Secondary Schizophrenia (27 page)

Brodmann areas
[68, 69]
documented reduced asso-Reality distortion was associated with hyperac-

ciations among proximate regions within the frontal
tivation in the medial prefrontal cortex
[172]
and
and temporal lobes, and strengthening of more dis-a persecutory attributional stance in patients was
tant (interlobar) fronto-temporal, as well as fronto-accompanied by more severe prefronto-amygdalar
parietal and temporo-occipital intercorrelations, albeit
disconnection
[173].

less prominently, in patients with schizophrenia.

Impaired connectivity between the anterior-

Fronto-temporal grey matter volume dissociations in
cingulate and supplementary motor areas was related
schizophrenics have been reported in some other

to negative symptoms. The poor functional outcome
investigations
[44,
152, 153].

in schizophrenia overall was associated with more
Thalamocortical dissociations in patients with

severe hypoactivation in the temporal lobe and cingu-schizophrenia, assessed in another two studies from
late gyrus, as well as more significant hypofrontality at
our laboratory
[154, 155],
were found to be rather
rest, as compared to the good-outcome patient group
widespread, especially with the prefrontal, medial-

[174]
. Finally, one of the often-reported schizophrenia
temporal, and cingulate-cortical regions in both
endophenotypes – impaired inhibition of saccadic
hemispheres and, for the pulvinar with the occip-eye movements – was ascribed to failure to activate
ital and orbito-frontal cortices in the right hemi-the lentiform nuclei, thalami, and the left inferior
sphere. The latter pulvino-cortical dissociations were
frontal gyrus in response to an antisaccadic task
proposed to be pathogenetically related to visual
[175].

attentional deficits amply described in patients with
schizophrenia.

Receptor occupancy evaluation

Functional imaging correlates of

with PET

Dopamine D

clinical symptomatology

2 receptor binding in neuroleptic-naive

patients with schizophrenia has in recent years been
A number of functional neuroimaging studies have
studied using raclopride-11C as the ligand. Reduced
in recent years increasingly focused on relationships
ligand binding has been reported in the thalamus
[176,

between regional abnormalities and specific clinical
177, 178],
especially within the left mediodorsal and
symptoms or syndromes of schizophrenia
[156].
Audi-pulvinar nuclei
[176],
as well as the anterior cingulate
tory hallucinations have been consistently related to
[176, 179],
amygdala
[176]
, but not the caudate
[177].

activations in the left superior temporal gyrus and,
The biggest effect has thus far been reported in the
66

Chapter 5 – Functional neuroimaging in schizophrenia

Figure 5.3
Significance probability mapping
[184]
test areas of decrease in FDG relative metabolic rate and D2 receptor binding. (See color
plate section.)
thalamus. One study that found no regional between-

Conclusion and new directions

group differences in the raclopride C11 binding
[180]

At the present time, all functional neuroimaging
did report a significant direct correlation between the
modalities are in transition from being strictly
ligand binding in the frontal lobe and the positive
research tools to assisting clinical diagnosis and
symptom severity in schizophrenics.

treatment choice. Work is being done on developing
Preliminary investigations with some other lig-

fMRI classificatory instruments aimed at image-based
ands have been less conclusive, with reports of either
identification of patients with schizophrenia
[185]

no intergroup differences
[181]
or elevated binding
and on PET prediction of response to neuroleptic
[182]
for serotonin 1A receptors, as well as the as-yet
treatment
[186].
This may be reasonably expected to
unreplicated finding of decreased frontal lobe binding
eventually make functional neuroimaging clinically
for histamine H1 receptors
[183].

useful for diagnosis and treatment.

67

The Neurology of Schizophrenia – Section 2

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