CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 4BRAIN IMAGINGLISA T. EYLER. . . in dementia praecox, partial damage to, or destruction ofcells, of the cerebral cortex must probably occur . . . whichmostly brings in its wake a singular, permanent impairment ofthe inner life.—KRAEPELIN (1919/1971, p. 154)Schizophrenia was first classified as a disorder in the early 1900s, during a time whenunique neuropathological features were being discovered for other disturbances ofthought and behavior, such as Alzheimer’s dementia. Thus, it was expected that postmortem studies of the brains of patients with schizophrenia would also reveal characteristicabnormalities that were pathognomonic for the disorder. Unfortunately, very few consistentpatterns were found based on initial qualitative investigations of the brains of patientswith schizophrenia. Interest in exploring the neuropathology of schizophreniaconsequently waned (coincident with increased interest in nonbiological theories of thecause of the disorder), and did not rise again until the 1970s, when several brain imagingmodalities became available that allowed for in vivo, quantitative measurement of structureand function. These techniques made it possible to detect more subtle deficits acrossgroups of patients and ushered in a new era of interest in brain abnormalities in schizophrenia.Since then, much has been learned about structural brain abnormalities usingvolumetric techniques such as computed tomography (CT) and magnetic resonance imaging(MRI), and neurochemical methods such as magnetic resonance spectroscopy (MRS).We have also learned a great deal about functional deficits of schizophrenia using electroencephalography(EEG), xenon blood flow techniques, positron emission tomography(PET), single photon emission computed tomography (SPECT), and functional magneticresonance imaging (fMRI). This chapter reviews the relative strengths and weaknesses ofthese techniques, as well as general findings from studies that have used these tools to exploredeficits associated with schizophrenia. Promising future directions for brain imagingin schizophrenia are also highlighted.35