Ventricular Enlargement in Poor-Outcome Schizophrenia

• Published in: Biological psychiatry (1969) 1998-06, Vol.43 (11), p.783-793
• Main Authors: Davis, Kenneth L, Buchsbaum, Monte S, Shihabuddin, Lina, Spiegel-Cohen, Jacqueline, Metzger, Michael, Frecska, Ede, Keefe, Richard S, Powchik, Peter
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Atrophy; Biological and medical sciences; Brain - pathology; brain asymmetry; brain atrophy; Cerebral Ventricles - pathology; Chronic Disease; Cognition Disorders - diagnosis; Cognition Disorders - pathology; Dominance, Cerebral - physiology; Follow-Up Studies; Humans; Kraepelinian subtype; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neurocognitive Disorders - diagnosis; Neurocognitive Disorders - pathology; Neurodegenerative Diseases - diagnosis; Neurodegenerative Diseases - pathology; Prognosis; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - pathology; skull size; temporal lobe; Tomography, X-Ray Computed
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(97)00553-2

Background: A subset of patients with schizophrenia, defined on the basis of longitudinal deficits in self-care, may show a classic (“Kraepelinian”) degenerative course. An independent validator of the phenomenologically defined Kraepelinian subtype might be provided by a structural indicator of possible brain degeneration: ventricular size as measured by computed tomography (CT). Methods: To examine whether Kraepelinian patients would show a differential increase in ventricular size over time, two CT scans were conducted at intervals separated by >4 years, an average of 5 years. Fifty-three male patients with DSM-III-R diagnoses of chronic schizophrenia were subdivided into Kraepelinian ( n = 22; mean age = 42 ± 8.6 years) and non-Kraepelinian ( n = 31; mean age = 38 ± 12.2 years) subgroups. Kraepelinian patients were defined on the basis of longitudinal criteria: >5 years of complete dependence on others for life necessities and care, lack of employment, and sustained symptomatology. Thirteen normal elderly volunteers (mean age = 60 ± 17.8) were also scanned at 4-year intervals. CT measurements were made by raters without knowledge of subgroup membership. A semiautomated computer program was used to trace the anterior horn, lateral ventricles, and temporal horns for each slice level on which they were clearly seen. Results: The ventricles showed a bilateral increase in size over the 4-year interval in the Kraepelinian subgroup, more marked in the left hemisphere than the right. By contrast, neither the non-Kraepelinian subgroup nor the normal volunteers showed significant CT changes from scan 1 to scan 2. Conclusions: Thus, the longitudinal dysfunctions in self-care that characterize the Kraepelinian patients were associated with an independent indicator of brain abnormality.