In Egyptian Schizophrenic Patients
|
|
|
|
|
|
|
|
|
|
| Regional Cerebral Blood Flow In Egyptian Schizophrenic Patients |
|||||||||
| A Thesis submitted for the fulfillment of | |||||||||
| M.D. Degree in Psychiatry | |||||||||
| Introduction | |||||||||
| Schizophrenia is one of the most debilitating psychiatric disorders. The handicap and cost of schizophrenia lays an economic, psychiatric and social burden both on the family and the state. This study aims to assist in understanding the etiology and neuropathology of schizophrenia, hence assisting in the advance of treatment, which would further help to layout the above described burden. | |||||||||
| With the development of modern diagnostic techniques, the etiological and neuro-pathological correlates for schizophrenia is becoming of high interest and focus. The rise of Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single-Photon Emission Tomography (SPECT) and correlation with the findings of these investigations had helped the research work in understanding more about etiology, symptom formation, and drug response in schizophrenia. | |||||||||
| Out of all these studies SPECT remains one of the most important and valuable research tool in detecting neuro-anatomical correlates. Cerebral SPECT is valid in the discrimination between patients diagnosed with schizophrenia and control subjects, and the Regional Cerebral Blood Flow (rCBF) pattern displays the best, in one or several regions of the brain (Ceballos et al, 1997). | |||||||||
| Many studies have investigated regional cerebral blood flow (rCBF) in schizophrenia, Previously, a decrease in frontal blood flow and metabolism (hypofrontality) was believed to correlate with schizophrenia (Steinberg et al, 1995). However there has been drought about these findings. Other studies found increase in rCBF in the left hemisphere together with globes Pallidus. Also studies attempting to correlate specific symptoms with functional image findings using SPECT Technique. It was found that positive symptoms showed different correlation with rCBF i.e. formal thought disorders and grandiosity correlated positively (and strongly) with bifrontal and bitemporal rCBF; delusions, hallucinations, and distrust correlated negatively (and strongly) with cingulate, left thalamic, left frontal, and left temporal rCBF. Stereotyped ideas as a negative symptom correlated negatively (and strongly) with left frontal, cingulate, left temporal, and left parietal rCBF (Sabri et al, 1997). | |||||||||
| Liddle et al (1992) defined these symptoms clusters: Psychomotor poverty, disorganization and reality distortion. and found that there were specific changes related to these syndromes. There was a reduced rCBF in left and medial prefrontal cortex correlated with psychomotor poverty, severity disorganization correlated with increased rCBF in the right medial prefrontal cortex and decreased perfusion of Brocca?s area and that reality distortion correlated with increased rCBF in the left hippocampul formation. | |||||||||
| Following treatment, hypofrontality was reduced to one region and temporal hypoperfusion disappeared. Formal thought disorders were accompanied by increased rCBF in the bilateral frontal interior and left temporal superior regions. Delusions were associated with hypoperfusion in the anterior cingulate cortex. Negative symptoms showed no linkage to hypofrontality, either before or after treatment. Factor analysis showed delusions and hallucinations loading on different dimensions. The disorganized dimension correlated positively with all regions of interest, whereas these were negatively correlated with reality distortion (Erkwoh et al, 1997). | |||||||||
| In the proposed thesis we will attempt to detect such changes in Egyptian patients and the change which may alter these changes after response to treatment. | |||||||||