ABSTRACT
Suicidal attempts are relatively frequent and clinically relevant in patients with schizophrenia. Recent studies have found gray matter differences in suicidal and non-suicidal depressive patients. However, no previous neuroimaging study has investigated possible structural abnormalities associated to suicidal behaviors in patients with schizophrenia. A whole-brain magnetic resonance voxel-based morphometric examination was performed on 37 male patients meeting the DSM-IV criteria for schizophrenia. Thirteen (35.14%) patients had attempted suicide. A non-parametric permutation test was computed to perform the comparability between groups. An analysis of covariance (AnCova) model was constructed with a statistical threshold of p<0.05 corrected for multiple comparisons. After controlling for age and severity of illness, results showed significant gray matter density reduction in left superior temporal lobe (p=0.03) and left orbitofrontal cortex (p=0.04) in patients who had attempted suicide when comparing with non-suicidal patients. Although sample size limitations and potential clinical heterogeneity preclude definitive conclusions, these data point to structural differences in key cerebral areas. Neuroimaging studies are necessary to expand our knowledge of biological mechanisms underlying suicide in schizophrenia.
Subject(s)
Frontal Lobe/pathology , Functional Laterality , Schizophrenia/pathology , Schizophrenic Psychology , Suicide/psychology , Temporal Lobe/pathology , Adult , Age Factors , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Psychiatric Status Rating Scales , Statistics, NonparametricABSTRACT
Introducción: Estudio prospectivo de 5 años, cuyo objetivo es evaluar la estabilidad temporal del diagnóstico de trastorno esquizofreniforme (TE) provisional y evaluar la validez predictiva de las características de buen pronóstico que define el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV). Sujetos y métodos: La muestra consta de 38 pacientes (23 varones y 15 mujeres) ingresados en el hospital, entre 1996 y 1998, por un primer episodio psicótico. Se realizaron 4 entrevistas de seguimiento: en el primer, segundo, tercer y quinto años. Los pacientes se evaluaron mediante la Brief Psychiatric Rating Scale (BPRS), la Escala de Evolución de Strauss-Carpenter, la entrevista clínica estructurada del DSM-IV (SCID) y la Escala de Evaluación de la Actividad Global (EEAG). Resultados: Completaron el seguimiento de 5 años 27 pacientes. El 25,9% mantenía el diagnóstico de TE a los 5 años y el 59,2% se clasificaron dentro del espectro esquizofrénico. La presencia en el primer ingreso de características de buen pronóstico se asoció con una mejor evolución a los 5 años, pero no se asoció al mantenimiento del diagnóstico de TE. Los pacientes que mantuvieron el diagnóstico de TE presentaron mejor evolución que los pacientes esquizofrénicos. Conclusiones: Tras 5 años de seguimiento, la mayoría de los pacientes continúan presentando síntomas y cumplen criterios de esquizofrenia o trastorno esquizoafectivo, lo que confirma la baja estabilidad del diagnóstico TE. Los hallazgos sugieren una asociación entre las características de buen pronóstico y una mejor evolución, aunque no se observa asociación con el mantenimiento del diagnóstico TE
Introduction: We performed a 5-year prospective study to evaluate the temporal stability of a provisional diagnosis of schizophreniform disorder (SFD) and evaluate the predictive value of the good prognostic features defined in the DSM-IV. Subjects and Methods: The sample consisted of 38 patients (23 men and 15 women) admitted to our hospital from 1996 to 1998 for a first psychotic episode. Four follow-up interviews were obtained: at the first, second, third and fifth years of follow-up. Patients were evaluated by means of the Brief Psychiatric Rating Scale (BPRS), the Strauss-Carpenter Scale, the Structured Clinical Interview of the DSM-IV (SCID) and the Global Assessment of Functioning Scale (GAF Scale) of the DSM-IV. Results: Twenty-seven patients completed the study. A total of 25.9% retained the diagnosis of SFD and 59.2% were classified as having a disorder of the schizophrenic spectrum. The presence of good prognostic features at the index admission was associated with better outcome, but not with maintenance of the diagnosis of SFD. After 5 years of follow-up, patients with SFD showed significantly better outcomes than did schizophrenic patients. Conclusions: After 5 years of follow-up most of the patients continued to have symptoms and met the criteria for schizophrenia or schizoaffective disorder, confirming the low stability of a provisional diagnosis of SFD. The results of this study suggest an association between good prognostic features and better outcome, but not with maintenance of a diagnosis of SFD