A five-year longitudinal study of the regional cerebral metabolic changes of a schizophrenic patient from the first episode using Tc-99m HMPAO SPECT

This is a naturalistic study of the relationship between cerebral metabolic activity, clinical symptoms and treatment response in a schizophrenic pati ent for 5 years from the onset of her illness. Serial technetium-99m-HMPAO brain SPECT was used to measure regional cerebral metabolism. The Cambridge Neurological Inventory and neuropsychological tests (WAIS-R verbal subscal es, Wisconsin Card Sorting Test, semantic verbal fluency, logical memory in Weschler Memory Scale) were used for neurocognitive assessment. Under-acti vity of the left temporal area was observed in the course of patient illnes s despite remission of the psychotic symptoms. Bilateral prefrontal metabol ic under-activity was noted at the emergence of negative symptoms, executiv e neurocognitive dysfunction and the treatment-resistant state. After respo nse to clozapine, the right prefrontal activity returned to a normal level. Our findings suggested that persistent left temporal underactivity detecte d by SPECT despite clinical remission may indicate a vulnerability for furt her relapses and development of a treatment-resistant state. Treatment-resi stant state, negative symptoms and executive neurocognitive deficit may inv olve abnormal prefrontal metabolic activity and can be alleviated in clozap ine-responsive patients.