VENTRICULAR ENLARGEMENT IN POOR-OUTCOME SCHIZOPHRENIA

Background: A subset of patients with schizophrenia, defined on the ba sis of longitudinal deficits in self-care, may show a classic (''Kraep elinian'') degenerative course. An independent validator of the phenom enologically defined Kraepelinian subtype might be provided by a struc tural indicator of possible brain degeneration: ventricular size as me asured by computed tomography (CT). Methods: To examine whether Kraepe linian patients would show a differential increase in ventricular size over time, two CT scans were conducted at intervals separated by >4 y ears, an average of 5 years. Fifty-three male patients with DSM-III-R diagnoses of chronic schizophrenia were subdivided into Kraepelinian ( n = 22; mean age = 42 +/- 8.6 years) and non-Kraepelinian (n = 31; mea n age = 38 +/- 12.2 years) subgroups. Kraepelinian patients were defin ed on the basis of longitudinal criteria: >5 years of complete depende nce on others for life necessities and care, lack of employment, and s ustained symptomatology. Thirteen normal elderly volunteers (mean age = 60 +/- 17.8) were also scanned at 4-year intervals. CT measurements were made by raters without knowledge of subgroup membership. A semiau tomated computer program was used to trace the anterior horn, lateral ventricles, and temporal horns for each slice level on which they were clearly seen. Results: The ventricles showed a bilateral increase in size over the 4-year interval in the Kraepelinian subgroup, more marke d in the left hemisphere than the right. By contrast, neither the non- Kraepelinian subgroup nor the normal volunteers showed significant CT changes from scan 1 to scan 2. Conclusions: Thus, the longitudinal dys functions in self-care that characterize the Kraepelinian patients wer e associated with an independent indicator of brain abnormality. (C) 1 998 Society of Biological Psychiatry.