COMPARING THE STRUCTURAL CHANGES IN THE BRAINS OF SCHIZOPHRENIC PATIENTS WITH AND WITHOUT THE DEFICIT SYNDROME OBSERVED IN THE LONG-TERM PERIOD
Project no. 20974 · Status: Kapanmış (Yayın bekleniyor) · 2019
Summary
INTRODUCTION: Schizophrenia is a psychiatric disorder which is seen in 1% of the society and results in significant loss of functionality. That the disorder starts at an early age and the chronic course of it makes the illness very preventive for the patients and their families. While the chronic disability primarily results from negative and cognitive symptoms, acute attacks result from exacerbation of positive symptoms such as delusions and hallucinations. Social and economic effects of the disorder are evident on the society and the families. Despite the extensive studies, the diagnostic accuracy and certainty of the disorder and the underlying pathophysiology of it is yet to be fully known. Differentiating a homogeneous subgroup in a heterogeneous disorder can be helpful to understand the pathophysiology about that disorder better. This study aims to find out the structural changes in the brains of the patients who have and who do not have the deficit syndrome in their long term observation (5 years), and aims to evaluate if the grey matter changes in the patients who have the deficit syndrome is more than in the patients who do not have the deficit syndrome, and its relations to the clinical differences. METHOD: 39 of 45 patients who had structural brain MR imaging in the study conducted by the MR research protocol has accepted to take part in the study. 5 of the patients who have declined to participate in the study are considered in the group which has the deficit syndrome and 1 of them is considered in the group which does not have the deficit syndrome. Informed consent form has been signed and detailed psychiatric examination has been done to the volunteers who agree with the criteria and agree to participate in the study. In addition to psychiatric examination, Structured Clinical Interview for DSM IV (SCID-I), Positive and Negative Symptoms Scale (PANSS), Negative Symptoms Assessment Scale (SANS), The Schedule For The Deficit Syndrome (SDS), Brief Negative Symptoms Scale (BNSS), Calgary Depression Scale (CDRS), Extrapyramidal Symptoms Assessment Scale (ESRS) have been conducted. Subsequently MR images have been obtained by using 3 Tesla MR devices and images obtained with 3D T1 weighted MP-RAGE sequences have been used for region of interest analysis. Volumes of brain subsections have been measured with FreeSurfer software package. RESULTS: There is no difference between the groups in terms of age, gender, education, employment status, marital status, duration of the disorder, familial clustering, current antipsychotic doses (chlorpromazine equivalents, mg/d), PANSS positive subscale, PANSS general psychopathology subscale (basal), ESRS (basal), and Calgary Depression Scale. As expected, in the group with the deficit syndrome, scores of the basal and current PANSS negative subscale, SANS and BNSS scale are distinctly higher compared to the group without the deficit syndrome (p<0,001). While the extrapyramidal symptom scale scores of the patients in DS group is high, their affective symptom (depression) scores are lower. It is seen that there is a tendency towards decreasing in the total volume of grey matter in the group with the deficit syndrome (z=-1,71 p=0,09) and there is a tendency towards increasing in the total volume of white matter in the group who does not have the deficit syndrome (z=-1,9 p=0,06). When the change in the basal and current volumes of the groups by years is compared, it is found out that in the group with the deficit syndrome, there is an enlargement in the volumes of right and left ventricles, and that it is statistically significant (respectively average difference=-1360,84 p=0,01; average difference=-1400,9 p=0,01). It is also