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Am J Psychiatry 1993; 150:1325-1336
Copyright © 1993 by American Psychiatric Association
Cortical-striatal-thalamic circuits and brain glucose metabolic activity in 70 unmedicated male schizophrenic patients
BV Siegel Jr, MS Buchsbaum, WE Bunney Jr, LA Gottschalk, RJ Haier, JB Lohr, S Lottenberg, A Najafi, KH Nuechterlein and SG Potkin
Department of Psychiatry, Mt. Sinai School of Medicine, Bronx, N.Y.
OBJECTIVE: The cortical-striatal-thalamic circuit modulates cognitive
processing and thus may be involved in the cognitive dysfunction in
schizophrenia. The imaging of metabolic rate in the structures making up
this circuit could reveal the correlates of schizophrenia and its main
symptoms. METHOD: Seventy male schizophrenic patients underwent
[18F]-fluorodeoxyglucose positron emission tomography after a period of at
least 4 weeks during which they had not received neuroleptic medication and
were compared to 30 age-matched male normal comparison subjects. RESULTS:
Analyses revealed decreased metabolism in medial frontal cortex, cingulate
gyrus, medial temporal lobe, corpus callosum, and ventral caudate and
increased metabolism in the left lateral temporal and occipital cortices in
the schizophrenic cohort. Consistent with previous studies, the
schizophrenic group had lower hypofrontality scores (ratios of lateral
frontal to occipital metabolism) than did comparison subjects. The lateral
frontal cortical metabolism of schizophrenic patients did not differ from
that of comparison subjects, while occipital cortical metabolism was high,
suggesting that lateral hypofrontality is due to abnormalities in occipital
rather than lateral frontal activity. Hypofrontality was more prominent in
medial than lateral frontal cortex. Brief Psychiatric Rating Scale (BPRS)
scores, obtained for each schizophrenic patient on the scan day, were
correlated with regional brain glucose metabolic rate. Medial frontal
cortical and thalamic activity correlated negatively with total BPRS score
and with positive and negative symptom scores. Lateral frontal cortical
metabolism and hypofrontality scores did not significantly correlate with
negative symptoms. Analyses of variance demonstrated a reduced right
greater than left asymmetry in the schizophrenic patients for the lateral
cortex as a whole, with simple interactions showing this effect
specifically in temporal and frontal cortical regions. CONCLUSIONS: Low
metabolic rates were confirmed in medial frontal cortical regions as well
as in the basal ganglia, consistent with the importance of the
cortical-striatal-thalamic pathways in schizophrenia. Loss of normal
lateralization patterns was also observed on an exploratory basis.
Correlations with negative symptoms and group differences were more
prominent in medial than lateral frontal cortex, suggesting that medial
regions may be more important in schizophrenic pathology.
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