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August 1995

Resting Cerebral Glucose Metabolism in First-Episode and Previously Treated Patients With Schizophrenia Relates to Clinical Features

Author Affiliations

From the Department of Psychiatry, Neuropsychiatry Program, Mental Health Clinical Research Center (Drs R. E. Gur, P. Mozley, Resnick, Shtasel, Arnold, and R. C. Gur and Ms Gallacher), the Department of Neurology, Cerebrovascular Research Center (Dr Reivich), and the Department of Radiology, Center for Functional and Metabolic Imaging (Drs L. Mozley, Karp, and Alavi), University of Pennsylvania School of Medicine, Philadelphia. Dr Resnick is currently affiliated with the Gerontology Research Center, National Institute of Aging, Baltimore, Md.

Arch Gen Psychiatry. 1995;52(8):657-667. doi:10.1001/archpsyc.1995.03950200047013

Background:  Functional neuroimaging can elucidate brain dysfunction in schizophrenia. The frontal, temporolimbic, and diencephalic regions have been implicated. There is a lack of prospective samples of firstepisode and previously treated patients followed up longitudinally.

Methods:  Patients and controls (42 per group) were studied. Positron emission tomography with fluorodeoxyglucose, cross-registered with magnetic resonance imaging, measured metabolism. Scales assessed clinical features, premorbid adjustment, and outcome.

Results:  There were no differences between groups in whole-brain metabolism or regional ratios or in anterior-posterior gradients, but left midtemporal metabolism was relatively higher in patients. This was pronounced in the negative and Schneiderian and absent in the paranoid subtypes. Higher metabolism and lower relative left hemispheric values were associated with better premorbid adjustment and outcome. A higher subcortical-cortical gradient was noted in first-episode patients.

Conclusions:  There are no resting metabolic abnormalities in any brain region, but abnormal gradients are evident. These vary in subtypes, and laterality is associated with functioning. The results support the hypothesis of temporolimbic disturbance in schizophrenia that is already present at the onset of illness.