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Frequency and severity of enlarged cavum septi pellucidi in childhood-onset schizophrenia
P C Nopoulos1, J N Giedd, N C Andreasen
1Mental Health Clinical Research Center, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Insights
Childhood-onset schizophrenia patients show significantly more enlarged cavum septi pellucidi (CSP) than healthy children. This suggests more severe brain developmental anomalies in early-onset schizophrenia, supporting neurodevelopmental models.
Area of Science:
- Neuroscience
- Psychiatry
- Developmental Biology
Background:
- Enlarged cavum septi pellucidi (CSP) is more frequent in schizophrenia patients.
- Neurodevelopmental models link brain dysgenesis severity to earlier symptom onset in schizophrenia.
Purpose of the Study:
- To test the hypothesis that more severe brain dysgenesis correlates with earlier schizophrenia onset.
- To investigate the prevalence and severity of cavum septi pellucidi (CSP) anomalies in childhood-onset schizophrenia.
Main Methods:
- Compared MRI scans of healthy volunteers (N=95) and childhood-onset schizophrenia patients (N=24).
- Blindly rated the size of the cavum septi pellucidi (CSP), defining abnormal enlargement as >6 mm.
- Assessed the frequency and severity of CSP anomalies in both groups.
Main Results:
- Significantly higher frequency of enlarged CSP in childhood-onset schizophrenia patients (12.5%) versus healthy controls (1.1%).
- Two of three patients with enlarged CSP exhibited complete septal leaflet nonfusion, a severe anomaly.
- These severe anomalies were more pronounced than those typically seen in adult-onset schizophrenia.
Conclusions:
- Childhood-onset schizophrenia is associated with more severe developmental brain anomalies, specifically enlarged cavum septi pellucidi.
- Findings support the neurodevelopmental hypothesis linking brain dysgenesis severity to earlier psychosis onset.
Objective:
Patients with schizophrenia have been reported to have a higher frequency of enlarged cavum septi pellucidi (CSP) in comparison with normal subjects. Neurodevelopmental models of schizophrenia suggest that the more severe the brain dysgenesis, the earlier the onset of psychotic symptoms. Study of patients with childhood-onset schizophrenia allows the opportunity to test this hypothesis.
Method:
Two groups of subjects were evaluated: healthy volunteers (N=95, mean age=11.7 years) and patients with childhood-onset schizophrenia (N=24, mean age=14.6 years). Magnetic resonance images of 1-mm resampled contiguous brain slices were rated blind to diagnosis. The size of the CSP was recorded as the number of consecutive slices in which the CSP was present. Abnormal enlargement was defined as a CSP greater than 6 mm in length.
Results:
The frequency of an enlarged CSP was significantly higher in the patient group: 12.5% (three of 24 subjects) versus 1.1% (one of 95 subjects). Also, two of the three patients with an enlarged CSP had complete nonfusion of the septal leaflets, a more severe anomaly than was found in the one comparison subject with an enlarged CSP and typically more severe than anomalies seen in groups with adult-onset schizophrenia.
Conclusions:
These findings suggest that patients with extremely early-onset (childhood) forms of schizophrenia may have more severe developmental brain anomalies than those with adult onset.