Ventricular enlargement in poor-outcome schizophrenia

Area of Science:

• Neuroscience
• Psychiatry
• Radiology

Background:

• Schizophrenia can present a degenerative (Kraepelinian) course in a subset of patients, characterized by severe self-care deficits.
• Brain structural changes, specifically ventricular enlargement, may serve as an objective marker for this degenerative course.

Purpose of the Study:

• To investigate if patients with the Kraepelinian subtype of schizophrenia exhibit a differential increase in brain ventricular size over time.
• To determine if ventricular enlargement, measured by computed tomography (CT), correlates with the phenomenological definition of the Kraepelinian subtype.

Main Methods:

• Fifty-three male patients diagnosed with chronic schizophrenia were divided into Kraepelinian (n=22) and non-Kraepelinian (n=31) subgroups based on longitudinal self-care and functional criteria.
• Two CT scans were performed on participants at intervals exceeding 4 years (average 5 years).
• Ventricular size was measured using a semiautomated computer program by blinded raters.

Main Results:

• The Kraepelinian subgroup demonstrated a significant bilateral increase in ventricular size over the 4-year interval, more pronounced in the left hemisphere.
• In contrast, the non-Kraepelinian subgroup and normal elderly volunteers showed no significant changes in ventricular size between scans.
• These findings suggest a progressive brain structural change specifically in the Kraepelinian subtype of schizophrenia.

Conclusions:

• The study provides evidence that the Kraepelinian subtype of schizophrenia, defined by severe longitudinal self-care deficits, is associated with an independent indicator of progressive brain abnormality.
• Ventricular enlargement over time serves as a structural correlate for the degenerative course observed in this patient subgroup.