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Structural Brain Differences Between Never-Treated Patients With Schizophrenia, With and Without Dyskinesia, and Normal Control Subjects
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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