ارتباط بالینی بزرگ سپتوم در اسکیزوفرنی: بازبینی از طریق توموگرافی کامپیوتری
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|30262||2015||18 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Asian Journal of Psychiatry, Available online 20 April 2015
Like prevalence of abnormal cavum septum pellucidum in patients of schizophrenia remains controversial, its role in clinical outcome, duration of illness and effect on treatment remains less understood as well. Our study examined clinical correlates of enlarged cavum septum pellucidum in schizophrenia. A total of 139 patients diagnosed with schizophrenia during the year 2012-2013 were taken for the study. We compared them in respect to the presence and absence of enlarged cavum septum pellucidum. We found 16 patients with enlarged cavum septum pellucidum and were compared with those without enlarged cavum septum pellucidum for socio-demographic and clinical variables. We also correlated these clinical variables with dimension of cavum septum pellucidum. We found statistically significant increased current age and duration of illness in patients with enlarged cavum septum pellucidum. The implications of these findings are discussed with possible confounding effect of current age on neuroimaging. No meaningful correlation was found. No difference in clinical variables was found. Retrospective design and use of computed tomography were limitation of our study.
Patients with schizophrenia have been found to have significant abnormalities in midline brain regions such as the corpus callosum (Woodruff et al., 1995 and Tibbo et al., 1998) septum pellucidum (Nopoulos et al., 1997, Kwon et al., 1998 and Nopoulos et al., 1998;) and cerebellar vermis (Rossi et al., 1993; Tran et al., 1998; Nopoulos et al., 1999). Among these several researches have been conducted on cavum septum pellucidi (CSP). But both the presence of CSP and its significance in schizophrenia remains unclear. It is suggested that CSP, particularly if it is large, should be considered a developmental anomaly that may contribute to neuropsychiatric abnormalities (Sarwar, 1989 and Nopoulos et al., 1997). Several studies have documented that patients with schizophrenia have an increased rate of enlarged cavum septum pellucidum (CSP) compared to healthy control groups (DeGreef et al., 1992a, DeLisi et al., 1993, Jurjus et al., 1993, Scott et al., 1993, Nopoulos et al., 1996, Galarza et al., 2004 and Filipovic et al., 2005) while this was not replicated in a recent study (Rajarethinam et al., 2007). Earlier and recent studies have attempted to examine relationships between CSP measures and clinical and demographic variables (Jurjus et al., 1993, Mathew et al., 1985 and Shioiri et al., 1996), symptoms (Mathew et al., 1985 and Nopoulos et al., 2000), duration of illness (Fukuzako et al., 1996 and Mathew et al., 1985), family history of illness (Uematsu and Kaiya, 1989), intellectual functioning (Nopoulos et al., 2000). While some studies have not documented any relationships between these variables and presence of CSP (DeLisi et al., 1993, Galarza et al., 2004, Jurjus et al., 1993, Rajarethinam et al., 2001 and Shioiri et al., 1996), few have found intriguing evidence. Uematsu & Kaiya (Uematsu and Kaiya, 1989) reported that CSP was significantly related to family history of schizophrenia while Nopoulos et al. (2000) reported a significant inverse relationship between size of CSP and IQ scores. Mathew et al. (1985) reported a significant correlation between age and septal area, and between duration of illness and septal area. Although the overall incidence of CSP between patients and controls was not found to differ, Fukuzako et al. (1996) noted that patients with a history of long-term institutionalization (> 3 years) had a significantly higher incidence of CSP. One recent case report has highlighted that abnormally large CSP may indicate worse prognosis in schizophrenia (Liao et al., 2012). Overall the functional implications of CSP in schizophrenia has not been consistently replicated and remain unclear. Hence, the present study tried to examine whether patients of schizophrenia with enlarged CSP have different sociodemographic and clinical profile than patients of schizophrenia without enlarged CSP. This study also examined whether a relationship could be identified between CSP measures and clinical symptoms of patients of schizophrenia. 2. Method 2.1. Subjects This is a retrospective study which was undertaken at Central Institute of Psychiatry, Ranchi, India. Initially all patients diagnosed with schizophrenia, who had undergone computed tomography (CT) of brain since 1st January, 2012 to 31st December, 2013 were included in this study. Diagnosis of schizophrenia was made according to Clinical Description and Diagnostic Guidelines (CDDG), International Classification of Diseases–10th version (ICD-10) by World Health Organization (WHO). Indications for neuroimaging were clinical suspicions of any organicity by treating psychiatrists or inadequate response to psychotropics. A total of 212 patients with schizophrenia had undergone CT of brain in the said period. Method of chart review was adopted. Any patient with a history of neurological illness, head injury with loss of consciousness, systemic illness with potential cognitive sequelae, or current substance abuse or past history of substance dependence were excluded. Finally total of 139 patients were recruited for this study. Ethical approval was obtained from institutional ethical committee before collecting data.
نتیجه گیری انگلیسی
Our study did not find any difference in clinical variables among patients of schizophrenia with or without enlarged CSP. Neither any clinical correlate could be established. Nonetheless, patients of schizophrenia having enlarged CSP appears to have a more chronic course and to be older than those who do not have enlarged CSP though it could not be established with confidence. Thus, whether enlarged CSP in study group is due to age related or due to neurodevelopmental disease process could not be established as well. Future studies on this area of interest will likely benefit from inclusion of larger samples of patients with abnormally large CSP, and with use of objective measures of clinical and treatment variables and use of magnetic resonance imaging to measure CSP.