Computed tomographic findings in schizophrenia: relation with symptom dimensions and sex differences

Objective: Loss of grey matter, a consistent finding in schizophrenia, is l ikely to be influenced by symptom : heterogeneity and sex. This study was c onducted to determine the extent and region of brain atrophy in schizophren ia and its relation to symptom syndromes and to patient sex. Design: Prospe ctive study of consecutive patients. Setting: Psychiatric department of a g eneral teaching hospital. Patients: Sixty-one consecutive patients (37 men and 24 women) admitted to hospital far acute exacerbation of schizophrenia, as diagnosed according to the DSM third edition, revised. Interventions: C omputed tomographic exami: nation of the head. Outcome measures: Diffuse at rophy and atrophy in the frontal and temporal regions and the sylvian fissu re were rated using the CT Rating Scale for Schizophrenia. Ratings were con trasted between male and female subjects; relations between atrophy ratings and 3 symptom dimensions of schizophrenia were examined for male and femal e subjects separately. Results: Widening of the sylvian fissure was positiv ely related to psychomotor poverty (r = 0.32, P < 0.01). There was a signif icantly stronger relation between diffuse atrophy and reality distortion in female than in male subjects. There was no sex difference in the atrophy r ating in all regions of the brain, and this lack of sex difference was not related to age of onset, length of illness or age at the time of the CT sca n. Conclusion: The morphological changes in the brain on CT are no greater in men than in women with schizophrenia. Different mechanisms may be involv ed in producing reality distortion symptoms in men and women.