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Am J Psychiatry 1994; 151:343-350
Copyright © 1994 by American Psychiatric Association
Clinical subtypes of schizophrenia: differences in brain and CSF volume
RE Gur, PD Mozley, DL Shtasel, TD Cannon, F Gallacher, B Turetsky, R Grossman and RC Gur
Department of Psychiatry, University of Pennsylvania, Philadelphia 19104.
OBJECTIVE: Investigations of the relation of clinical features of
schizophrenia to neuroanatomic measures have produced inconclusive results.
The purpose of this study was to examine measures of whole- brain volume in
men and women and relate them to clinical subtypes of schizophrenia.
METHOD: Magnetic resonance imaging measures of cranial, brain, and
ventricular and sulcal CSF volume were examined in 81 patients with
schizophrenia (50 men and 31 women), divided into subgroups based on their
symptom profiles, and 81 demographically matched healthy comparison
subjects. RESULTS: The men had higher cranial and brain volumes than the
women. The patients had smaller cranial and brain volumes than the
comparison subjects; they also had higher ventricular CSF volumes and thus
higher ventricle-brain ratios (VBRs). Ratio elevations were larger for the
female than for the male schizophrenic patients. The patients with
predominantly negative symptoms of schizophrenia had higher VBRs and sulcal
CSF-brains ratios than the comparison subjects, although the component
volumes did not differ. The patients with predominantly Schneiderian
symptoms had higher VBRs than the comparison subjects but showed reduced
cranial and brain volumes. The paranoid patients had normal VBRs, reduced
sulcal CSF-brain ratios, and lower cranial and sulcal CSF volumes.
CONCLUSIONS: The results suggest two patterns of neuroanatomic whole- brain
abnormalities that differ in severity according to the relative prominence
of negative, Schneiderian, and paranoid symptoms. These patterns may
reflect differential involvement of dysgenic and atrophic
pathophysiological processes. Sex moderates abnormalities in the
neuroanatomic features of schizophrenia.
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