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Relationship to Symptoms and Clinical Subtype

Bruce Turetsky, MD; Patricia E. Cowell, PhD; Ruben C. Gur, PhD; Robert I. Grossman, MD; Derri L. Shtasel, MD; Raquel E. Gur, MD, PhD

Arch Gen Psychiatry. 1995;52(12):1061-1070.

Abstract
Background
Quantitative magnetic resonance imaging (MRI) studies demonstrate reduced brain volumes in schizophrenics, but specific structural abnormalities have not been clearly delineated. The structural abnormalities of this disorder are likely to be heterogeneous, consistent with its diverse clinical presentation. To investigate the relationship between structural abnormality and clinical symptoms, we examined regional brain and cerebral spinal fluid (CSF) volumes in a large sample of schizophrenic patients and controls, with patients aggregated into clinical subtypes.

Methods
Right and left hemisphere frontal and temporal lobe brain and CSF volumes were quantified from 5-mm axial spin-echo MRIs for 71 schizophrenic patients and 77 age- and sex-matched controls. The following four standardized rating scales were used to assess symptom severity: Negative Symptoms, Disorganization, Schneiderian Delusions and Hallucinations, and Suspicion-Hostility. Patients were also subtyped as either deficit or nondeficit on the basis of enduring negative symptoms.

Results
Schizophrenic patients overall exhibited ab-a normal brain asymmetry, with selective decrease in brain volume in the left temporal and right frontal regions. Left temporal lobe parenchymal volume reduction and CSF volume increase were correlated with the severity of negative symptoms. Consistent with this, the subtype analysis revealed abnormal temporal lobe asymmetry for the deficit subgroup only. Right frontal lobe volume reduction correlated with the duration of illness, independent of symptom severity or schizophrenic subtype.

Conclusions
Abnormal lateral asymmetry suggests selective structural deficits in schizophrenia, rather than diffusely undifferentiated CNS abnormalities. The pattern of regional abnormalities is related to clinical symptoms, with negative symptoms being associated with left temporal lobe rather than frontal lobe abnormality. This is consistent with suggestions of a temporolimbic prefrontal network abnormality in schizophrenia. Further longitudinal studies are warranted, using higherresolution MRI technology and gray matter—white matter segmentation to confirm and extend these findings.

Author Affiliations
From the Departments of Psychiatry (Drs Turetsky, Cowell, R. C. Gur, Shtasel, and R. E. Gur) and Radiology (Dr Grossman), University of Pennsylvania, Philadelphia.

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