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Lateral ventricular size in schizophrenia: relationship to the disease process and its clinical manifestations

Published online by Cambridge University Press:  09 July 2009

D. G. C. Owens*
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
E. C. Johnstone
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
T. J. Crow
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
C. D. Frith
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
J. R. Jagoe
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
L. Kreel
Affiliation:
Division of Psychiatry and the Division of Computing and Statistics, Clinical Research Centre, Harrow Middlesex, and the Department of Radiology, Newham District General Hospital, London
*
1 Address for correspondence: Dr D. G. C. Owens, Division of Psychiatry, Clinical Research Centre, Watford Road, Harrow, Middlesex, HAI 3UJ.

Synopsis

Using computed tomography, lateral ventricular size was studied in a sample of 112 institutionalized chronic schizophrenic patients (selected from 510 cases to investigate the correlates of the defect state and intellectual decline and the effects of insulin, electroconvulsive and neuroleptic treatment), and compared with matched groups of non-institutionalized schizophrenics, patients with first schizophrenic episodes, institutionalized and non-institutionalized patients with primary affective disorder, and neurotic out-patients. Age was significantly correlated (P < 0·0002) with lateral ventricular size, but the institutionalized schizophrenic patients had significantly larger (P < 0·025) lateral ventricles than the neurotics when age was taken into account. Ventricular enlargement was unrelated to past physical treatment (neuroleptics, insulin coma and electroconvulsive therapy).

Within the group of institutionalized schizophrenic patients few correlates of ventricular enlargement were identified; thus in this population increased ventricular size was not clearly associated with the features of the defect state (negative symptoms and intellectual impairment). however, there was a curvilinear (inverted-U) relationship between intellectual function and ventricular size was significantly related to absence of hallucinations, impairment of social behaviour, inactivity and the presence of abnormal involuntary movements.

The findings confirm that structural brain changes do occur in chronic schizophrenia, but illustrate some of the difficulties in elucidating the clinical significance of ventricular enlargement. Lateral not bimodal; the relationship to particular features of the disease is complex and likely to emerge only in studies with a large sample size.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1985

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References

American Psychiatrie Association (1979). Report of the Task Force on Late Neurological Effects of Antipsychotic Drugs. APA: Washington, D.C.Google Scholar
Andreasen, N. C., Olsen, S. A., Dennert, J. W. & Smith, M. R. (1982). Ventricular enlargement in schizophrenia: relationship to positive and negative symptoms. American Journal of Psychiatry 139, 297302.Google ScholarPubMed
Asano, N. (1967). Pneumoencephalographic study of schizophrenia. In Clinical Genetics in Psychiatry (ed. Mitsuda, N.), pp. 209219. Igaku-Shoin: Tokyo.Google Scholar
Barron, S. A., Jacobs, L. & Kinkel, W. R. (1976). Changes in size of normal lateral ventricles during aging determined by computerized tomography. Neurology (Minneapolis) 26, 10111013.CrossRefGoogle ScholarPubMed
Benes, F., Sunderland, P., Jones, B. D., Le May, M., Cohen, B. M. & Lipinski, J. F. (1982). Normal ventricles in young schizophrenics. British Journal of Psychiatry 141, 9093.CrossRefGoogle ScholarPubMed
Broser, K. (1949). Brain weight and brain processes in schizophrenia. Archiv fur Psychiatrie und Zeitschrift Neurologie 182, 439444.CrossRefGoogle Scholar
Campbell, R., Hay, P., Russell, D. B. & Zacks, D. J. (1979). CT scan variants and genetic heterogeneity in schizophrenia. American Journal of Psychiatry 136, 722723.Google ScholarPubMed
Corsellis, J. A. N. (1976). Psychoses of obscure pathology. In Greenfield's Neuropathology (ed. Blackwood, H. and Corsellis, J. A. N.), pp. 903915. Arnold: London.Google Scholar
Crow, T. J. (1980). Molecular pathology of schizophrenia: more than one disease process? British Medical Journal 280, 6668.CrossRefGoogle ScholarPubMed
Crow, T. J. (1982). Institutionalisation and the defects of schizophrenia. British Journal of Psychiatry 140, 212213.CrossRefGoogle Scholar
Crow, T. J., Johnstone, E. C. & Owen, F. (1979). Research on schizophrenia. In Recent Advances in Clinical Psychiatry, Vol. 3 (ed. Granville-Grossman, K.), pp. 136. Churchill Livingstone: London.Google Scholar
Crow, T. J., Cross, A. J., Johnstone, E. C. & Owen, F. (1982). Two syndromes in schizophrenia and their pathogenesis. In Schizophrenia as a Brain Disease (ed. Henn, F. A. and Nasrallah, H. A.), pp. 196234. Oxford University Press: Oxford.Google Scholar
David, G. B. (1957). The pathological anatomy of the schizophrenias. In Schizophrenia: Somatic Aspects (ed. Richter, D.), pp. 93130. Pergamon: New York.Google Scholar
Donnelly, E. F., Weinberger, D. R., Waldman, I. N. & Wyatt, R. J. (1980). Neuropsychological prediction of structural brain abnormalities on computed tomography in a group of chronic schizophrenic patients. Journal of Nervous and Mental Disease 168, 305308.CrossRefGoogle Scholar
Donovan, J. F., Galbraith, A. J. & Jackson, H. (1949). Some observations on leucotomy and investigations by pneumoencephalography. Journal of Mental Science 95, 655666.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, A., Winokur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.CrossRefGoogle ScholarPubMed
Friedberg, J. (1977). Shock treatment, brain damage and memory loss: a neurological perspective. American Journal of Psychiatry 134, 10101014.Google ScholarPubMed
Golden, C. J., Moses, J. A., Zelazowski, R., Graber, B., Zatz, L. M., Horvath, T. B. & Berger, P. A. (1980). Cerebral ventricular size and neuropsychological impairment in young chronic schizophrenics. Archives of General Psychiatry 37, 619623.CrossRefGoogle ScholarPubMed
Gross, G., Huber, G. & Schuttler, R. (1982). Computerised tomography studies in schizophrenic diseases. Archiv für Psychiatrie und Nervenkrankheiten 231, 519526.CrossRefGoogle ScholarPubMed
Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology, pp. 534537. Department of Health, Education and Welfare: Washington D.C.Google Scholar
Haug, J. O. (1962). Pneumoencephalographic studies in mental disease. Acta Psychiatrica Scanainavica 38, Suppl. 165.Google ScholarPubMed
Hay, P. (1977). Electroencephalographic variants and genetic predisposition to schizophrenia. Journal of Neurology, Neurosurgery and Psychiatry 40, 753755.Google Scholar
Huber, G. (1957). Pneumoencephalographische und Psychopalhologische Bilder Bei Endogen Psychosen. Springer-Verlag: Berlin.Google Scholar
Jacobi, W. & Winkler, H. (1927). Encephalographische Studien an chronisch Schizophrenen. Archiv für Psychiatrie und Nervenkrankheiten 81, 299332.CrossRefGoogle Scholar
Jacoby, R. & Levy, R. (1980). Computed tomography in the elderly: III. Affective disorder. British Journal of Psychiatry 136, 270275.CrossRefGoogle Scholar
Jellinek, E. H. (1976). Cerebral atrophy and cognitive impairment in chronic schizophrenia. Lancet ii, 12021203.CrossRefGoogle Scholar
Jernigan, T. L., Zatz, L. M., Moses, J. A. & Berger, P. A. (1982). Computed tomography in schizophrenics and normal volunteers. Archives of General Psychiatry 39, 765770.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Crow, T. J., Frith, C. D., Husband, J. & Kreel, L. (1976). Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet ii, 924926.CrossRefGoogle Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., Stevens, M., Kreel, L. & Husband, J. (1978). The dementia of dementia praecox. Acta Psychiatrica Scandinavica 57, 305324.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Owens, D. G. C., Gold, A., Crow, T. J. & Macmillan, J. F. (1981). Institutionalisation and the defects of schizophrenia. British Journal of Psychiatry 139, 195203.CrossRefGoogle ScholarPubMed
Johnstone, E. C., Owens, D. G. C., Gold, A., Macmillan, J. F. & Crow, T. J. (1982). A comparison between the outcome of severe schizophrenic and severe manic depressive illnesses. XIIIth CINP Congress Abstracts, p. 360.Google Scholar
Krawiecka, M., Goldberg, D. & Vaughan, M. (1977). A standardised psychiatric assessment for rating chronic psychotic patients. Acta Psychiatrica Scandinavica 55, 299308.CrossRefGoogle ScholarPubMed
Lader, M. H., Ron, M. & Petursson, H. (1984). Computed axial brain tomography in long term benzodiazepine users. Psychological Medicine 14, 203206.CrossRefGoogle ScholarPubMed
Levi, C., Gray, J. E., McCullough, E. C. & Hattery, R. R. (1982). The unreliability of CT numbers as absolute values. American Journal of Radiology 139, 443447.Google ScholarPubMed
Marks, V. & Rose, F. C. (1965). Hypoglycaemia. Blackwell Scientific: Oxford.Google ScholarPubMed
Marsden, C. D. (1976). Cerebral atrophy and cognitive impairment in chronic schizophrenia. Lancet ii, 1079.CrossRefGoogle Scholar
Meddis, R. (1980). Unified analysis of variance by ranks. British Journal of Mathematical and Statistical Psychology 33, 8498.CrossRefGoogle Scholar
Meese, W., Kluge, W., Grumme, T. & Hopfenmuller, W. (1980). CT evaluation of the CSF spaces of healthy persons. Neuroradioiogy 19, 131136.CrossRefGoogle ScholarPubMed
Mundt, C. H., Radii, W. & Gluck, E. (1980). Computertomographische Untersuchungen der Liquorraume an chronisch schizophrenen Patienten. Nervenarzt 51, 743748.Google Scholar
Nagy, K. (1963). Pneumoencephalographische Befunde bei endogen Psychosen. Nervenarzt 34, 543548.Google Scholar
Nasrallah, H. A., Jacoby, C. G., McCalley-Whitters, M. & Kuperman, S. (1982). Cerebral ventricular enlargement in subtypes of chronic schizophrenia. Archives of General Psychiatry 39, 773777.CrossRefGoogle ScholarPubMed
Nieto, D. & Escobar, A. (1972). Major psychoses. In Pathology of the Nervous System (ed. Minckler, J.), pp. 26542665. McGraw-Hill: New York.Google Scholar
Nyback, H., Wiesel, F. A., Berggren, B. M. & Hindmarsh, T. (1982). Computed tomography of the brain in patients with acute psychosis and in healthy volunteers. Acta Psychiatrica Scandinavica 65, 403414.CrossRefGoogle ScholarPubMed
Owens, D. G. C. & Johnstone, E. C. (1980). The disabilities of chronic schizophrenia: their nature and the factors contributing to their development. British Journal of Psychiatry 136, 384395.CrossRefGoogle Scholar
Owens, D. G. C., Johnstone, E. C., Bydder, G. M. & Kreel, L. (1980). Unsuspected organic disease in chronic schizophrenia demonstrated by computer tomography. Journal of Neurology, Neurosurgery and Psychiatry 43, 10651069.CrossRefGoogle Scholar
Owens, D. G. C., Johnstone, E. C. & Frith, C. D.(1982). Spontaneous involuntary disorders of movement in neuroleptic treated and untreated chronic schizophrenics – prevalence, severity and distribution. Archives of General Psychiatry 39, 452461.CrossRefGoogle Scholar
Pearlson, G. D. & Verloff, A. E. (1981). Computerised tomographic scan changes in manic depressive illness. Lancet ii, 470.CrossRefGoogle Scholar
Penn, R. D., Belanger, M. G. & Yasnoff, W. A. (1978). Ventricular volume in man computed from CAT scans. Annals of Neurology 3, 216223.CrossRefGoogle ScholarPubMed
Reveley, A. M., Reveley, M. A. & Murray, R. M. (1983). Enlargement of cerebral ventricles in schizophrenics is confined to those without known genetic predisposition. Lancet ii, 525.CrossRefGoogle Scholar
Rieder, R. O., Donnelly, E. F., Herdt, J. R. & Waldman, I. N. (1979). Sulcal prominence in young chronic schizophrenic patients: CT scan findings associated with impairment on neuropsychological tests. Psychiatry Research 1, 18.CrossRefGoogle ScholarPubMed
Rieder, R. O., Mann, L. S., Weinberger, D. R., van Kammen, D. P. & Post, R. M. (1983). Computed tomographic scans in patients with schizophrenia, schizoaffective and bipolar affective disorder. Archives of General Psychiatry 40, 735739.CrossRefGoogle ScholarPubMed
Ron, M. A., Acker, W., Shaw, G. K. & Lishman, W. A. (1982). Computerised tomography of the brain in chronic alcoholism – a survey and follow-up study. Brain 105, 497514.CrossRefGoogle ScholarPubMed
Simpson, G. M., Lee, L. H., Zoubok, B. & Gardos, G. (1979). A rating scale for tardive dyskinesia. Psychopharmacology 64, 171179.CrossRefGoogle ScholarPubMed
Standish-Barry, H. M. A. S., Bouras, N., Bridges, P. K. & Bartlett, J. R. (1982). Pneumoencephalographic and computerised axial tomography scan changes in affective disorder. British Journal of Psychiatry 141, 614617.CrossRefGoogle ScholarPubMed
Stevens, J. (1982). Neuropathology of schizophrenia. Archives of General Psychiatry 39, 11311139.CrossRefGoogle ScholarPubMed
Storey, P. B. (1966). Lumbar air encephalography in chronic schizophrenia: a controlled experiment. British Journal of Psychiatry 112, 135144.CrossRefGoogle ScholarPubMed
Takahashi, R., Inanaga, V., Kato, N., Kumashiro, H., Nishimura, T., Okuma, T., Otsuki, S., Sakai, T., Sato, T. & Shimazono, Y. (1981). CT scanning and the investigation of schizophrenia. In Biological Psychiatry 1981 (ed. Perris, C.Struwe, G.Jansson, B.), pp. 259268. Elsevier: Amsterdam.Google Scholar
Weinberger, D. R., Torrey, E. F., Neophytides, N. & Wyatt, R. J. (1979). Lateral cerebral ventricular enlargement in chronic schizophrenia. Archives of General Psychiatry 36, 735739.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Bigelow, L. I. B., Kleinman, J. E., Klein, S. T., Rosenblatt, J. E. & Wyatt, R. J. (1980 a). Cerebral ventricular enlargement in chronic schizophrenia: an association with poor response to treatment. Archives of General Psychiatry 37, 11 13.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Cannon-Spoor, E., Potkin, S. G. & Wyatt, R. J. (1980 b). Poor premorbid adjustment and CT scan abnormalities in chronic schizophrenia. American Journal of Psychiatry 137, 14101413.Google ScholarPubMed
Weinberger, D. R., De Lisi, L. E., Perman, G., Targum, S. & Wyatt, R. J. (1982). CT scans in schizophreniform disorder and other acute psychiatric patients. Archives of General Psychiatry 39, 778783.CrossRefGoogle Scholar
Weinberger, D. R., Wagner, R. L. & Wyatt, R. J. (1983). Neuro-pathological studies of schizophrenia: a selective review. Schizophrenia Bulletin 9, 193212.CrossRefGoogle Scholar
Wildi, E., Linder, A. & Costoulas, G. (1967). Schizophrenie et involution cerebrale senile. Psychiatry and Neurology 154, 126.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Withers, E. & Hinton, J. (1971). Three forms of the clinical tests of the sensorium and their reliability. British Journal of Psychiatry 119, 18.CrossRefGoogle ScholarPubMed
Zatz, L. M., Jernigan, T. J. & Ahumada, A. J. Jr (1982). Changes on computed cranial tomography with aging: intracranial fluid volume. American Journal of Neuroradiology 3, 111.Google ScholarPubMed