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Prefrontal and Temporal Blood Flow in Schizophrenia: Resting and Activation Technetium-99m-HMPAO SPECT Patterns in Young Neuroleptic-Naive Patients with Acute Disease

Nuclear Medicine and Psychiatry Departments, Hospital Clínic i Provincial of Barcelona
Biophysics and Bioengineering Laboratory, Faculty of Medicine, University of Barcelona, Barcelona, Spain

Correspondence: For correspondence or reprints contact: Ana M. Catafau, MD, Service de Medicina Nuclear, Hospital Clinic i Provincial, Villarroel, 170. 08036, Barcelona, Spain.

ABSTRACT

This study assesses prefrontal and temporal regional cerebral blood flow (rCBF) changes in young, neuroleptic-naive schizophrenic patients with acute disease. Methods: A selected population of 10 young, never-treated schizophrenic women with acute disease was studied by two hexamethylpropyleneamine oxime (HMPAO) brain SPECT sessions, performed 48 hr apart, both at rest and during a prefrontal activation task using the Wisconsin Card Sort Test (WCST). All patients met Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised criteria for schizophrenia or schizophreniform disorder, were neuroleptic-naive and had acute symptoms. Results: Under resting conditions, the schizophrenic group had significantly higher rCBF in the prefrontal regions, mainly in the left side and including the anterior cingulate, than did the controls. In addition, schizophrenic patients showed significant interhemispheric differences in prefrontal and posterior temporal index values at rest (left hyperfrontality and left hypotemporality). During WCST activation, the control group showed significant increases in prefrontal blood flow, whereas the schizophrenic group did not. Conclusion: These result support a physiologic dysfunction of the prefrontal cortex in schizophrenia that is present at the onset of the illness prior to neuroleptic treatment. Furthermore, both left hyperfrontality and left hypotemporality may indicate a brain lateralization defect in schizophrenia.

Key Words: HMPAO • SPECT • Wisconsin Card Sort Test • schizophrenia • neuroleptic-naive

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