CEREBRAL PERFUSION CHANGES IN NEWLY-DIAGNOSED ACUTE AND NEVERTREATED SCHIZOPHRENIC-PATIENTS PRE AND POST PSYCHOPHARMACOTHERAPY USING TC-99MHMPAO SPECT

Tc-99m hexamethyl propylene amine oxime (HMPAO) was used to compare ce rebral perfusion changes in twenty-two newly diagnosed, acute never-tr eated schizophrenic patients before and after treatment with typical a ntipsychotics. CT brain scanning was also performed before exposure to pharmacotherapy in twenty of the above patients, only two of whom sho wed abnormalities in the CT scans. Fourteen patients had normal, and e ight had abnormal cerebral blood flow before treatment. Of the eight p atients who had abnormal CBF studies, six demonstrated decreased and t wo demonstrated increased HMPAO retention. Five of the six hypo-perfus ions were in the left hemisphere, and one was bilateral. The two hyper -perfusions were in the basal ganglia. Of the eleven patients who had cerebral perfusion studies after treatment with typical neuroleptics, five patients continued to have normal cerebral perfusion, two convert ed from normal to hypoperfusion, one from hypo to normal perfusion, tw o remained hypo, and one converted from hyper to hypo-perfusion. The r esults of this study did not support the hypothesis of hypofrontality, and the reduction of metabolism in the basal ganglia; and some suppor t was obtained for the left lateralised reduction in CBF in some acute schizophrenics. The results also showed no consistent pattern of neur oleptic medication effect on CBF changes in treated schizophrenics. Th e functional CBF changes shown by SPECT in some of the schizophrenics in this study before treatment were not matched by structural deficits by CT brain scans.