Childhood-onset psychotic disorders: Magnetic resonance imaging of volumetric differences in brain structure

Objective: Although childhood-onset schizophrenia is rare, children with br ief psychotic symptoms and prominent emotional disturbances commonly presen t diagnostic and treatment problems. Quantitative anatomic brain magnetic r esonance images (MRIs) of a subgroup of children with psychotic disorder no t otherwise specified were compared with those of children with childhood-o nset schizophrenia and healthy comparison subjects. Method: Anatomic MRIs were obtained for 71 patients (44 with childhood-onse t schizophrenia and 27 with psychotic disorder not otherwise specified) and 106 healthy volunteers. Most patients had been treated with neuroleptics. Volumetric measurements for the cerebrum, anterior frontal region, lateral ventricles, corpus callosum, caudate, putamen, globus pallidus, and midsagi ttal thalamic area were obtained. Results: Patients had a smaller total cerebral volume than healthy comparis on subjects. Analysis of covariance for total cerebral volume and age found that lateral ventricles were larger in both patient groups than in healthy comparison subjects and that schizophrenia patients had a smaller midsagit tal thalamic area than both subjects with psychotic disorder not otherwise specified and healthy comparison subjects. Conclusions: Pediatric patients with psychotic disorder not otherwise speci fied showed a pattern of brain volumes similar to those found in childhood- onset schizophrenia. Neither group showed a decrease in volumes of temporal robe structures. Prospective longitudinal magnetic resonance imaging and c linical follow-up studies of both groups are currently underway to further validate the distinction between these two disorders.