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A Magnetic Resonance Imaging Study

Robin G. McCreadie, DSc, MD, FRCPsych; Rangaswamy Thara, MD, PhD; Ramachandran Padmavati, MD; Tirupati N. Srinivasan, MD; Sandeep D. Jaipurkar, MD

Arch Gen Psychiatry. 2002;59:332-336.

Background  In south India, abnormal movements indistinguishable from tardive dyskinesia have been observed in chronically ill patients with schizophrenia who have never received antipsychotic medication. The present study, using magnetic resonance imaging, examines brain structure in such patients, in those without dyskinesia, and in normal control subjects.

Methods  Chronically ill patients with schizophrenia with and without dyskinesia and controls were identified in villages south of Chennai, India (each group, n = 31). Patients' mental state was assessed by the Positive and Negative Syndrome Scale for schizophrenia, dyskinesia by the Abnormal Involuntary Movements Scale, and parkinsonism by the Simpson and Angus scale. In patients and controls, magnetic resonance imaging measured the volume of the caudate and lentiform nuclei and the lateral ventricle-hemisphere ratio.

Results  The left lentiform nucleus was significantly (11%) larger in patients with dyskinesia compared with controls, and the right lateral ventricle-hemisphere ratio was significantly (33%) larger in patients without dyskinesia compared with controls. In all 3 groups, there were significant positive correlations between age and ventricle-hemisphere ratio. In controls, but not in patients, there were significant negative correlations between age and the volume of the caudate and lentiform nuclei.

Conclusions  Never-treated patients with dyskinesia may have striatal pathologic conditions and may represent a subgroup of patients with schizophrenia; in those without abnormal movements, cortical atrophy is more apparent. The schizophrenic process may interfere with normal age-related anatomical changes in the basal ganglia.

From the Department of Clinical Research, Crichton Royal Hospital, Dumfries, Scotland (Dr McCreadie); and the Schizophrenia Research Foundation (Drs Thara, Padmavati, and Srinivasan) and Department of Neuroradiology, Vijaya Medical Centre (Dr Jaipurkar), Chennai, India.

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