Structural and Functional Correlates of Subsyndromes in Chronic Schizophrenia

Abstract

Recent psychopathological studies consistently identified a delusional, a negative, and a disorganized subsyndrome in chronic schizophrenia. The aim of our studies was to investigate the subsyndromes with respect to their underlying cerebral changes using computed tomography (CT) and positron emission tomography (PET). In a CT study 50 DSM III schizophrenics were subgrouped according to four factors identified by a factor analysis of BPRS ratings. This procedure identified three chronic clusters (delusional ideation, negative symptoms, and disorganization) and one cluster with a remitting course of the disorder. Both the negative and the delusional subsyndrome were associated with a widening of the frontal interhemispheric fissure. Disorganization was associated with neurological soft signs, an increased ventricle brain ratio, and width of the 3rd ventricle. The same subgrouping was applied in a 18F-deoxyglucose PET study of 79 neuroleptic free DSM III schizophrenic patients and 47 healthy controls. The delusional subsyndrome was associated with a decreased hippocampal function, while the negative subsyndrome showed a prominent hypofrontality and left temporal cortex changes. Both the delusional and the negative subsyndrome were associated with a decreased activity in the medial frontal gyms in comparison to the other schizophrenic patients and the healthy controls. The disorganized subsyndrome was characterized by an overactivity in the parietal cortex and motor strip and a decreased activity in the corpus callosum. These findings support the differentiation of three subsyndromes in chronic schizophrenia. The subsyndromes seem to be characterized by deviant patterns of cerebral alterations, rather than deficits in a single location.

DRD4 exon 3 variants associated with delusional symptomatology in major psychoses: A study on 2,011 affected subjects

“…The factor composition is as follows: excitement (items: excessive activity, reduced need for sleep, pressured speech, elevated mood, thoughts racing, increased sociability, increased self‐esteem, irritable mood, distractibility, agitated activity, dysphoria, grandiose delusions, reckless activity), depression (items: loss of pleasure, loss of energy/tiredness, diminished libido, excessive self‐reproach, slowed activity, poor appetite, poor concentration, suicidal ideation, weight loss, diurnal variation, early morning waking, delusions of guilt), delusion (items: persecutory delusions, well‐organized delusions, delusions of influence, widespread delusions, primary delusional perception, delusions and hallucinations lasting for 1 week, persecutory/jealous delusions and hallucinations, thought insertion, thought withdrawal, thought broadcast, third‐person auditory hallucinations), disorganization (items: speech difficult to understand, incoherent, positive formal thought disorder, inappropriate affect, bizarre behavior, bizarre delusions), and negative (items: blunted affect, negative formal thought disorder, restricted affect, catatonia). The factors resulted stable after enlargement of the sample including the present one (data not shown) and are coherent with previous analyses [Liddle, 1987; Peralta et al, 1992; Andreasen et al, 1995; Cuesta and Peralta, 1995; Maziade et al, 1995; Schroder et al, 1995]. The fifth factor was included in order to allow comparisons with previous findings [Cardno et al, 1996].…”

Correlates of Symptom Dimensions in Schizophrenia Obtained with the Spanish Version of the Manchester Scale

“…Total positive, disorganization and negative factor scores were not significantly correlated with any CT measurement. Our findings do not support the hypothesis that severity of symptom dimensions is positively correlated with structural brain abnormalities measured by CT [26][27][28], and no clear conclusion can be reached for the moment [20,[29][30][31][32][33].…”

Magnetic Resonance Imaging in Studying Schizophrenia, Negative Symptoms, and the Glutamate System

“…Several studies have shown a reduced activation of the prefrontal cortex in schizophrenic patients with negative symptoms (25, 31–33). This principal finding of “hypofrontality” associated with negative symptoms has been confirmed by later studies though for different subregions of the prefrontal cortex.…”