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Progressive Ventricular Change During Adolescence

Judith L. Rapoport, MD; Jay Giedd, MD; Sanjiv Kumra, MD; Leslie Jacobsen, MD; Amy Smith; Paul Lee; Jean Nelson, MHS; Susan Hamburger, MS

Arch Gen Psychiatry. 1997;54(10):897-903.

Abstract
Background
There is controversy about progression in brain abnormalities in later-onset schizophrenia. This study looked for more striking progression in brain abnormalities during adolescence in a chronically ill, treatment-refractory sample of patients with childhood-onset schizophrenia who had had more prepsychotic developmental disturbance, but clinical and neurobiological characteristics similar to those of patients with treatment-refractory adult-onset schizophrenia who have poor outcome.

Methods
Anatomic brain magnetic resonance images were obtained for 16 children and adolescents with onset of schizophrenia by 12 years of age and 24 temporally yoked, age- and sex-matched healthy controls. Subjects were scanned on initial admission and rescanned after 2 years with the identical equipment and measurement methods.

Results
Childhood schizophrenics showed a significantly greatenr increase in ventricular volume than did controls, for whom ventricles did not increase significantly (analysis of variance, diagnosisx time, F=16.1, P<.001). A significant decrease in midsagittal thalamic area was also seen for the schizophrenics (P=.03), which was unchanged at rescan for controls. These differential brain changes correlated significantly with each other and tended to be predicted by both prepsychotic developmental abnormality (Premorbid Assessment Scale, P=.06) and Brief Psychiatric Rating Scale at follow-up (P=.07).

Conclusions
More consistent progressive ventricular enlargement was seen during adolescence for this childhood-onset sample than has been reported for adultonset populations. The brain imaging results support other clinical data showing both early and late deviations in brain development for at least this rare subgroup of treatment-refractory, very-early-onset schizophrenic patients.

Author Affiliations
From the Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md.

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