Active and remitted schizophrenia: psychopathological and regional cerebral blood flow findings

Single photon emission computed tomography with technetium-99m-d,l-hexameth ylpropyleneamine oxime (Tc-99m-HMPAO) was used to assess regional cerebral blood flow (rCBF) during both florid and remitted stages of schizophrenia. Forty schizophrenic patients in an active phase of illness (diagnosis by DS M-III-R) were examined in two clinical states (ill vs. improved). At study entry, 24 patients were drug-naive, five were currently drug-free, and 11 w ere being treated with antipsychotic medication. Twenty medical patients wh o suffered from non-specific headaches but were free of neurological and ps ychiatric symptoms served as control subjects. At initial examination durin g the active phase of illness, cerebral perfusion patterns in the schizophr enic patients were characterized by both hypofrontality and hypotemporality . After remission, hypofrontality was no longer apparent in two of four fro ntal regions, and hypotemporality disappeared completely. As assessed with the Positive and Negative Syndrome Scale (PANSS), formal thought disorders, hallucinations, and ideas of grandiosity correlated with rCBF in the activ e phase of illness, but not after remission. In the remitted but not in the florid stare, blunted affect, difficulties in abstract thinking, lack of s pontaneity, and stereotyped thoughts correlated with rCBF. Correlations of five symptoms with rCBF changed significantly from first to second examinat ion. The present study suggests that correlations between single psychotic symptoms and rCBF differ significantly in florid vs. remitted phases of sch izophrenia. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.