CORRELATION OF POSITIVE SYMPTOMS EXCLUSIVELY TO HYPERPERFUSION OR HYPOPERFUSION OF CEREBRAL-CORTEX IN NEVER-TREATED SCHIZOPHRENICS

Background Studies of schizophrenia by single photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown both regional cerebral hyperperfusion and hypoperfusion. The aim of th is study was to examine the inter-relations between regional cerebral blood flow (rCBF), psychopathology, and effects of neuroleptic therapy . Methods 24 never-treated patients with acute schizophrenia were exam ined with hexamethyl-propyleneamine-oxime brain SPECT and assessed psy chopathologically according to the positive and negative syndrome scal e; they were studied again after neuroleptic treatment and psychopatho logical remission. rCBF values that deviated from those of 20 controls by more than 2 SD were regarded as abnormal. Findings Both hyperperfu sed and hypoperfused patterns were found among schizophrenia patients during acute illness. The seven positive symptoms on the symptom scale showed different correlations with rCBF, formal thought disorders and grandiosity correlated positively (and strongly) with bifrontal and b itemporal rCBF; delusions, hallucinations, and distrust correlated neg atively (and strongly) with cingulate, left thalamic, left frontal, an d left temporal rCBF. Stereotyped ideas as a negative symptom correlat ed negatively (and strongly) with left frontal, cingulate, left tempor al, and left parietal rCBF, After neuroleptic treatment (and reduction of positive symptoms), only negative symptoms correlated exclusively with bifrontal, bitemporal, cingulate, basal ganglia, and thalamic hyp operfusion, Interpretation Different positive symptoms are accompanied by different rCBF values-some related to hyperperfusion, others to hy poperfusion. This finding may help to explain observed inconsistencies of perfusion patterns in drug-naive schizophrenics.