Cerebral blood flow in schizophrenia

doi:10.1016/0014-4886(88)90204-X

Experimental Neurology

Volume 100, Issue 1, April 1988, Pages 98-111

https://doi.org/10.1016/0014-4886(88)90204-X Get rights and content

Abstract

The regional cerebral blood flow of 27 young (mean age 24 years) schizophrenic patients was measured using the intravenous ¹³³Xe method. The results were compared with those obtained from a group of age- and sex-matched control subjects. The main findings of the study were as follows: (a) the gray matter mean values of cerebral blood flow for both hemispheres were slightly but significantly lower in the schizophrenic group, and the statistical variance was significantly greater in the patients than in the control group; (b) the mean value for each hemisphere was found to be significantly lower for the right hemisphere; (c) the physiological hyperfrontal patterns of cerebral blood flow were identical in patients and controls; (d) visual hallucinations were associated with a reduction of regional cerebral blood flow in the temporo-occipital regions; and (3) antipsychotic medication did not appear to influence gray matter cerebral blood flow.

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Cited by (15)

A systematic review and meta-analysis of the effects of antipsychotic medications on regional cerebral blood flow (rCBF) in schizophrenia: Association with response to treatment
2014, Neuroscience and Biobehavioral Reviews
Citation Excerpt :
One cross-sectional study included medication-naïve patients, and also reported no differences compared to treated patients. However, the sample size was so small (n = 3) that it may have lacked statistical power (Dousse et al., 1988). Instead, longitudinal studies of antipsychotic-naïve patients provide a more powerful design to investigate potential effects.
Evaluating the short- and long-term effects of antipsychotics on brain physiology is a key factor in advancing our understanding of neurophysiological changes in psychosis and improving prediction of treatment response. Understanding the nature of such changes is crucial to the interpretation of neuroimaging findings in patients with schizophrenia and psychoses in general. This review has systematically appraised existing evidence on resting cerebral blood flow (rCBF) in schizophrenia, before and after antipsychotic treatment, relating the findings to symptom severity. The review shows that antipsychotics exert regional effects on rCBF, particularly in frontal and basal ganglia regions, and that different antipsychotic generations have differential effects on rCBF. These findings are supported by an exploratory meta-analysis of a subset of studies. The review also highlights the relative lack of studies that use a priori definitions of treatment response, which is an important step in identifying testable hypotheses and ensuring clinical relevance of remission criteria. Finally, the review highlights important considerations for future psychopharmacological studies investigating the potential for rCBF to predict symptomatic improvement, which could inform the management of treatment in schizophrenia.
On the sensitivity of ASL MRI in detecting regional differences in cerebral blood flow
2010, Magnetic Resonance Imaging
Citation Excerpt :
ASL MRI, as a biomarker for baseline neural activity, has great potentials in clinical applications. However, questions remained as to whether ASL MRI can detect small CBF differences on the order of 10%, which is the typical range of CBF deficit occurring in many psychiatric and neurological disorders [31–34]. The present study provides a systematic investigation into the detection power of ASL and the optimal strategies for data analysis.
Arterial-spin-labeling (ASL) magnetic resonance imaging (MRI) provides a noninvasive tool to measure cerebral blood flow (CBF) and is increasingly used as a surrogate for baseline neural activity. However, the power of ASL MRI in detecting CBF differences between patient and control subjects is hampered by inter-subject variations in global CBF, which are associated with non-neural factors and may contribute to the noise in the across-group comparison. Here, we investigated the sensitivity of this technique and proposed a normalization strategy to better detect such a difference. A “model” situation was employed in which two visual stimuli (i.e. cross fixation and flashing checkerboard) were presented to two groups of subjects to mimic “control” and “patient” groups (N=7 for each group), respectively. It was found that absolute CBF (aCBF) in the occipital lobe in the checkerboard group was 26.0% greater compared to the fixation group, but the level of significance was modest (P=.03). In contrast, when normalizing the CBF with whole-brain CBF or CBF in a reference region [termed relative CBF (rCBF)], the statistical significance was improved considerably (P<.003). For voxel-based analysis, the rCBF indices correctly detected CBF differences in the occipital lobe in the across-group comparison, while aCBF failed to detect any significant cluster using the same statistical threshold. We also performed Monte Carlo simulation to confirm the experimental findings and found that the power improvement was most pronounced when signal-to-noise-ratio is moderate and the underlying CBF difference was small. The simulation also showed that, with the proposed normalization, a detection power of 80% can be achieved using a sample size of about 20. In summary, rCBF is a more sensitive index to detect small differences in CBF, rather than the much-sought-after aCBF, since it reduces data noise caused by inter-subject variations in global CBF.
The effect of antipsychotic medication on relative cerebral blood perfusion in schizophrenia: Assessment with Technetium-99m hexamethyl-propyleneamine oxime single photon emission computed tomography
1997, Biological Psychiatry
Functional neuroimaging studies in schizophrenia have often been confounded by various factors including medication status. To explore the effects of antipsychotic medications on relative regional cerebral perfusion, we scanned a group of 33 persons with schizophrenia twice, while receiving a stable dose of antipsychotic and after being off antipsychotics for 3 weeks, using technetium-99m hexamethylpropyleneamine oxime single photon emission computed tomography (Tc-99m HMPAO-SPECT). We found that antipsychotics significantly increased the mean relative cerebral perfusion in the left basal ganglia. Additionally, patients receiving thiothixene (n = 9) had a significantly greater increase in relative cerebral perfusion in the basal ganglia than patients receiving haloperidol (n = 12). These findings indicate that antipsychotics lead to regional increases in cerebral perfusion and that antipsychotic status must be controlled for in functional neuroimaging studies. Functional neuroimaging techniques such as SPECT may be useful in furthering our understanding of the mechanism of antipsychotics.
Regional cerebral blood flow in first break and chronic schizophrenic patients and normal controls
1995, Schizophrenia Research
Dynamic ¹³³Xe Single Photon Emission Computed Tomography (SPECT) was used to measure the resting regional cerebral blood flow (rCBF) in 16 neuroleptic free schizophrenic and schizophreniform male patients and 13 age-matched male normal controls. A subgroup consisting of ‘first break’ patients who had never been exposed to neuroleptic treatment were age-matched to a subgroup of young chronic patients most of whom had been previously exposed to neuroleptics. The age-adjusted rCBF values were compared among first breaks, young chronics, normal controls, and a subgroup of older, more chronic patients. In first break patients, we found significantly lower absolute global cerebral blood flow and significantly lower superior frontal, middle frontal, and middle temporal absolute rCBF compared to normals. We also found significantly lower relative superior frontal rCBF in first breaks vs. normals, and higher relative superior frontal and relative middle frontal rCBF in older chronics vs. the other groups. For relative posterior temporal rCBF there was greater asymmetry (right side > left) in first breaks and young chronics compared to normals and older chronics.
Regional differentiation of cortical activity in schizophrenia: a complementary approach to conventional analysis of regional cerebral blood flow
1995, Psychiatry Research: Neuroimaging
This study examines an alternative to a narrow locus-of-dysfunction cortical pathophysiology in schizophrenia, which in turn suggests a modified approach to the analysis of data from regional cerebral blood flow studies. The results provide qualified support for a model of impaired differentiation of cortical activity in schizophrenia. As an index of the differentiation of cortical fields, regional gradients of cortical blood flow were examined. Medicated patients (n = 15) failed to show the differentiation of networks in frontal areas during a verbal memory recognition task observed in normal comparison subjects (n = 15). Unmedicated patients (n = 15) at rest tended to lose normal lateralization and had increased gradients in the right frontal area compared with normal comparison subjects.
Regional cerebral blood flow in schizophrenia: Repeated studies during a psychotic episode
1990, Psychiatry Research: Neuroimaging
Regional cerebral blood flow (rCBF) measurements and clinical ratings were performed on 17 schizophrenic patients and a subgroup of 10 medicationfree patients before and after treatment. While clinically exacerbated patients had normal blood flow, patients in remission showed a redistribution of flow with lower values in frontal areas. Anteroposterior ratios correlated with the degree of behavioral disturbances, suggesting that the level of frontal lobe activity in schizophrenia may be a function of the patient's clinical state at the time of study.

View all citing articles on Scopus

¹: We thank Mr. Ait-Bachir, Mrs. Agnèes Barrier, and Christine Dronneau for their technical assistance in the measurement of cerebral blood flow. This research was supported by INSERM, CNRS, and the University Paris VII.

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Cerebral blood flow in schizophrenia

Abstract

Cerebral artery spasms and hallucinogenic activity

Science

Regional cerebral blood flow in schizophrenics

Arch. Gen. Psychiatry

133 Xe inhalation method analysis of reproductibility: Some of its physiological implications

Stroke

Simultaneous electroencephalography and cerebral glucography with positron emission tomography in normals and patients with schizophrenia

J. Cereb. Blood Flow Metab. (Suppl.)

Brain function in psychiatric disorder. I. Regional cerebral blood flow in mediated schizophrenics

Arch. Gen. Psychiatry

Regional cerebral blood flow in schizophrenic patients at rest and during Wisconsin card sort tasks

Regional distribution of cerebral blood flow in schizophrenia

Regional cerebral blood flow related to psychiatric symptoms in dementia with onset in the presenile period

Acta Psychiatr. Scand.

Cognitive reduction in presenile dementia related to regional abnormalities of the cerebral blood flow

Br. J. Psychiatry

Blood flow and oxidative metabolism of the brain in the course of acute schizophrenia

Acta Neurol. Scand.

Hyperfrontal distribution of the cerebral grey matter flow in resting wakefulness: On the functional anatomy of the conscious state

Acta Neurol. Scand.

Abnormalities of regional cerebral blood flow distribution in patients with chronic schizophrenia

Acta Psychiatr. Scand.

Distribution of cerebral activity in chronic schizophrenia

Lancet

Abnormal distribution of cerebral activity in chronic schizophrenia

J. Psychiatr. Res.

Assessment of severe damage to the brain by multiregional measurements of cerebral blood flow

CBF and metabolism in schizophrenia. The effect of barbiturate seminarcosis, insulin coma and electroshock

Am. J. Psychiatry

Regional cerebral blood flow in schizophrenic disorders

Eur. Neurol.