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The spectrum of structural brain changes in schizophrenia: age of onset as a predictor of cognitive and clinical impairments and their cerebral correlates

Published online by Cambridge University Press:  09 July 2009

E. C. Johnstone ,
D. G. C. Owens ,
G. M. Bydder ,
N. Colter ,
T. J. Crow  and
C. D. Frith
E. C. Johnstone*
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
D. G. C. Owens
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
G. M. Bydder
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
N. Colter
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
T. J. Crow
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
C. D. Frith
Affiliation:
Division of Psychiatry, Clinical Research Centre, Harrow and Department of Magnetic Resonance Imaging, Royal Postgraduate Medical School, London
*
1Address for correspondence: Dr E. C. Johnstone, Department of Psychiatry, Clinical Research Centre, Watford Road, Harrow, Middlesex, HA1 3UJ.
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Synopsis

A range of cerebral structures was assessed in a series of 172 CT scans of groups of psychiatric patients (including 101 in-patients with chronic schizophrenia) and related to assessments of clinical state and psychological function. Ventricular indices were increased in patients with schizophrenia by comparison with patients with other psychiatric disorders: brain area, which is modestly positively correlated with ventricular indices, was significantly (P < 0·01) reduced in patients with schizophrenia. Among in-patients with chronic schizophrenia, measures of increased ventricular size were significantly associated with impaired social behaviour and with movement disorder. Memory for famous names in the distant past (a test of remote memory) was the only psychological test which showed significant associations with indices of ventricular size; this suggests that ventricular enlargement and its psychological sequelae occur relatively early in the disease process. Dichotomization of the sample of schizophrenic patients around the mean age of onset revealed that a range of clinical and psychological functions are significantly more abnormal in those with an early age of onset than in those in whom the onset was later. Early onset cases also perform less well academically and occupationally before illness onset. Within the early onset group some significant correlations between cognitive function and brain area were seen.

The findings suggest that: (i) some at least of the structural changes in schizophrenia arise at a time when the brain is still developing; and (ii) age of onset is an important determinant of social and intellectual impairment and is relevant to the relationship between brain structure and cognitive deficits.

Type
Research Article
Information
Psychological Medicine , Volume 19 , Issue 1 , February 1989 , pp. 91 - 103
Copyright
Copyright © Cambridge University Press 1989

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