Altered Relationships Between rCBF in Different Brain Regions of Never-Treated Schizophrenics

Summary

Aim of this study was to investigate the relations between regiona cerebral blood flow (rCBF) of different brain regions in acute schizophrenia and following neuroleptic treatment.

Methods: Twenty-two never-treated, acute schizophrenic patients were examined with HMPAO brain SPECT and assessed psychopathological-ly, and reexamined following neuroleptic treatment (over 96.8 days) and psychopathological remission. rCBF was determined by region/cerebel-lar count quotients obtained from 98 irregular regions of interest (ROIs), summed up to 11 ROIs on each hemisphere. In acute schizophrenics, interregional rCBF correlations of each ROI to every other ROI were compared to the interregional correlations following neuroleptic treatment and to those of controls.

Results: All significant correlations of rCBF ratios of different brain regions were exclusively positive in controls and patients. In controls, all ROIs of one hemisphere except the mesial temporal ROI correlated significantly to its contralateral ROI. Each hemisphere showed significant frontal-temporal correlations, as well as cortical-subcortical and some cortico-limbic. In contrast, in acute schizophrenics nearly every ROI correlated significantly with every other ROI, without a grouping or relation of the rCBF of certain ROIs as in controls. After neuroleptic treatment and clinical improvement, this diffuse pattern of correlations remained.

Conclusions: These results indicate differences in the neuronal interplay between regions in schizophrenic and healthy subjects. In never-treated schizophrenics, diffuse interregional rCBF correlations can be seen as a sign of change and dysfunction of the systems regulating specificity and diversity of the neuronal functions. Neuroleptic therapy and psychopathologic remission showed no normalizing effect on interregional correlations.

Zusammenfassung

Ziel der vorliegenden Studie war es, die Beziehungen zwischen den rCBF-Werten von verschiedenen Hirnregionen bei noch nie behandelten, floride psychotischen, schizophrenen Patienten vor und nach neuroleptischer Medikation mit denen von Kontrollen zu vergleichen.

Methode: Zweiundzwanzig erstmanifeste Patienten wurden drug-naiv und nach neuroleptischer Medikation (96,8 Tage) und klinischer Besserung mit HMPAO-SPECT sowie psychiatrisch untersucht. rCBF wurde durch 98 ROIs, die zu je 11 Summen-ROIs auf jeder Hemisphäre zusammengefaßt wurden, durch Normierung auf das Zerebellum ausgewertet. Die interregionalen rCBF-Korrelationen von jeder Summen-ROI zu allen anderen Summen-ROIs der floriden Schizophrenen wurden verglichen vor und nach Therapie sowie mit dem Kontrollkollektiv (n = 20).

Ergebnisse: Alle signifikanten rCBF-Korrelationen waren bei Patienten und Kontrollen positiv. Bei den Kontrollen korrelierte der rCBF jeder Summen-ROI einer Hemisphäre mit Ausnahme der mesial temporalen signifikant zur korrespondierenden kontralateralen ROI. Weiterhin zeigten sich signifikante rCBF-Korrelationen frontal-temporal, kortikal-subkortikal sowie auch einige kortiko-limbische innerhalb der jeweiligen Hemisphäre. Im Gegensatz dazu korrelierte bei floriden Schizophrenen der rCBF praktisch jeder Summen-ROI mit allen anderen. Eine Gruppierung des rCBF nur bestimmter Regionen wie bei den Kontrollen war nicht zu erkennen. Auch nach neuroleptischer Therapie und klinischer Besserung änderte sich dieses diffuse Korrelationsmuster nicht.

Schlußfolgernd zeigen diese Resultate Unterschiede im neuronalen Netzwerk verschiedener Hirnregionen zwischen Schizophrenen und Kontrollen, was als Dysfunktion der die Spezifität und Vielfalt der neuronalen Funktionen regulierenden Systeme gedeutet wird. Erstmalig wurde gezeigt, daß kein normalisierender Effekt einer neuroleptischen Behandlung und klinischen Besserung auf die diffusen Interkorrelationen besteht.

Keywords

HMPAO brain SPECT - rCBF - never-treated schizophrenics - PANSS - neuroleptic treatment - interregional correlations

Schlüsselwörter

HMPAO-Hirn-SPECT - rCBF - drug-naive Schizophrene - PANSS - neuroleptische Behandlung - interregionale Korrelationen

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