Computed Tomographic Brain Studies and Treatment Response in Schizophrenia

Abstract

Ventricular enlargement has been described in chronic schizophrenia since 1927. The CT Scan has stimulated considerable interest and studies have shown that 50% of chronic schizophrenics and up to 20% of acute schizophrenics have enlarged ventricles. Widening of cortical sulci, cerebellar atrophy, third ventricular enlargement and reversed hemispheric assymetry have also been reported. Ventricular enlargement seems to both predate the development of psychosis and to develop further during the course of the illness. Twin studies indicate that ventricular enlargement may be the result both of genetic vulnerability and of environmental onslaught. The other abnormalities may be secondary. Schizophrenics without ventricular enlargement show disturbances of a range of Dopamine-related variables. Schizophrenics with ventricular enlargement show some evidence of serotonin and noradrenaline cell loss. Very few published papers address the issue of treatment response. These seem to demonstrate a relationship between enlargement and poor response to neuroleptic medication. Schizophrenics with very large ventricles may also be particularly sensitive to the adverse effects of neuroleptics. It is not yet clear that the CT Scan may be used to identify patients unlikely to respond to medication. Long term prospective studies are required.