abnormalities of brain structure and function, proposed as disease endophenotypes. We have examined the neurobiology of schizophrenia using neurodevelopmental markers, structural MRI (sMRI), EEG spectral power, and coherence as well as neuropsychological testing in neuroleptic-naïve, recent-onset schizophrenia (NRS) subjects. It has been our focus to link the positive and negative symptom dimensions of schizophrenia with their underlying neural correlates specifically reflecting fronto-temporal circuitry dysfunction. We found that MPAs and NSSs constituted independent neurodevelopmental markers of schizophrenia and would afford greater predictive validity when used as a composite endophenotype. In an exploratory factor analytic study of the dimensionality of psychopathology, we noted that the symptoms segregated into three dimensions, viz., positive, negative, and disorganization, even in NRS subjects. Executive function tests as well as EEG spectral power and coherence studies revealed that the symptom dimensions of schizophrenia could be linked to specific neural correlates. In an attempt to study the relationship between the symptom dimensions and brain structure and function using MRI, we have proposed neuroanatomical definitions with cytoarchitectonic meaning for parcellation of the prefrontal sub-divisions. Using sMRI, we have found specific corpus callosal abnormalities that possibly link the temporo-parietal association cortices with the positive symptom dimension. Recently, we also found evidence for neurodevelopmental deviance in schizophrenia possibly involving the frontal pole (FP)-driven cortical network, in a sMRI study linking FP volume and total brain volume with age in NRS subjects and age-, gender- and education-matched healthy subjects. Overall, our findings highlight the potential significance of linking the homogeneous symptom dimensions of schizophrenia with dysfunctional connectivity in the fronto-temporal region.
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Affiliation(s)
- John P. John
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Hallak JEC, Crippa JADS, Pinto JP, Machado de Sousa JP, Trzesniak C, Dursun SM, McGuire P, Deakin JFW, Zuardi AW. Total agenesis of the corpus callosum in a patient with childhood-onset schizophrenia. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 65:1216-9. [PMID: 18345433 DOI: 10.1590/s0004-282x2007000700024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 10/09/2007] [Indexed: 11/22/2022]
Abstract
The hypothesis that schizophrenia involves aberrant inter-hemispheric communication has a long pedigree, however its precise role remains unclear. We therefore report the case of a total agenesis of the corpus callosum in a 21-year-old man with childhood-onset schizophrenia. The presence of schizophrenia with very early onset on absence of corpus callosum offers an opportunity to examine neurodevelopmental model and theories regarding to interhemispheric communication in the pathogenesis of psychosis.
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Affiliation(s)
- Jaime Eduardo Cecilio Hallak
- Department of Neurology, Psychiatry and Psychological Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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John JP, Shakeel K. M, Jain S. Corpus callosal area differences and gender dimorphism in neuroleptic-naïve, recent-onset schizophrenia and healthy control subjects. Schizophr Res 2008; 103:11-21. [PMID: 18585006 PMCID: PMC2605782 DOI: 10.1016/j.schres.2008.04.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/21/2008] [Accepted: 04/28/2008] [Indexed: 10/21/2022]
Abstract
The study of corpus callosal morphometry is important to unravel the underlying connectivity disturbance in schizophrenia. We studied the corpus callosal area in schizophrenia subjects compared to healthy subjects, while controlling for several confounders that could affect morphometric measures of the corpus callosum (CC). Areas of the whole CC and its sub-regions obtained by two geometric partitioning schemes were studied in 23 right-handed neuroleptic-naïve, recent-onset, schizophrenia patients and compared with 23 right-handed age-, sex- and education-matched healthy subjects. The patients did not differ from controls in whole CC area. On tripartite division of the CC, the area of the anterior sub-region was significantly higher in patients compared to controls. On radial division into 5 sub-regions, the anterior truncus area was significantly higher in patients compared to controls. There was a significant effect of gender (F>M) on the area measures; however there was no significant diagnosis()gender effect. Age, age of onset, duration of illness and psychopathology ratings did not show any significant correlations with whole CC area and area of CC sub-regions. The finding of increased area of the anterior truncus that possibly comprises white fibres connecting the temporal association cortices could be indicative of an "abnormal functional hyperconnection" involving these regions in positive symptom schizophrenia. Additionally, the finding of females having larger areas of the whole CC and of the anterior and middle sub-regions could reflect a "normal hyperconnection" underlying increased ambilaterality in females.
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Affiliation(s)
- John P John
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Mohammed Shakeel K.
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore
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Walterfang M, Wood AG, Reutens DC, Wood SJ, Chen J, Velakoulis D, McGorry PD, Pantelis C. Morphology of the corpus callosum at different stages of schizophrenia: cross-sectional study in first-episode and chronic illness. Br J Psychiatry 2008; 192:429-34. [PMID: 18515892 DOI: 10.1192/bjp.bp.107.041251] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The shape of the corpus callosum may differ in schizophrenia, although no study has compared first-episode with established illness. AIMS To investigate the size and shape of the corpus callosum in a large sample of people with first-episode and established schizophrenia. METHOD Callosal size and shape were determined using high-resolution magnetic resonance imaging on 76 patients with first-episode schizophrenia-spectrum disorders, 86 patients with established schizophrenia and 55 healthy participants. RESULTS There were no significant differences in total area across groups. Reductions in callosal width were seen in the region of the anterior genu in first-episode disorder (P<0.005). Similar reductions were seen in the chronic schizophrenia group in the anterior genu, but also in the posterior genu and isthmus (P=0.0005). CONCLUSIONS Reductions in anterior callosal regions connecting frontal cortex are present at the onset of schizophrenia, and in established illness are accompanied by changes in other regions of the callosum connecting cingulate, temporal and parietal cortices.
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Affiliation(s)
- Mark Walterfang
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne; North Western Mental Health Program, Sunshine Hospital, Royal Melbourne Hospital, Melbourne [corrected]
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Abstract
OBJECTIVE Children with the early-onset type of conduct disorder (CD) are at high risk for developing an antisocial personality disorder. Although there have been several neuroimaging studies on morphometric differences in adults with antisocial personality disorder, little is known about structural brain aberrations in boys with CD. METHOD Magnetic resonance imaging and voxel-based morphometry were used to assess abnormalities in gray matter volumes in 23 boys ages 12 to 17 years with CD (17 comorbid for attention-deficit/hyperactivity disorder) in comparison with age- and IQ-matched controls. RESULTS Compared with healthy controls, mean gray matter volume was 6% smaller in the clinical group. Compared with controls, reduced gray matter volumes were found in the left orbitofrontal region and bilaterally in the temporal lobes, including the amygdala and hippocampus on the left side in the CD group. Regression analyses in the clinical group indicated an inverse association of hyperactive/impulsive symptoms and widespread gray matter abnormalities in the frontoparietal and temporal cortices. By contrast, CD symptoms correlated primarily with gray matter reductions in limbic brain structures. CONCLUSIONS The data suggest that boys with CD and comorbid attention-deficit/hyperactivity disorder show brain abnormalities in frontolimbic areas that resemble structural brain deficits, which are typically observed in adults with antisocial behavior.
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Meta-analysis of magnetic resonance imaging studies of the corpus callosum in schizophrenia. Schizophr Res 2008; 101:124-32. [PMID: 18289833 DOI: 10.1016/j.schres.2008.01.005] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 12/26/2007] [Accepted: 01/04/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The corpus callosum plays a pivotal role in inter-hemispheric transfer and integration of information. Magnetic resonance studies have reported callosal abnormalities in schizophrenia but findings have been inconsistent. Uncertainty has persisted despite a meta-analytic evaluation of this structure several years ago. We set out to perform a further meta-analysis with the addition of the numerous reports published on the subject to test the hypothesis that the corpus callosum is abnormal in schizophrenia. METHOD A systematic search was carried out to identify suitable magnetic resonance studies which reported callosal areas in schizophrenia compared to controls. Results from the retrieved studies were compared in a meta-analysis whilst the influence of biological and clinical variables on effect size was ascertained with meta-regression analysis. RESULTS Twenty-eight studies were identified. Corpus callosum area was reduced in schizophrenia in comparison to healthy volunteers. This effect was larger in first episode patients. Similarly, heterogeneity detected among the studies was associated with course of illness indicating that chronic subjects with schizophrenia showed larger callosal areas. There was no evidence of publication bias. CONCLUSIONS This study confirms the presence of reduced callosal areas in schizophrenia. The effect is of a larger magnitude at first presentation and less so in subjects with a chronic course generally medicated with antipsychotics.
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Vloet TD, Konrad K, Huebner T, Herpertz S, Herpertz-Dahlmann B. Structural and functional MRI- findings in children and adolescents with antisocial behavior. BEHAVIORAL SCIENCES & THE LAW 2008; 26:99-111. [PMID: 18327828 DOI: 10.1002/bsl.794] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The developmental course of children with conduct disorder (CD) is heterogeneous. Especially children who exhibit symptoms early in their lifetimes are characterized by a negative outcome. Neurobiological aspects of CD have been investigated in these children but little is known about structural and functional brain aberrations. METHODS We describe the developmental taxonomy of children with CD and focus on those with the early onset subtype. Structural MRI data of these children and antisocial adults are recapitulated. The impact of investigating neurobiological underpinnings of antisocial behavior and how this might contribute to future forensic and psychiatric assessments is discussed. RESULTS/ CONCLUSION: Children display similar structural aberrations of fronto-limbic structures to adults with antisocial behavior, and amygdala dysfunction might be closely related to dysregulated emotions. Though the investigation of biological factors in antisocial subjects has made great progress in recent years, today MRI is still a rather complex, expensive and indistinct method for forensic assessment.
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Affiliation(s)
- Timo D Vloet
- Department of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen, University Hospital, Neuenhofer Weg 21, D-52074 Aachen, Germany.
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Sun H, Yushkevich PA, Zhang H, Cook PA, Duda JT, Simon TJ, Gee JC. Shape-based normalization of the corpus callosum for DTI connectivity analysis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2007; 26:1166-78. [PMID: 17896590 DOI: 10.1109/tmi.2007.900322] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The continuous medial representation (cm-rep) is an approach that makes it possible to model, normalize, and analyze anatomical structures on the basis of medial geometry. Having recently presented a partial differential equation (PDE)-based approach for 3-D cm-rep modeling [1], here we present an equivalent 2-D approach that involves solving an ordinary differential equation. This paper derives a closed form solution of this equation and shows how Pythagorean hodograph curves can be used to express the solution as a piecewise polynomial function, allowing efficient and robust medial modeling. The utility of the approach in medical image analysis is demonstrated by applying it to the problem of shape-based normalization of the midsagittal section of the corpus callosum. Using diffusion tensor tractography, we show that shape-based normalization aligns subregions of the corpus callosum, defined by connectivity, more accurately than normalization based on volumetric registration. Furthermore, shape-based normalization helps increase the statistical power of group analysis in an experiment where features derived from diffusion tensor tractography are compared between two cohorts. These results suggest that cm-rep is an appropriate tool for normalizing the corpus callosum in white matter studies.
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Affiliation(s)
- Hui Sun
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA .
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Andreone N, Tansella M, Cerini R, Rambaldelli G, Versace A, Marrella G, Perlini C, Dusi N, Pelizza L, Balestrieri M, Barbui C, Nosè M, Gasparini A, Brambilla P. Cerebral atrophy and white matter disruption in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2007; 257:3-11. [PMID: 16960652 DOI: 10.1007/s00406-006-0675-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Abstract
Several magnetic resonance imaging (MRI) studies have shown cerebral atrophy in established schizophrenia, although not in all reports. Discrepancies may mostly be due to population and postprocessing differences. Recently, disruption of cortical white matter integrity has also been reported in chronic patients with schizophrenia. In this study we explored tridimensional (3D) cerebral volumes and white matter microstructure in schizophrenia with structural and diffusion magnetic resonance. Twenty-five patients with established schizophrenia and 25 1:1 matched normal controls underwent a session of MRI using a Siemens 1.5T-scanner. 3D brain volume reconstruction was performed with the semi-automatic software Amira (TGS, San Diego, CA), whereas the apparent diffusion coefficients (ADCs) of cortical white matter water molecules were obtained with in-house developed softwares written in MatLab (The Mathworks-Inc., Natick, MA). Compared to controls, patients with schizophrenia had significantly smaller gray matter intracranium and total brain volumes, increased 4th ventricle volumes, and greater temporal and occipital ADCs. Patients treated with typical antipsychotic medication (N = 9) had significantly larger right lateral and 4th ventricles compared to those on atypical antipsychotic drugs. Intracranial volumes significantly inversely correlated with left temporal ADC in patients with schizophrenia. Also, age correlated directly with right, left, and 3rd ventricle volumes and inversely with gray matter intracranium volumes in individuals with schizophrenia. This study confirmed the presence of cortical atrophy in patients with schizophrenia, especially in those on typical antipsychotic drugs, and the existence of white matter disruption. It also suggested that physiological aging effects on brain anatomy may be abnormally pronounced in schizophrenia.
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Affiliation(s)
- Nicola Andreone
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
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Vloet TD, Neufang S, Herpertz-Dahlmann B, Konrad K. Bildgebungsbefunde bei Kindern und Jugendlichen mit ADHS, Tic-Störungen und Zwangserkrankungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2006; 34:343-55. [PMID: 16981155 DOI: 10.1024/1422-4917.34.5.343] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: ADHS, Tic-Störung, Tourette-Syndrom und Zwangsstörung sind gekennzeichnet durch Defizite in der Handlungskontrolle und treten überzufällig häufig komorbid auf. Es bestehen Hinweise auf eine gemeinsame neurobiologische Basis. Der folgende Übersichtsartikel fasst Ergebnisse aus Bildgebungsstudien zu diesen Störungen im Kindes- und Jugendalter zusammen, wobei strukturelle und funktionelle Befunde durch Magnetresonanztomographie einen Schwerpunkt einnehmen. Übereinstimmend zeigen sich im Vergleich zu gesunden Kontrollen morphologische Veränderungen im Bereich von Basalganglien und präfrontalem Kortex sowie abnorme Aktivierungen in fronto-striatalen Systemen. Vor allem beim ADHS und Tourette-Syndrom werden präfrontale Abweichungen gefunden, die beim letzteren milder ausgeprägt sind und unter Umständen auf Kompensationsmechanismen zurückzuführen sein könnten. Beim ADHS finden sich zusätzlich kleine, globale morphologische Veränderungen im gesamten Kortex und im Zerebellum, beim Tourette-Syndrom werden zudem Auffälligkeiten im okzipitalen Kortex beschrieben. Bei der Zwangserkrankung bestehen weitere strukturelle und funktionelle Aberrationen im Bereich von Amygdala und Thalamus und zudem orbito-frontale Funktionsveränderungen, die beim ADHS eher im ventralen präfrontalen Kortex zu finden sind. Diese Befunde scheinen insgesamt mit Störungen in kortiko-striato-thalamiko-kortikalen Regelkreisen assoziiert zu sein und u. a. in Verbindung mit Dysfunktionen im Bereich der Inhibition von motorischen Reaktionen, impulsiven Handlungen und unerwünschten Gedanken zu stehen. Generell wird die Aussagekraft und Vergleichbarkeit vieler Studien durch kleine und heterogene Gruppen sowie methodische Unterschiede eingeschränkt.
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Affiliation(s)
- Timo D Vloet
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Aachen, Neuenhofer Weg 21, DE-52074 Aachen.
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Abstract
OBJECTIVE To describe the case of a person with schizophrenia and agenesis of the corpus callosum. CONCLUSION A 24-year-old Caucasian woman with schizophrenia was incidentally found to have complete agenesis of the corpus callosum. A comprehensive neuropsychiatric assessment allowed management to be specifically tailored to the patient's unique clinical profile.
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Walterfang M, Wood SJ, Velakoulis D, Copolov D, Pantelis C. Diseases of white matter and schizophrenia-like psychosis. Aust N Z J Psychiatry 2005; 39:746-56. [PMID: 16168032 DOI: 10.1080/j.1440-1614.2005.01678.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse the available data regarding the presentation of psychosis in diseases of central nervous system (CNS) white matter. METHOD The available neurological and psychiatric literature on developmental, neoplastic, infective, immunological and other white matter diseases was reviewed. RESULTS A number of diseases of the white matter can present as schizophrenia-like psychoses, including leukodystrophies, neoplasms, velocardiofacial syndrome, callosal anomalies and inflammatory diseases. CONCLUSIONS Production of psychotic symptoms may result from functional asynchrony of interdependent regions, due to alterations in critical circuits as a result of pathology. The nature, location and timing of white matter pathology seem to be the key factors in the development of psychosis, especially during the critical adolescent period of association area myelination. Diseases that disrupt the normal formation of myelin appear to cause psychosis at higher rates than those that disrupt mature myelinated structures. Diffuse rather than discrete lesions, in particular those affecting frontotemporal zones, are also more strongly associated with schizophrenia-like psychosis. These illnesses point to the central role that white matter plays in maintaining CNS connectivity and to how pathology of the white matter may contribute to the neurobiology of psychosis.
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Affiliation(s)
- Mark Walterfang
- Melbourne Neuropsychiatry Centre, Level 2, John Cade Building, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia.
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Durany N, Thome J. Neurotrophic factors and the pathophysiology of schizophrenic psychoses. Eur Psychiatry 2005; 19:326-37. [PMID: 15363470 DOI: 10.1016/j.eurpsy.2004.06.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Revised: 04/15/2004] [Accepted: 04/26/2004] [Indexed: 12/26/2022] Open
Abstract
The aim of this review is to summarize the present state of findings on altered neurotrophic factor levels in schizophrenic psychoses, on variations in genes coding for neurotrophic factors, and on the effect of antipsychotic drugs on the expression level of neurotrophic factors. This is a conceptual paper that aims to establish the link between the neuromaldevelopment theory of schizophrenia and neurotrophic factors. An extensive literature review has been done using the Pub Med database, a service of the National Library of Medicine, which includes over 14 million citations for biomedical articles back to the 1950s. The majority of studies discussed in this review support the notion of alterations of neurotrophic factors at the protein and gene level, respectively, and support the hypothesis that these alterations could, at least partially, explain some of the morphological, cytoarchitectural and neurobiochemical abnormalities found in the brain of schizophrenic patients. However, the results are not always conclusive and the clinical significance of these alterations is not fully understood. It is, thus, important to further neurotrophic factor research in order to better understand the etiopathogenesis of schizophrenic psychoses and, thus, potentially develop new treatment strategies urgently needed for patients suffering from these devastating disorders.
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Affiliation(s)
- Nuria Durany
- Faculty of Health Science, International University of Catalonia, c// Josep Trueta s/n, 08190 San Cugat del Vallès (Barcelona), Spain.
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Coggins PE, Kennedy TJ, Armstrong TA. Bilingual corpus callosum variability. BRAIN AND LANGUAGE 2004; 89:69-75. [PMID: 15010238 DOI: 10.1016/s0093-934x(03)00299-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2003] [Indexed: 05/24/2023]
Abstract
Magnetic resonance imaging was used to produce midsagittal images of the corpus callosum of 19 right-handed adult male and female subjects. The preliminary findings of this study indicate that significant adaptation in the anterior midbody of the corpus callosum has occurred to accommodate multiple language capacity in bilingual individuals compared to monolingual individuals. The main interpretation of this finding is that the precentral gyrus is involved in bilingual faculty adaptation assuming a role consistent with the somatotopical input to areas dedicated to the mouth, and input to association tracts connecting the premotor and supplementary motor cortices. This paper discusses possible implications to neuroscientists, second language educators, and their students.
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Affiliation(s)
- Porter E Coggins
- Department of Mathematics and Computing at the University of Wisconsin-Stevens Point, Stevens Point, WI 54481, USA.
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Keller A, Jeffries NO, Blumenthal J, Clasen LS, Liu H, Giedd JN, Rapoport JL. Corpus callosum development in childhood-onset schizophrenia. Schizophr Res 2003; 62:105-14. [PMID: 12765750 DOI: 10.1016/s0920-9964(02)00354-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Corpus callosum (CC) size and interhemispheric communication differences have been reported between patients with schizophrenia and normal controls. Childhood-onset schizophrenia (COS) is a severe form of the disorder that is continuous with later-onset disorder. Corpus callosal area was examined for COS at initial scan and prospectively through adolescence, and related to other developmental abnormalities for this group. METHOD A total of 113 anatomic brain MRI scans were obtained from 55 COS (22 female) and 110 scans from 56 age- and gender-matched healthy volunteers (22 female), across ages 8-24. Baseline and prospective rescans were obtained at approximately 2-year intervals. The midsagittal areas for total corpus callosum and seven subregions were calculated using an automated system. Cross-sectional and longitudinal data were combined using mixed model regression analysis to compare developmental changes for the two groups. RESULTS No diagnostic differences were seen at time of initial scan. Longitudinally, and in contrast to healthy volunteers, patients with schizophrenia showed a significant difference in developmental trajectory for the area of the splenium, both before (p=0.012) and after (p=0.05) adjustment for total cerebral volume. The area of the splenium becomes significantly smaller in COS, starting at about age 22. CONCLUSION Patients with schizophrenia showed a significant difference in developmental trajectory for the splenial area, which seems to decline for COS. If replicated, this may reflect anticipated late occipital and extrastriate changes in brain regions.
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Affiliation(s)
- Audrey Keller
- Child Psychiatry Branch, National Institute of Mental Health, Building 10, Room 3N 202, 10 Center Drive MSC 1600, Bethesda, MD 20892-1600, USA
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Lahuis B, Kemner C, Van Engeland H. Magnetic resonance imaging studies on autism and childhood-onset schizophrenia in children and adolescents - a review. Acta Neuropsychiatr 2003; 15:140-7. [PMID: 26983357 DOI: 10.1034/j.1601-5215.2003.00021.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To find out whether the neurodevelopmental disorders autism and childhood-onset schizophrenia have a common developmental pathway and whether the abnormalities detected are 'disorder-specific', by reviewing magnetic resonance imaging (MRI) studies. METHODS As a result of a Medline search, we were able to access 28 studies on autism and 12 studies on childhood-onset schizophrenia, which focused on children and adolescents. RESULTS Larger lateral ventricles were found to be a common abnormality in both disorders. 'Disorder-specific' abnormalities in patients with autism were larger brains, a larger thalamic area, and a smaller right cingulate gyrus. Subjects with childhood-onset schizophrenia were found to have smaller brains, a smaller amygdalum and thalamus, and a larger nucleus caudatus. In subjects with childhood-onset schizophrenia, abnormalities appeared to progress over a limited period of time. CONCLUSIONS Because the study designs varied so much, the results should be interpreted cautiously. Before abnormalities found in the disorders can be designated as equal or 'disorder-specific', it will be essential to perform large longitudinal and cross-sectional follow-up studies.
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Affiliation(s)
- Bertine Lahuis
- 1Department of Child and Adolescent Psychiatry, University of Utrecht, the Netherlands
| | - Chantal Kemner
- 1Department of Child and Adolescent Psychiatry, University of Utrecht, the Netherlands
| | - Herman Van Engeland
- 1Department of Child and Adolescent Psychiatry, University of Utrecht, the Netherlands
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Lee KH, Williams LM, Breakspear M, Gordon E. Synchronous gamma activity: a review and contribution to an integrative neuroscience model of schizophrenia. BRAIN RESEARCH. BRAIN RESEARCH REVIEWS 2003; 41:57-78. [PMID: 12505648 DOI: 10.1016/s0165-0173(02)00220-5] [Citation(s) in RCA: 368] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Synchronous high frequency (Gamma band) activity has been proposed as a candidate mechanism for the integration or 'binding' of distributed brain activities. Since the first descriptions of schizophrenia, attempts to characterize this disorder have focused on disturbances in such integrative processing. Here, we review both micro- and macroscopic neuroscience research into Gamma synchrony, and its application to understanding schizophrenia. The review encompasses evidence from both animal and human studies for the functional significance of Gamma activity, the association between Gamma dysfunction and information processing disturbances, and the relevance of specific Gamma dysfunctions to the integration and extension of previous disconnection models of schizophrenia. Attention is given to the relationship between Gamma activity and the heterogeneous symptoms of schizophrenia. Existing studies show that measures of Gamma activity have the potential to explain far more of the variance in schizophrenia performance than previous neurophysiological measures. It is concluded that measures of Gamma synchrony offer a valuable window into the core integrative disturbance in schizophrenia cognition.
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Affiliation(s)
- Kwang-Hyuk Lee
- Cognitive Neuroscience Unit, Department of Psychology, University of Sydney, and The Brain Dynamics Centre, Westmead Hospital, 2145, Sydney, NSW, Australia
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Durany N, Michel T, Zöchling R, Boissl KW, Cruz-Sánchez FF, Riederer P, Thome J. Brain-derived neurotrophic factor and neurotrophin 3 in schizophrenic psychoses. Schizophr Res 2001; 52:79-86. [PMID: 11595394 DOI: 10.1016/s0920-9964(00)00084-0] [Citation(s) in RCA: 281] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disturbed neural development has been postulated as a crucial factor in the pathophysiology of schizophrenic psychoses. The neurobiochemical basis for such changes of cytoarchitecture and changed neural plasticity could involve an alteration in the regulation of neurotrophic factors. In order to test this hypothesis, BDNF and NT-3 levels in post-mortem brain tissue from schizophrenic patients were determined by ELISA. There was a significant increase in BDNF concentrations in cortical areas and a significant decrease of this neurotrophin in hippocampus of patients when compared with controls. NT-3 concentrations of frontal and parietal cortical areas were significantly lower in patients than in controls. These findings lend further evidence to the neurotrophin hypothesis of schizophrenic psychoses which proposes that alterations in expression of neurotrophic factors could be responsible for neural maldevelopment and disturbed neural plasticity, thus being an important event in the etiopathogenesis of schizophrenic psychoses.
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Affiliation(s)
- N Durany
- Laboratory for Neurochemistry, University of Würzburg, Würzburg, Germany.
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Mazziotta J, Toga A, Evans A, Fox P, Lancaster J, Zilles K, Woods R, Paus T, Simpson G, Pike B, Holmes C, Collins L, Thompson P, MacDonald D, Iacoboni M, Schormann T, Amunts K, Palomero-Gallagher N, Geyer S, Parsons L, Narr K, Kabani N, Le Goualher G, Feidler J, Smith K, Boomsma D, Hulshoff Pol H, Cannon T, Kawashima R, Mazoyer B. A four-dimensional probabilistic atlas of the human brain. J Am Med Inform Assoc 2001; 8:401-30. [PMID: 11522763 PMCID: PMC131040 DOI: 10.1136/jamia.2001.0080401] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2001] [Accepted: 05/01/2001] [Indexed: 11/04/2022] Open
Abstract
The authors describe the development of a four-dimensional atlas and reference system that includes both macroscopic and microscopic information on structure and function of the human brain in persons between the ages of 18 and 90 years. Given the presumed large but previously unquantified degree of structural and functional variance among normal persons in the human population, the basis for this atlas and reference system is probabilistic. Through the efforts of the International Consortium for Brain Mapping (ICBM), 7,000 subjects will be included in the initial phase of database and atlas development. For each subject, detailed demographic, clinical, behavioral, and imaging information is being collected. In addition, 5,800 subjects will contribute DNA for the purpose of determining genotype- phenotype-behavioral correlations. The process of developing the strategies, algorithms, data collection methods, validation approaches, database structures, and distribution of results is described in this report. Examples of applications of the approach are described for the normal brain in both adults and children as well as in patients with schizophrenia. This project should provide new insights into the relationship between microscopic and macroscopic structure and function in the human brain and should have important implications in basic neuroscience, clinical diagnostics, and cerebral disorders.
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Affiliation(s)
- J Mazziotta
- UCLA School of Medicine, Los Angeles, California, USA.
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Frodl T, Meisenzahl EM, Müller D, Greiner J, Juckel G, Leinsinger G, Hahn H, Möller HJ, Hegerl U. Corpus callosum and P300 in schizophrenia. Schizophr Res 2001; 49:107-19. [PMID: 11343870 DOI: 10.1016/s0920-9964(00)00123-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional abnormalities in the interhemispheric transfer via the corpus callosum in schizophrenia may result in filtering problems and information processing problems, which may in turn be related to the synchronization of cortical event-related activity. To explore whether a relationship exists between corpus callosum (CC) size, measured with in-vivo magnetic resonance imaging, and late auditory event-related P300 potentials, 50 patients with schizophrenia as well as 50 healthy controls were examined. The absolute CC size and subregional areas, as well as the CC areas adjusted for total brain volume, were not significantly different between patients with schizophrenia and controls. While no significant group differences were observed for P3a-, P3b-, PSW-amplitudes and P3b-latencies, P3a- and PSW-latencies were significantly prolonged for patients with schizophrenia. Absolute CC total size was significantly correlated with P3b-amplitudes in healthy controls (r=0.29; P=0.044). In patients with schizophrenia, significant correlations were observed between the subregion of the posterior body of the CC and positive slow wave (PSW; r=0.47; P=0.001). P3a-, P3b- and PSW-latencies were not significantly correlated to CC size in either patients with schizophrenia or healthy controls. The results are discussed in terms of the possibility that abnormalities in interhemispheric transfer may underlie the mechanisms of schizophrenia.
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Affiliation(s)
- T Frodl
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
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Abstract
After more than 100 years of research, the neuropathology of schizophrenia remains unknown and this is despite the fact that both Kraepelin (1919/1971: Kraepelin, E., 1919/1971. Dementia praecox. Churchill Livingston Inc., New York) and Bleuler (1911/1950: Bleuler, E., 1911/1950. Dementia praecox or the group of schizophrenias. International Universities Press, New York), who first described 'dementia praecox' and the 'schizophrenias', were convinced that schizophrenia would ultimately be linked to an organic brain disorder. Alzheimer (1897: Alzheimer, A., 1897. Beitrage zur pathologischen anatomie der hirnrinde und zur anatomischen grundlage einiger psychosen. Monatsschrift fur Psychiarie und Neurologie. 2, 82-120) was the first to investigate the neuropathology of schizophrenia, though he went on to study more tractable brain diseases. The results of subsequent neuropathological studies were disappointing because of conflicting findings. Research interest thus waned and did not flourish again until 1976, following the pivotal computer assisted tomography (CT) finding of lateral ventricular enlargement in schizophrenia by Johnstone and colleagues. Since that time significant progress has been made in brain imaging, particularly with the advent of magnetic resonance imaging (MRI), beginning with the first MRI study of schizophrenia by Smith and coworkers in 1984 (Smith, R.C., Calderon, M., Ravichandran, G.K., et al. (1984). Nuclear magnetic resonance in schizophrenia: A preliminary study. Psychiatry Res. 12, 137-147). MR in vivo imaging of the brain now confirms brain abnormalities in schizophrenia. The 193 peer reviewed MRI studies reported in the current review span the period from 1988 to August, 2000. This 12 year period has witnessed a burgeoning of MRI studies and has led to more definitive findings of brain abnormalities in schizophrenia than any other time period in the history of schizophrenia research. Such progress in defining the neuropathology of schizophrenia is largely due to advances in in vivo MRI techniques. These advances have now led to the identification of a number of brain abnormalities in schizophrenia. Some of these abnormalities confirm earlier post-mortem findings, and most are small and subtle, rather than large, thus necessitating more advanced and accurate measurement tools. These findings include ventricular enlargement (80% of studies reviewed) and third ventricle enlargement (73% of studies reviewed). There is also preferential involvement of medial temporal lobe structures (74% of studies reviewed), which include the amygdala, hippocampus, and parahippocampal gyrus, and neocortical temporal lobe regions (superior temporal gyrus) (100% of studies reviewed). When gray and white matter of superior temporal gyrus was combined, 67% of studies reported abnormalities. There was also moderate evidence for frontal lobe abnormalities (59% of studies reviewed), particularly prefrontal gray matter and orbitofrontal regions. Similarly, there was moderate evidence for parietal lobe abnormalities (60% of studies reviewed), particularly of the inferior parietal lobule which includes both supramarginal and angular gyri. Additionally, there was strong to moderate evidence for subcortical abnormalities (i.e. cavum septi pellucidi-92% of studies reviewed, basal ganglia-68% of studies reviewed, corpus callosum-63% of studies reviewed, and thalamus-42% of studies reviewed), but more equivocal evidence for cerebellar abnormalities (31% of studies reviewed). The timing of such abnormalities has not yet been determined, although many are evident when a patient first becomes symptomatic. There is, however, also evidence that a subset of brain abnormalities may change over the course of the illness. The most parsimonious explanation is that some brain abnormalities are neurodevelopmental in origin but unfold later in development, thus setting the stage for the development of the symptoms of schizophrenia. Or there may be additional factors, such as stress or neurotoxicity, that occur during adolescence or early adulthood and are necessary for the development of schizophrenia, and may be associated with neurodegenerative changes. Importantly, as several different brain regions are involved in the neuropathology of schizophrenia, new models need to be developed and tested that explain neural circuitry abnormalities effecting brain regions not necessarily structurally proximal to each other but nonetheless functionally interrelated. (ABSTRACT TRUNCATED)
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Affiliation(s)
- M E Shenton
- Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Harvard Medical School, Brockton, MA 02301, USA.
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Sowell ER, Toga AW, Asarnow R. Brain abnormalities observed in childhood-onset schizophrenia: a review of the structural magnetic resonance imaging literature. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2000; 6:180-5. [PMID: 10982495 DOI: 10.1002/1098-2779(2000)6:3<180::aid-mrdd5>3.0.co;2-i] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood-onset schizophrenia (COS) is a rare, severe form of schizophrenia in which there are structural brain abnormalities that may be related to the psychotic symptomatology and neurocognitive deficits found in these patients. While there are numerous structural imaging studies of the adult-onset variant of schizophrenia (with many conflicting findings), relatively few brain imaging studies of COS have been conducted. This paper summarizes the extant literature of magnetic resonance imaging (MRI) studies of structural brain abnormalities in COS, and compares findings to similar studies of adult-onset patients. Volumetric MRI studies of COS patients have consistently shown evidence for increased ventricular volume, reduced cerebral gray matter, and increased caudate volume, consistent with findings from adult-onset studies. Other volumetric brain abnormalities are observed in COS patients, such as reduced total brain volume, but not consistently across all studies. Voxel-based morphometric analyses have revealed abnormalities in the shape and spatial location of structures in COS such as the corpus callosum, caudate, and thalamus that could not be observed in the more traditional volumetric assessments. Similar findings also are observed in adult-onset patients. Progressive degenerative changes, such as ventricular enlargement, appear to occur in COS only until young adulthood where there is an apparent asymptote with no further degenerative changes. This is consistent with the lack of progressive changes noted in most longitudinal studies of adult-onset schizophrenia.
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Affiliation(s)
- E R Sowell
- Department of Neurology, Laboratory of Neuro Imaging, University of California, Los Angeles, California 90095-1769, USA.
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Abstract
Updated findings from the ongoing National Institute of Mental Health Child Psychiatry Branch longitudinal study of childhood-onset schizophrenia (COS) are presented, along with replications from collaborators at other sites. Clinical and neurobiologic continuities of COS with poor-outcome adult-onset schizophrenia suggests that their underlying pathophysiology is the same. However, these early-onset cases appear to have more striking genetic contributions to their etiology. Updated findings involve risk factors (birth complications, cytogenic abnormalities, early language and motor problems, and familial psychopathology), treatment trials, and brain magnetic resonance imaging studies.
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Affiliation(s)
- J L Rapoport
- Child Psychiatry Branch (Building 10, Room 3N202), National Institute of Mental Health, 10 Center Drive, MSC 1600, Bethesda, MD 20892-1600, USA.
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Hendren RL, De Backer I, Pandina GJ. Review of neuroimaging studies of child and adolescent psychiatric disorders from the past 10 years. J Am Acad Child Adolesc Psychiatry 2000; 39:815-28. [PMID: 10892223 DOI: 10.1097/00004583-200007000-00010] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To review recent neuroimaging studies of serious emotional disorders in youth and identify problems and promise of neuroimaging in clinical practice. METHOD Published reports from refereed journals are briefly described, critiqued, and synthesized into a summary of the findings to date. RESULTS Childhood-onset schizophrenia shows progressive ventricular enlargement, reduction in total brain and thalamus volume, changes in temporal lobe structures, and reductions in frontal metabolism. Autistic disorder is associated with cerebellar changes, greater total brain and lateral ventricle volume, and asymmetry. The prefrontal cortex and the basal ganglia are consistently reported as abnormal in attention-deficit/hyperactivity disorder. Patients with anorexia nervosa show enlarged CSF spaces and reductions in gray and white matter that are only partially reversible with weight recovery. CONCLUSIONS Results from neuroimaging studies of childhood-onset psychiatric disorders suggest consistency in the structures found to be abnormal, but inconsistencies in the nature of these abnormalities. Although neuroimaging technology holds great promise for neurodevelopmental research, it is not yet a diagnostic instrument.
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Affiliation(s)
- R L Hendren
- Institute for Quality, Research and Training, UMDNJ-Robert Wood Johnson, New Brunswick 08901, USA
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Downhill JE, Buchsbaum MS, Wei T, Spiegel-Cohen J, Hazlett EA, Haznedar MM, Silverman J, Siever LJ. Shape and size of the corpus callosum in schizophrenia and schizotypal personality disorder. Schizophr Res 2000; 42:193-208. [PMID: 10785578 DOI: 10.1016/s0920-9964(99)00123-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The size and shape of the corpus callosum were assessed on sagittal section magnetic resonance images in 27 patients with schizophrenia, 13 patients with schizotypal personality disorder (SPD), and 30 healthy volunteers. High-resolution 1.2mm axial SPGR images were acquired and resectioned so that the sagittal plane passed through the anterior and posterior commissures and was parallel to the interhemispheric fissure. The corpus callosum and the whole brain were traced on midsagittal section slices of each brain, and the callosum was divided into 30 anteroposterior sectors. Pixel-by-pixel chi-square and thin-plate spline analyses were used to assess between-group shape differences. Size of the corpus callosum was smaller anteriorly in the genu of the corpus callosum and posteriorly in the splenium in schizophrenic patients than in normal controls. The genu of the corpus callosum was larger in SPD patients than in schizophrenic patients or normal controls. The posterior corpus callosum was largest in normal controls, smaller in SPD patients, and smallest in schizophrenic patients. Shape analysis was consistent with these size comparisons, and suggested a downward bowing of the corpus callosum in schizophrenic and SPD patients. SPD patients also had a region of the callosum just posterior to the genu that was narrower than in the other two groups. The decreases in corpus callosal size in schizophrenia varied directly with length of illness, perhaps indicative of a progressive process. The patient-control differences in callosal size and shape are consistent with a hypothesis of decreased connectivity between the left and the right hemispheres in schizophrenia and SPD.
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Affiliation(s)
- J E Downhill
- Department of Psychiatry, Box 1505, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA
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Usiskin SI, Nicolson R, Krasnewich DM, Yan W, Lenane M, Wudarsky M, Hamburger SD, Rapoport JL. Velocardiofacial syndrome in childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry 1999; 38:1536-43. [PMID: 10596254 DOI: 10.1097/00004583-199912000-00015] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Deletion of chromosome 22q11 (velocardiofacial syndrome) is associated with early neurodevelopmental abnormalities and with schizophrenia in adults. The rate of 22q11 deletions was examined in a series of patients with childhood-onset schizophrenia (COS), in whom early premorbid developmental and cognitive impairments are more pronounced than in adult-onset cases. METHOD Through extensive recruiting and screening, a cohort of 47 patients was enrolled in a comprehensive study of very-early-onset schizophrenia. All were tested with fluorescence in situ hybridization for deletions on chromosome 22q11. RESULTS Three (6.4%) of 47 patients were found to have a 22q11 deletion. All 3 COS patients with 22q11 deletions had premorbid impairments of language, motor, and social development, although their physical characteristics varied. Brain magnetic resonance imaging revealed increased midbody corpus callosum area and ventricular volume in relation both to healthy controls and to other COS patients. CONCLUSIONS The rate of 22q11 deletions in COS is higher than in the general population (0.025%, p < .001) and may be higher than reported for adult-onset schizophrenia (2.0%, p = .09). These results suggest that 22q11 deletions may be associated with an earlier age of onset of schizophrenia, possibly mediated by a more salient neurodevelopmental disruption.
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Affiliation(s)
- S I Usiskin
- Child Psychiatry Branch, NIMH, Bethesda, MD, USA
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Abstract
Childhood-onset schizophrenia (defined by an onset of psychosis by age 12) is a rare and severe form of the disorder that is clinically and neurobiologically continuous with the adult-onset disorder. There is growing evidence for more salient risk or etiologic factors, particularly familial, in this possibly more homogeneous patient population. For the 49 patients with very early onset schizophrenia studied to date at the National Institute of Mental Health, there were more severe premorbid neuro-developmental abnormalities, a higher rate of cytogenetic anomalies, and a seemingly higher rate of familial schizophrenia and spectrum disorders than later onset cases. There was no evidence for increased obstetric complications or environmental stress. These data, while preliminary, suggest that a very early age of onset of schizophrenia may be secondary to greater familial vulnerability. Consequently, genetic studies of these patients may be particularly informative and may provide important etiologic information.
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Affiliation(s)
- R Nicolson
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892-1600, USA
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James AC, Crow TJ, Renowden S, Wardell AM, Smith DM, Anslow P. Is the course of brain development in schizophrenia delayed? Evidence from onsets in adolescence. Schizophr Res 1999; 40:1-10. [PMID: 10541001 DOI: 10.1016/s0920-9964(99)00042-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A degree of ventricular enlargement, together with a reduction of total cortical mass and loss of asymmetry is reported in schizophrenia, but the meaning is obscure. These changes may reflect an anomaly of brain development. Brain structure was assessed on a 1.5-Tesla MRI scan in a series of 29 adolescents at the time of a first episode of schizophrenia and compared with 15 adolescents with other serious psychiatric disturbance (mostly psychotic) and 20 normal adolescent controls. The age at scan ranged between 13 and 20 years. In the adolescents with a diagnosis of schizophrenia, total brain volume increased with age in a way that differed significantly (p=0.007) from that seen in patients with other psychiatric disturbance and normal controls. Thus, brain growth, as assessed by this index, had reached a plateau in the control group by the age of 13 years, but this was not true of patients with schizophrenia. The measure that most clearly distinguished the groups (p<0.001 after co-varying for height and sex) was the volume of the left lateral ventricle the ventricle was significantly larger in patients with schizophrenic illness, and ventricular size increased with age to a greater extent in the patient group, although not significantly so, than in normal controls. Thus, aspects of brain growth are delayed in patients with early onset schizophrenia, and the greatest severity of illness is reflected in a component of growth that is lateralized to the dominant hemisphere. Individuals who develop serious psychiatric illness, including schizophrenia, represent a fraction of the population in whom a component of the relative development of the cerebral hemispheres occurs late.
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Affiliation(s)
- A C James
- Highfield Family Adolescent Unit, Warneford Hospital, Oxford, UK
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Boroojerdi B, Töpper R, Foltys H, Meincke U. Transcallosal inhibition and motor conduction studies in patients with schizophrenia using transcranial magnetic stimulation. Br J Psychiatry 1999; 175:375-9. [PMID: 10789306 DOI: 10.1192/bjp.175.4.375] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transcranial magnetic stimulation of the motor cortex may not only elicit excitatory responses in hand muscles contralateral to the stimulated hemisphere, but may also suppress tonic voluntary electromyogram activity in muscles ipsilateral to the stimulation. This inhibition is mediated between the motor cortices via the corpus callosum. AIMS To investigate motor excitability and interhemispheric (transcallosal) connections in patients with schizophrenia. METHOD Transcallosal inhibition and motor conduction parameters were investigated in ten patients with schizophrenia and in ten age- and gender-matched healthy subjects. RESULTS Transcallosal conduction time (TCT) and duration of the inhibition were significantly longer in patients with schizophrenia (mean (s.d.)): TCT, 12.4 (2.9) ms in normal subjects and 15.3 (2.6) ms in patients (P = 0.03); mean duration, 34.1 (4.9) ms in normal subjects and 51.9 (16.8) ms in patients (P = 0.01). CONCLUSIONS Magnetic motor conduction parameters are unaltered in schizophrenia, but transcallosal inhibition is significantly delayed and prolonged. This may indicate abnormal function of the corpus callosum in these patients.
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Affiliation(s)
- B Boroojerdi
- Department of Neurology, University Hospital, Aachen, Germany.
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Giedd JN, Blumenthal J, Jeffries NO, Rajapakse JC, Vaituzis AC, Liu H, Berry YC, Tobin M, Nelson J, Castellanos FX. Development of the human corpus callosum during childhood and adolescence: a longitudinal MRI study. Prog Neuropsychopharmacol Biol Psychiatry 1999; 23:571-88. [PMID: 10390717 DOI: 10.1016/s0278-5846(99)00017-2] [Citation(s) in RCA: 295] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. Interest in the morphologic development of the corpus callosum (CC) during childhood and adolescence stems from adolescent changes in cognitive functions subserved by the CC, reports of CC anomalies for a wide variety of childhood neuropsychiatric illnesses, and controversy regarding sexual dimorphism. 2. Characterization of the normal developmental pattern of the CC is hindered by enormous variability of its size. This is especially problematic for cross-sectional studies seeking to assess possible non-linear developmental curves. 3. To more accurately characterize developmental changes, a longitudinal brain magnetic resonance imaging study with subjects rescanned at approximately 2 year intervals was conducted resulting in 251 scans from 139 healthy children and adolescents. 4. Midsagittal area of the CC, especially the posterior regions, increased robustly from ages 5 to 18 years. 5. Although the genu of the CC was significantly larger in males there were no sex differences in mean area after adjustment for total cerebral volume and the growth patterns did not differ between sexes. 6. Analysis revealed a non-linear increase in the splenium, the most posterior region, with increases greatest in the younger years. 7. The results of this longitudinal study, in addition to confirming and extending previous cross-sectional reports, provide an increasingly accurate yardstick from which to assess pathological development.
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Affiliation(s)
- J N Giedd
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA.
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