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Structural Brain Abnormalities in Bipolar Affective Disorder: Ventricular Enlargement and Focal Signal Hyperintensities

Structural Brain Abnormalities in Bipolar Affective Disorder: Ventricular Enlargement and Focal... Abstract • Structural brain abnormalities were examined in a sample of 48 patients with bipolar affective disorder who were compared with 54 schizophrenic patients and 47 normal controls. As in our previous work using computed tomographic scanning, lateral ventricular enlargement was due to a diagnostic effect. In this study, the effect was more prominent in the schizophrenic men, while a trend was seen in the bipolar men. Women in both groups did not differ significantly from normal subjects. This finding is possibly consistent with the fact that men have a higher frequency of birth anomalies such as hydrocephalus. Since one cause of such birth anomalies might be periventricular hemorrhage or infarction, we also evaluated all scans for the presence of small focal regions of signal hyperintensity. A significant increase in the number of focal signal hyperintensities was noted in the bipolar patients, in comparison with normal subjects, but not in the schizophrenics. The bipolar patients with focal signal hyperintensities had a trend toward larger ventricular size than those without. The pathophysiological significance of these findings is unclear. References 1. Johnstone EC, Frith CD, Crow TJ, Husband J, Kreel L. Cerebral ventricular size and cognitive impairment in chronic schizophrenia . Lancet . 1976;2:924-926.Crossref 2. Weinberger DR, Bigelow LB, Kleinman JE, Klein ST, Rosenblatt JE, Wyatt RJ. Cerebral ventricular enlargement in chronic schizophrenia . Arch Gen Psychiatry . 1980;37:11-13.Crossref 3. Andreasen NC, Smith MR, Jacoby CG, Dennert JW, Olsen SA. Ventricular enlargement in schizophrenia: definition and prevalence . Am J Psychiatry . 1982;139:292-296. 4. Buchsbaum MS, Ingvar DH, Kessler R, Waters RN, Cappelletti J, van Kammen DP, King AC, Johnson JL, Manning RG, Flynn RW, Bunney WE, Sokoloff L. Cerebral glucography with positron tomography . Arch Gen Psychiatry . 1982;39:251-259.Crossref 5. Buchsbaum MS, Haier RJ. Functional and anatomical brain imaging: impact on schizophrenia research . Schizophr Bull . 1987;13:115-132.Crossref 6. Gur RE, Resnick SM, Gur RC, Alavi A, Caroff S, Kushner M, Reivich M. Regional brain function in schizophrenia, II: repeated evaluation with positron emission tomography . Arch Gen Psychiatry . 1987;44:126-129.Crossref 7. Gur RE, Resnick SM, Alavi A, Gur RC, Caroff S, Dann R, Silver FL, Saykin AJ, Chawluk JB, Kushner M, Reivich M. Regional brain function in schizophrenia, I: a positron emission tomography study . Arch Gen Psychiatry . 1987;44:119-125.Crossref 8. Gur RE, Gur RC, Skolnick BE, Caroff S, Obrist WD, Resnick S, Reivich M. Brain function in psychiatric disorders, III: regional cerebral blood flow in unmedicated schizophrenics . Arch Gen Psychiatry . 1985;42:329-334.Crossref 9. Weinberger DR, Berman KF, Zec RF. Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia, I: regional cerebral blood flow (rCBF) evidence . Arch Gen Psychiatry . 1986;43:114-124.Crossref 10. Weinberger DR, Berman KF, Illowsky BP. Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia, III: a new cohort and evidence for a monoaminergic mechanism . Arch Gen Psychiatry . 1988;45:609-615.Crossref 11. Volkow ND, Brodie JD, Wolf AP, Gomez-Mont F, Cancro R, Van Gelder P, Russell JAG, Overall J. Brain organization in schizophrenia . J Cereb Blood Flow Metab . 1986;6:441-446.Crossref 12. DeMeyer MK, Gilmor R, DeMeyer WE, Hendrie H, Edwards M, Franco JN. Third ventricle size and ventricular/brain ratio in treatment-resistant psychiatric patients . J Operational Psychiatry . 1984;15:2-8.Crossref 13. Largen JW, Smith RC, Calderon M, Baumgartner R, Lu R-B, Schoolar JC, Ravichandran GK. Abnormalities of brain structure and density in schizophrenia . Biol Psychiatry . 1984;19:991-1013. 14. Luchins DJ, Lewine RRJ, Meltzer HY. Lateral ventricular size, psychopathology, and medication response in the psychoses . Biol Psychiatry . 1984;19:29-44. 15. Pandurangi AK, Dewan MJ, Lee SH, Ramachandran T, Levy BF, Boucher M, Yozawitz A, Major L. The ventricular system in chronic schizophrenic patients: a controlled computed tomography study . Br J Psychiatry . 1984;144:172-176.Crossref 16. Pearlson GD, Garbacz DJ, Breakey WR, Ahn HS, DePaulo JR. Lateral ventricular enlargement associated with persistent unemployment and negative symptoms in both schizophrenia and bipolar disorder . Psychiatry Res . 1984;12:1-9.Crossref 17. Reveley AM, Reveley MA, Murray RM. Cerebral ventricular enlargement in nongenetic schizophrenia: a controlled twin study . Br J Psychiatry . 1984;144:89-93.Crossref 18. Schulsinger F, Parnas J, Petersen ET, Schulsinger H, Teasdale TW, Mednick SA, Møller L, Silverton L. Cerebral ventricular size in the offspring of schizophrenic mothers: a preliminary study . Arch Gen Psychiatry . 1984;41:602-606.Crossref 19. DeLisi LE, Goldin LR, Hamovit JR, Maxwell ME, Kurtz D, Nurnberger JL, Gershon ES. Cerebral ventricular enlargement as a possible genetic marker for schizophrenia . Psychopharmacol Bull . 1985;21:365-367. 20. Kemali D, Maj M, Galderisi S, Salvati A, Starace F, Valente A, Pirozzi R. Clinical, biological, and neuropsychological features associated with lateral ventricular enlargement in DSM-III schizophrenic disorder . Psychiatry Res . 1986;21:137-149.Crossref 21. Owens DGC, Johnstone EC, Crow TJ, Frith CD, Jagoe JR, Kreel L. Lateral ventricular size in schizophrenia: relationship to the disease process and its clinical manifestations . Psychol Med . 1985;15:27-41.Crossref 22. Williams AO, Reveley MA, Kolakowska T, Ardern M, Mandelbrote BM. Schizophrenia with good and poor outcome, II: cerebral ventricular size and its clinical significance . Br J Psychiatry . 1985;146:239-246.Crossref 23. Losonczy MF, Song IS, Mohs RC, Small NA, Davidson M, Johns CA, Davis KL. Correlates of lateral ventricular size in chronic schizophrenia, I: behavioral and treatment response measures . Am J Psychiatry . 1986;143:976-981. 24. Obiols-Llandrich JE, Ruscalleda J, Masferrer M. Ventricular enlargement in young chronic schizophrenics . Acta Psychiatr Scand . 1986;73:42-44.Crossref 25. Turner SW, Toone BK, Brett-Jones JR. Computerized tomographic scan changes in early schizophrenia: preliminary findings . Psychol Med . 1986;16:219-225.Crossref 26. Niu-Fan G, He-Qin Y, Guo-Jung C, Ming-Dao Z, Ming-Yuan Z, Zhen-Yi X. CT scans of the brain in families with a high frequency of schizophrenia . In: Cazzullo GL, Invernizzi G, Sacchetti E, Vita A, eds. Etiopathogenetic Hypotheses of Schizophrenia: The Impact of Epidemiological, Biochemical and Neuromorphological Studies . Lancaster, England: MTP Press Ltd; 1987:109-115. 27. Rabins P, Pearlson G, Jayaram G, Steele C, Tune L. Increased ventricleto-brain ratio in late-onset schizophrenia . Am J Psychiatry . 1987;144:1216-1218. 28. Sacchetti E, Vita A, Calzeroni A, Invernizzi G, Cazzullo CL. Neuromorphological correlates of schizophrenic disorders: focus on cerebral ventricular enlargement . In: Cazzullo GL, Invernizzi G, Sacchetti E, Vita A, eds. Etiopathogenetic Hypotheses of Schizophrenia: The Impact of Epidemiological, Biochemical and Neuromorphological Studies . Lancaster, England: MTP Press Ltd; 1987:67-91. 29. Pfefferbaum A, Zipursky RB, Lim KO, Zatz LM, Stahl SM, Jernigan TL. Computed tomographic evidence for generalized sulcal and ventricular enlargement in schizophrenia . Arch Gen Psychiatry . 1988;45:633-640.Crossref 30. Rossi A, Stratta P, deCataldo S. Cortical and subcortical computed tomographic study in schizophrenia . J Psychiatr Res . 1988;22:99-105.Crossref 31. Shelton RC, Karson CN, Doran AR, Pickar D, Bigelow LB, Weinberger DR. Cerebral structural pathology in schizophrenia: evidence for a selective prefrontal cortical defect . Am J Psychiatry . 1988;145:154-163. 32. Andreasen NC, Swayze V, Flaum M, Yates WR, Arndt S, McChesney C. Ventricular enlargement in schizophrenia evaluated with CT scanning: effects of gender, age, and stage of illness . Arch Gen Psychiatry . 1990;47:1008-1015.Crossref 33. Jacoby RJ, Levy R. Computed tomography in the elderly, III: affective disorder . Br J Psychiatry . 1980;136:270-275.Crossref 34. Jacoby RJ, Levy R, Bird M. Computed tomography and the outcome of affective disorder: a followup of elderly patients . Br J Psychiatry . 1981;139:288-292.Crossref 35. Nasrallah HA, McCalley-Whitters M, Jacoby CG. Cortical atrophy in schizophrenia and mania: a comparative CT study . J Clin Psychiatry . 1982;43:439-441. 36. Dolan RJ, Calloway SP, Mann AH. Cerebral ventricular size in depressed subjects . Psychol Med . 1985;15:873-878.Crossref 37. Scott ML, Golden CJ, Ruedrich SL, Bishop RJ. Ventricular enlargement in major depression . Psychiatry Res . 1983;8:91-93.Crossref 38. Rieder RO, Mann LS, Weinberger DR, Van Kammen DP, Post RM. Computed tomographic scans in patients with schizophrenia, schizoaffective, and bipolar affective disorder . Arch Gen Psychiatry . 1983;40:735-739.Crossref 39. Targum SD, Rosen LN, DeLisi LE, Weinberger DR, Citrin CM. Cerebral ventricular size in major depressive disorders: association with delusional symptoms . Biol Psychiatry . 1983;18:329-336. 40. Shima S, Shikano T, Kitamura T. Depression and ventricular enlargement . Acta Psychiatr Scand . 1984;70:275-277.Crossref 41. Schlegel S, Kretzschmar K. Computed tomography in affective disorders, I: ventricular and sulcal measurements . Biol Psychiatry . 1987;22:4-14.Crossref 42. Rossi A, Stratta P, Petruzzi C, de Donatis M, Nisticò R, Casacchia M. A computerised tomographic study in DSM-III affective disorders . J Affective Disord . 1987;12:259-262.Crossref 43. Dewan MJ, Haldipur CV, Lane EE, Ispahani A, Boucher MF, Major LF. Bipolar affective disorder, I: comprehensive quantitative computer tomography . Acta Psychiatr Scand . 1988;77:670-676.Crossref 44. Andreasen NC, Swayze V, Flaum M, Alliger R, Cohen G. CT abnormalities in affective disorder: clinical and demographic correlates . Am J Psychiatry . In press. 45. Phelps ME, Mazziotta JC, Baxter L, Gerner R. Positron emission tomographic study of affective disorders: problems and strategies . Ann Neurol . 1984;15( (suppl) ):S149-S156.Crossref 46. Schwartz JM, Baxter LR Jr, Mazziotta JC, Gerner RH, Phelps ME. The differential diagnosis of depression: relevance of positron emission tomography studies of cerebral glucose metabolism to the bipolar-unipolar dichotomy . JAMA . 1987;258:1368-1374.Crossref 47. Baxter LR, Phelps ME, Mazziotta JC, Schwartz JM, Gerner RH, Selin CE, Sumida RM. Cerebral metabolic rates for glucose in mood disorders: studies with positron emission tomography and fluorodeoxyglucose F 18 . Arch Gen Psychiatry . 1985;42:441-447.Crossref 48. Buchsbaum MS, DeLisi LE, Holcomb HH, Cappelletti J, King AC, Johnson J, Hazlett E, Dowling-Zimmerman S, Post RM, Morihisa J, Carpenter W, Cohen R, Pickar D, Weinberger DR, Margolin R, Kessler RM. Anteroposterior gradients in cerebral glucose use in schizophrenia and affective disorders . Arch Gen Psychiatry . 1984;41:1159-1166.Crossref 49. Baxter LR Jr, Schwartz JM, Phelps ME, Mazziotta JC, Guze BH, Selin CE, Gerner RH, Sumida RM. Reduction of prefrontal cortex glucose metabolism common to three types of depression . Arch Gen Psychiatry . 1989;46:243-252.Crossref 50. Uytdenhoef P, Portelange P, Jacquy J, Charles G, Linkowski P, Mendlewicz J. Regional cerebral blood flow and lateralized hemispheric dysfunction in depression . Br J Psychiatry . 1983;143:128-132.Crossref 51. Guenther W, Moser E, Mueller-Spahn F, von Oefele K, Buell U, Hippius H. Pathological cerebral blood flow during motor function in schizophrenic and endogenous depressed patients . Biol Psychiatry . 1986;21:889-899.Crossref 52. Rush AJ, Schlesser MA, Stokely E, Bonte FR, Altshuller KZ. Cerebral blood flow in depression and mania . Psychopharmacol Bull . 1982;18:6-8. 53. Mathew RJ, Meyer JS, Francis DJ, Semchuk KM, Mortel K, Claghorn JL. Cerebral blood flow in depression . Am J Psychiatry . 1980;137:1449-1450. 54. Gur RE, Skolnick BE, Gur RC, Caroff S, Rieger W, Obrist WD, Younkin D, Reivich M. Brain function in psychiatric disorders, II: regional cerebral blood flow in medicated unipolar depressives . Arch Gen Psychiatry . 1984;41:695-699.Crossref 55. DuPont RM, Jernigan TL, Gillin JC, Butters N, Delis DC, Hesselink JR. Subcortical signal hyperintensities in bipolar patients detected by MRI . Psychiatry Res . 1987;21:357-358.Crossref 56. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders , Third Edition. Washington, DC: American Psychiatric Association; 1980. 57. Andreasen NC, Nasrallah HA, Dunn VD, Olson SC, Grove WM, Ehrhardt JC, Coffman JA, Crossett JHW. Structural abnormalities in the frontal system in schizophrenia: a magnetic resonance imaging study . Arch Gen Psychiatry . 1986;43:136-144.Crossref 58. Andreasen NC, Ehrhardt JC, Swayze VW II, Alliger RJ, Yuh WTC, Cohen G, Ziebell S. Magnetic resonance of the brain in schizophrenia: the pathophysiological significance of structural abnormalities . Arch Gen Psychiatry . 1990;47:35-46.Crossref 59. Andreasen NC. Comprehensive Assessment of Symptoms and History (CASH) . Iowa City, Iowa: University of Iowa Press; 1985. 60. Andreasen NC. The Scale for the Assessment of Negative Symptoms (SANS) . Iowa City, Iowa: University of Iowa Press; 1983. 61. Andreasen NC. The Scale for the Assessment of Positive Symptoms (SAPS) . Iowa City, Iowa: University of Iowa Press; 1984. 62. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry . 1976;33:766-771.Crossref 63. Folstein MF, Folstein SE, McHugh P. 'Mini Mental State': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 64. Kertesz A, Black SE, Tokar G, Benke T, Carr T, Nicholson L. Periventricular and subcortical hyperintensities on magnetic resonance imaging 'Rims, caps, and unidentified bright objects.' Arch Neurol . 1988;45:404-408.Crossref 65. Stevens JR. Neuropathology of schizophrenia . Arch Gen Psychiatry . 1982;39:1131-1139.Crossref 66. Lesch A, Bogerts B. The diencephalon in schizophrenia: evidence for reduced thickness of the periventricular grey matter . 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Structural Brain Abnormalities in Bipolar Affective Disorder: Ventricular Enlargement and Focal Signal Hyperintensities

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American Medical Association
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Copyright © 1990 American Medical Association. All Rights Reserved.
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0003-990X
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1598-3636
DOI
10.1001/archpsyc.1990.01810230070011
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Abstract

Abstract • Structural brain abnormalities were examined in a sample of 48 patients with bipolar affective disorder who were compared with 54 schizophrenic patients and 47 normal controls. As in our previous work using computed tomographic scanning, lateral ventricular enlargement was due to a diagnostic effect. In this study, the effect was more prominent in the schizophrenic men, while a trend was seen in the bipolar men. Women in both groups did not differ significantly from normal subjects. This finding is possibly consistent with the fact that men have a higher frequency of birth anomalies such as hydrocephalus. Since one cause of such birth anomalies might be periventricular hemorrhage or infarction, we also evaluated all scans for the presence of small focal regions of signal hyperintensity. A significant increase in the number of focal signal hyperintensities was noted in the bipolar patients, in comparison with normal subjects, but not in the schizophrenics. The bipolar patients with focal signal hyperintensities had a trend toward larger ventricular size than those without. The pathophysiological significance of these findings is unclear. References 1. Johnstone EC, Frith CD, Crow TJ, Husband J, Kreel L. Cerebral ventricular size and cognitive impairment in chronic schizophrenia . Lancet . 1976;2:924-926.Crossref 2. Weinberger DR, Bigelow LB, Kleinman JE, Klein ST, Rosenblatt JE, Wyatt RJ. Cerebral ventricular enlargement in chronic schizophrenia . Arch Gen Psychiatry . 1980;37:11-13.Crossref 3. Andreasen NC, Smith MR, Jacoby CG, Dennert JW, Olsen SA. Ventricular enlargement in schizophrenia: definition and prevalence . Am J Psychiatry . 1982;139:292-296. 4. Buchsbaum MS, Ingvar DH, Kessler R, Waters RN, Cappelletti J, van Kammen DP, King AC, Johnson JL, Manning RG, Flynn RW, Bunney WE, Sokoloff L. Cerebral glucography with positron tomography . Arch Gen Psychiatry . 1982;39:251-259.Crossref 5. Buchsbaum MS, Haier RJ. Functional and anatomical brain imaging: impact on schizophrenia research . Schizophr Bull . 1987;13:115-132.Crossref 6. Gur RE, Resnick SM, Gur RC, Alavi A, Caroff S, Kushner M, Reivich M. Regional brain function in schizophrenia, II: repeated evaluation with positron emission tomography . Arch Gen Psychiatry . 1987;44:126-129.Crossref 7. Gur RE, Resnick SM, Alavi A, Gur RC, Caroff S, Dann R, Silver FL, Saykin AJ, Chawluk JB, Kushner M, Reivich M. Regional brain function in schizophrenia, I: a positron emission tomography study . Arch Gen Psychiatry . 1987;44:119-125.Crossref 8. Gur RE, Gur RC, Skolnick BE, Caroff S, Obrist WD, Resnick S, Reivich M. Brain function in psychiatric disorders, III: regional cerebral blood flow in unmedicated schizophrenics . Arch Gen Psychiatry . 1985;42:329-334.Crossref 9. Weinberger DR, Berman KF, Zec RF. Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia, I: regional cerebral blood flow (rCBF) evidence . Arch Gen Psychiatry . 1986;43:114-124.Crossref 10. Weinberger DR, Berman KF, Illowsky BP. Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia, III: a new cohort and evidence for a monoaminergic mechanism . Arch Gen Psychiatry . 1988;45:609-615.Crossref 11. Volkow ND, Brodie JD, Wolf AP, Gomez-Mont F, Cancro R, Van Gelder P, Russell JAG, Overall J. Brain organization in schizophrenia . J Cereb Blood Flow Metab . 1986;6:441-446.Crossref 12. DeMeyer MK, Gilmor R, DeMeyer WE, Hendrie H, Edwards M, Franco JN. Third ventricle size and ventricular/brain ratio in treatment-resistant psychiatric patients . J Operational Psychiatry . 1984;15:2-8.Crossref 13. Largen JW, Smith RC, Calderon M, Baumgartner R, Lu R-B, Schoolar JC, Ravichandran GK. Abnormalities of brain structure and density in schizophrenia . Biol Psychiatry . 1984;19:991-1013. 14. Luchins DJ, Lewine RRJ, Meltzer HY. Lateral ventricular size, psychopathology, and medication response in the psychoses . Biol Psychiatry . 1984;19:29-44. 15. Pandurangi AK, Dewan MJ, Lee SH, Ramachandran T, Levy BF, Boucher M, Yozawitz A, Major L. The ventricular system in chronic schizophrenic patients: a controlled computed tomography study . Br J Psychiatry . 1984;144:172-176.Crossref 16. Pearlson GD, Garbacz DJ, Breakey WR, Ahn HS, DePaulo JR. Lateral ventricular enlargement associated with persistent unemployment and negative symptoms in both schizophrenia and bipolar disorder . Psychiatry Res . 1984;12:1-9.Crossref 17. Reveley AM, Reveley MA, Murray RM. Cerebral ventricular enlargement in nongenetic schizophrenia: a controlled twin study . Br J Psychiatry . 1984;144:89-93.Crossref 18. Schulsinger F, Parnas J, Petersen ET, Schulsinger H, Teasdale TW, Mednick SA, Møller L, Silverton L. Cerebral ventricular size in the offspring of schizophrenic mothers: a preliminary study . Arch Gen Psychiatry . 1984;41:602-606.Crossref 19. DeLisi LE, Goldin LR, Hamovit JR, Maxwell ME, Kurtz D, Nurnberger JL, Gershon ES. Cerebral ventricular enlargement as a possible genetic marker for schizophrenia . Psychopharmacol Bull . 1985;21:365-367. 20. Kemali D, Maj M, Galderisi S, Salvati A, Starace F, Valente A, Pirozzi R. Clinical, biological, and neuropsychological features associated with lateral ventricular enlargement in DSM-III schizophrenic disorder . Psychiatry Res . 1986;21:137-149.Crossref 21. Owens DGC, Johnstone EC, Crow TJ, Frith CD, Jagoe JR, Kreel L. Lateral ventricular size in schizophrenia: relationship to the disease process and its clinical manifestations . Psychol Med . 1985;15:27-41.Crossref 22. Williams AO, Reveley MA, Kolakowska T, Ardern M, Mandelbrote BM. Schizophrenia with good and poor outcome, II: cerebral ventricular size and its clinical significance . Br J Psychiatry . 1985;146:239-246.Crossref 23. Losonczy MF, Song IS, Mohs RC, Small NA, Davidson M, Johns CA, Davis KL. Correlates of lateral ventricular size in chronic schizophrenia, I: behavioral and treatment response measures . Am J Psychiatry . 1986;143:976-981. 24. Obiols-Llandrich JE, Ruscalleda J, Masferrer M. Ventricular enlargement in young chronic schizophrenics . Acta Psychiatr Scand . 1986;73:42-44.Crossref 25. Turner SW, Toone BK, Brett-Jones JR. Computerized tomographic scan changes in early schizophrenia: preliminary findings . Psychol Med . 1986;16:219-225.Crossref 26. Niu-Fan G, He-Qin Y, Guo-Jung C, Ming-Dao Z, Ming-Yuan Z, Zhen-Yi X. CT scans of the brain in families with a high frequency of schizophrenia . In: Cazzullo GL, Invernizzi G, Sacchetti E, Vita A, eds. Etiopathogenetic Hypotheses of Schizophrenia: The Impact of Epidemiological, Biochemical and Neuromorphological Studies . Lancaster, England: MTP Press Ltd; 1987:109-115. 27. Rabins P, Pearlson G, Jayaram G, Steele C, Tune L. Increased ventricleto-brain ratio in late-onset schizophrenia . Am J Psychiatry . 1987;144:1216-1218. 28. Sacchetti E, Vita A, Calzeroni A, Invernizzi G, Cazzullo CL. Neuromorphological correlates of schizophrenic disorders: focus on cerebral ventricular enlargement . In: Cazzullo GL, Invernizzi G, Sacchetti E, Vita A, eds. Etiopathogenetic Hypotheses of Schizophrenia: The Impact of Epidemiological, Biochemical and Neuromorphological Studies . Lancaster, England: MTP Press Ltd; 1987:67-91. 29. Pfefferbaum A, Zipursky RB, Lim KO, Zatz LM, Stahl SM, Jernigan TL. Computed tomographic evidence for generalized sulcal and ventricular enlargement in schizophrenia . Arch Gen Psychiatry . 1988;45:633-640.Crossref 30. Rossi A, Stratta P, deCataldo S. Cortical and subcortical computed tomographic study in schizophrenia . J Psychiatr Res . 1988;22:99-105.Crossref 31. Shelton RC, Karson CN, Doran AR, Pickar D, Bigelow LB, Weinberger DR. Cerebral structural pathology in schizophrenia: evidence for a selective prefrontal cortical defect . Am J Psychiatry . 1988;145:154-163. 32. Andreasen NC, Swayze V, Flaum M, Yates WR, Arndt S, McChesney C. Ventricular enlargement in schizophrenia evaluated with CT scanning: effects of gender, age, and stage of illness . Arch Gen Psychiatry . 1990;47:1008-1015.Crossref 33. Jacoby RJ, Levy R. Computed tomography in the elderly, III: affective disorder . Br J Psychiatry . 1980;136:270-275.Crossref 34. Jacoby RJ, Levy R, Bird M. Computed tomography and the outcome of affective disorder: a followup of elderly patients . Br J Psychiatry . 1981;139:288-292.Crossref 35. Nasrallah HA, McCalley-Whitters M, Jacoby CG. Cortical atrophy in schizophrenia and mania: a comparative CT study . J Clin Psychiatry . 1982;43:439-441. 36. Dolan RJ, Calloway SP, Mann AH. Cerebral ventricular size in depressed subjects . Psychol Med . 1985;15:873-878.Crossref 37. Scott ML, Golden CJ, Ruedrich SL, Bishop RJ. Ventricular enlargement in major depression . Psychiatry Res . 1983;8:91-93.Crossref 38. Rieder RO, Mann LS, Weinberger DR, Van Kammen DP, Post RM. Computed tomographic scans in patients with schizophrenia, schizoaffective, and bipolar affective disorder . Arch Gen Psychiatry . 1983;40:735-739.Crossref 39. Targum SD, Rosen LN, DeLisi LE, Weinberger DR, Citrin CM. Cerebral ventricular size in major depressive disorders: association with delusional symptoms . Biol Psychiatry . 1983;18:329-336. 40. Shima S, Shikano T, Kitamura T. Depression and ventricular enlargement . Acta Psychiatr Scand . 1984;70:275-277.Crossref 41. Schlegel S, Kretzschmar K. Computed tomography in affective disorders, I: ventricular and sulcal measurements . Biol Psychiatry . 1987;22:4-14.Crossref 42. Rossi A, Stratta P, Petruzzi C, de Donatis M, Nisticò R, Casacchia M. A computerised tomographic study in DSM-III affective disorders . J Affective Disord . 1987;12:259-262.Crossref 43. Dewan MJ, Haldipur CV, Lane EE, Ispahani A, Boucher MF, Major LF. Bipolar affective disorder, I: comprehensive quantitative computer tomography . Acta Psychiatr Scand . 1988;77:670-676.Crossref 44. Andreasen NC, Swayze V, Flaum M, Alliger R, Cohen G. CT abnormalities in affective disorder: clinical and demographic correlates . Am J Psychiatry . In press. 45. Phelps ME, Mazziotta JC, Baxter L, Gerner R. Positron emission tomographic study of affective disorders: problems and strategies . Ann Neurol . 1984;15( (suppl) ):S149-S156.Crossref 46. Schwartz JM, Baxter LR Jr, Mazziotta JC, Gerner RH, Phelps ME. The differential diagnosis of depression: relevance of positron emission tomography studies of cerebral glucose metabolism to the bipolar-unipolar dichotomy . JAMA . 1987;258:1368-1374.Crossref 47. Baxter LR, Phelps ME, Mazziotta JC, Schwartz JM, Gerner RH, Selin CE, Sumida RM. Cerebral metabolic rates for glucose in mood disorders: studies with positron emission tomography and fluorodeoxyglucose F 18 . 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Journal

Archives of General PsychiatryAmerican Medical Association

Published: Nov 1, 1990

References

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