Single‐Photon Emission Computed Tomography of the Brain in Acute Mania and Schizophrenia

Abstract

Single-photon emission computed tomography (SPECT) imaging with n-isopropyliodoamphetamine (IMP) was performed on 11 patients with bipolar mania, 21 acute schizophrenics, and 15 healthy control subjects. Subjects were evaluated with neuropsychological tests and psychiatric rating scales. SPECT brain studies were blindly evaluated to assess the degree of radiopharmaceutical uptake in three neuroanatomical regions of interest in each hemisphere. All the control subjects, 1 manic patient, and 1 schizophrenic patient had normal brain SPECT uptake patterns. The scans of all others were read as abnormal. Hypofrontality was noted in some schizophrenics and maniacs. A significant increase in tracer uptake in temporal lobes was observed in both patient groups, more prominently in the manic patients. Increased and decreased basal ganglia uptake was also observed in patients. Both manic and schizophrenic patients showed cortical tracer heterogeneity of varying degree. The patterns of cerebral SPECT uptake seen in these acute psychoses were not specific for a diagnosis, but may be associated with dimensions of psychopathology. Because the patterns are different from those seen in cerebrovascular disease and the dementias, they may prove to be helpful in differential diagnosis.

The dual origin hypothesis: An evolutionary brain-behavior framework for analyzing psychiatric disorders

“…Although data in primary mania is limited, a number of functional imaging studies have demonstrated state-dependent focal abnormalities in cerebral blood flow/metabolism (AlMousawi et al, 1996;Blumberg et al, 2000;Blumberg et al, 1999;Goodwin et al, 1997;Gyulai et al, 1997;Migliorelli et al, 1993;Nobler et al, 1994;O'Connell et al, 1995;Rubin et al, 1995). Broadly consistent with the literature on secondary mania, altered temporal lobe activity has been reported in several functional imaging studies of primary mania.…”

Executive Function in Patients with Remitted Bipolar Disorder and Schizophrenia and Its Relationship with Functional Outcome

“…Both groups were compared with respect to executive functioning. Similar levels of cognitive impairment would be expected in mania and acute schizophrenia, since some overlapping has also been observed with respect to clinical symptomatology or neuroimaging findings in these states [4, 19, 24, 25], in spite of contradictions of several investigations [26, 27]. Nevertheless, less attention has been paid to the most extreme positions of the postulated common pathway between schizophrenia and bipolar disorder, such as remitted bipolar patients and negative schizophrenics.…”

The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings

“…However, after adjusting for hemispheric metabolism, which was also decreased in depression, the specific regional specificity in the striatum was less clear. O'Connell et al 72 reported increased blood flow in the basal ganglia, with right-sided flow greater than left, in bipolar patients during mania. Blumberg et al 64 partially replicated this finding as they observed increased blood flow in the left head of the caudate in manic compared with healthy subjects.…”