Magnetic Resonance Correlates of Poor Outcome Schizophrenia

Introduction: Schizophrenia is a disease with heterogeneous features and a disabling longitudinal outcome. Imaging techniques may allow identifying measurable markers of different subgroups of patients, who share common clinical course and, probably, a similar hereditary pathway. Major findings reported, both on cross-sectional and longitudinal studies, an association between larger ventricles or smaller prefrontal and temporal volumes and poor clinical outcome, defined by severity of symptoms and need of frequent assistance and hospitalizations. Smaller volumes in hippocampus and limbic structures were correlated with worse psychopathology. Objectives: We investigated the relationship between clinical and psychosocial measures and imaging data in a cohort of patients with schizophrenia. We followed up the progression of the illness in this cohort of patients, and identified determinants of relapse or remission. The study focused cross-sectionally and longitudinally on? a sample of chronic patients, who underwent magnetic resonance assessment twice. Methods: Patients with schizophrenia and healthy controls were recruited as part of a longitudinal study (First study). Baseline recruitment was conducted between December 2002 and April 2004. Patients with co-morbid psychiatric or neurological disorders, were excluded. Healthy control comparison subjects, had no DSM-IV axis I disorders or current major medical illness. Assessment included a baseline and a follow up magnetic resonance session and administration of a battery of clinical and psychosocial scales. Post processing analysis consisted in manual and automatic tracing. Multivariate analysis of variance (ANOVA), correlation matrices and regression models were applied to investigate the potential role of the different clinical and psychosocial data on MR measures. Results: We first assessed volume of hippocampus and its correlation with clinical and psychosocial functioning measures and found a reduction of hippocampal volume in those patients with lower educational levels, greater duration of illness, positive and negative symptoms’ scores number of hospitalizations and with lower quality of life. Secondly, we measured prefrontal volumes in the same sample. Patients with poor outcome had lower psychosocial functioning compared to good outcome. Compared to healthy controls, both group of patients had altered prefrontal cortex volumetric structure; in particular, lower volume in prefrontal cortex was even more pronounced in poor outcome patients.