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July 1987

Hat Size in Schizophrenia

Author Affiliations

Section on Clinical Neuropsychiatry Intramural Research Program National Institutes of Mental Health William A. White Building Saint Elizabeths Hospital Washington, DC 20032

Arch Gen Psychiatry. 1987;44(7):672. doi:10.1001/archpsyc.1987.01800190092014

To the Editor.—  The report by Andreasen et al1 of reduced midsagittal frontal lobe area in patients with schizophrenia is an interesting contribution to the sizeable literature implicating pathologic changes of the frontal cortex in this illness. It is the latest echo of numerous claims made by neuropathologists during the first half of this century2; it is consistent with several computed tomography (CT) studies that have reported increased cortical markings prefrontally3; and it may relate to physiological cerebral imaging data suggesting cognitively specific dysfunction of the prefrontal cortex.3In contrast to the prefrontal finding, Andreasen and colleagues'1 observation of reduced midsagittal cranial area is surprising and much less consistent with earlier studies. If this finding can be confirmed, it has profound meaning for our understanding of the pathogenesis of schizophrenia. Since brain and cranial development are closely linked, reduced head size implicates a pathologic insult

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