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To:
Journal of PRACTICAL NEUROLOGY Letters
Electronic Letters to:
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Electronic letters published:
![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Qualitative versus quantitative assessment of brain developmental abnormalities in schizophrenia
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José Alexandre Crippa, Associated Lecturer Department of Neuropsychiatry and Medical Psychology, Faculty of Medicine, University of Săo Paulo, Antonio Waldo Zuardi, Geraldo F. Busatto, Antonio Carlos Santos, David J. Araújo, Jaime Eduardo Cecílio Hallak, Philip K. McGuire
Send letter to journal:
jcrippa{at}fmrp.usp.br José Alexandre Crippa, et al.
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Dear Editor,
We would like to contribute on the article entitled “Radiological findings in individuals at high risk of schizophrenia and patients with first episode psychosis” by Borgwardt et al. [1] and on a letter by the same group [2], in which they comment on our own paper investigating this issue [3]. The authors highlight that they have found [1] a lower prevalence of cavum septum pellucidum (CSP) both in subjects with first-episode schizophrenia (3.3%) and individuals at high risk for psychosis (5.7%), when compared to our findings in schizophrenic patients (21.1%). We agree with Borgwardt et al. [2] that their use of a qualitative rather than a quantitative method may explain their finding of a lower estimated frequency of CSP. We would also argue that the acquisition of high-resolution, 1-mm contiguous MRI brain slices in our study may have led to a more accurate estimation of the prevalence of CSP, as well as allowing the quantitative assessment of their size. Borgwardt et al. [2] also stressed the value of searching for a wider range of structural brain anomalies in psychosis, instead of focusing on a single abnormality, such as the CSP. In regard to that, MRI images in our study [3] were also inspected visually for the presence of other gross anomalies in midline brain structures, by a consensus between two neuroradiologists blind to sex, diagnosis and clinical status of subjects. At this assessment, one of the patients with schizophrenia was found to have a lipoma adherent to the anterior face of the splenium of the corpus callosum; one other case presented a parietal hemangioma, another patient presented total agenesis of the corpus callosum, while a fourth patient had a complete non-fusion of the entire length of the septum pellucidum – an anomaly termed ‘combined CSP and cavum vergae’. None of the observed abnormalities implicated in a change in the diagnosis from DSM-IV schizophrenia to psychotic disorder due to an ‘organic’ medical condition. We did not find any other gross or pathological midline abnormalities in any of the subjects studied. However, the following normal or minor brain variations were additionally found (data not presented before), only in the schizophrenia group: asymetrical ventricular system (n=4) and presence of arachnoid cyst (n=1). Thus, taking all those findings together, it is possible to conclude that in our sample, there is also a significantly (p = 0.001) higher proportion of radiological findings in patients with schizophrenia (9 of 38 or 23.7%) compared to healthy controls (none of 38). Although this was not the main objective of our study and the qualitative MRI assessment we have used was not standardized, our results are supportive of the findings reported by Borgwardt et al. [1] We suggest that future MRI studies, instead of focusing on either qualitative or quantitative assessments only, should systematically employ both approaches to evaluate the same sample. This may be of greater help for our understanding of the role of developmental anomalies in the neuropathology of schizophrenia. References [1] S.J. Borgwardt, E.W. Radue, K. Götz, et al., Radiological findings in individuals at high risk of schizophrenia and patients with first episode psychosis. J Neurol Neurosurg Psychiatry 2006;77:229–33. [2] Borgwardt SJ, Radue EW, Riecher-Rossler A. Cavum septum pellucidum in patients with first episode psychosis and individuals at high risk of psychosis. Eur Psychiatry 2006; 22:264. [3] J.A. De Souza Crippa, A.W. Zuardi, G.F. Busatto, et al., Cavum septum pellucidum and adhesio interthalamica in schizophrenia: an MRI study. Eur Psychiatry 2006; 21: 291–9. Competing interest: None |
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