CLINICAL HANDBOOK OF SCHIZOPHRENIA

4. Brain Imaging 43KEY POINTS• On average, patients with schizophrenia have bigger ventricles, smaller brains, and smallertemporal, parietal, and frontal lobes than healthy individuals, but the magnitude of this meandifference is modest.• Volumetric deficits among patients may be related to cognitive deficits and clinical symptoms,but more research into the functional significance of structural abnormalities isneeded.• At rest, patients with schizophrenia tend to have mild deficits in frontal lobe blood flow andmetabolism, and the degree of deficit may be related to age, duration of illness, and medicationeffects.• Metabolic deficits of the basal ganglia and temporal lobes also are commonly observedamong patients with schizophrenia.• Cognitive challenge tests reveal abnormalities of frontal and temporal lobe functioningamong patients with schizophrenia, but the nature and direction of these deficits may be relatedto task difficulty.• Electrophysiological abnormalities during controlled and automatic processing are prevalentamong patients with schizophrenia and may be related to functional outcome.• Future directions for brain imaging in schizophrenia include integration between differentimaging modalities, a focus on measurement of functional connectivity between regions,use of imaging in treatment studies, and a combination of imaging and genetic methods.REFERENCES AND RECOMMENDED READINGSAntonova, E., Sharma, T., Morris, R., & Kumari, V. (2004). The relationship between brain structureand neurocognition in schizophrenia: A selective review. Schizophrenia Research, 70(2–3), 117–145.Buchsbaum, M. S., & Hazlett, E. A. (1998). Positron emission tomography studies of abnormal glucosemetabolism in schizophrenia. Schizophrenia Bulletin, 24(3), 343–364.Davis, C. E., Jeste, D. V., & Eyler, L. T. (2005). Review of longitudinal functional neuroimaging studiesof drug treatments in patients with schizophrenia. Schizophrenia Research, 78(1), 45–60.Ford, J. M. (1999). Schizophrenia: The broken P300 and beyond. Psychophysiology, 36(6), 667–682.Hill, K., Mann, L., Laws, K. R., Stephenson, C. M., Nimmo-Smith, I., & McKenna, P. J. (2004).Hypofrontality in schizophrenia: A meta-analysis of functional imaging studies. Acta PsychiatricaScandinavica, 110(4), 243–256.Kraepelin, E. (1971). Dementia praecox and paraphrenia. Huntington, NY: Krieger. (Original workpublished 1919)Light, G. A., & Braff, D. L. (1999). Human and animal studies of schizophrenia-related gating deficits.Current Psychiatry Reports, 1(1), 31–40.Manoach, D. S. (2003). Prefrontal cortex dysfunction during working memory performance inschizophrenia: Reconciling discrepant findings. Schizophrenia Research, 60(2–3), 285–298.Shenton, M. E., Dickey, C. C., Frumin, M., & McCarley, R. W. (2001). A review of MRI findings inschizophrenia. Schizophrenia Research, 49(1–2), 1–52.Steen, R. G., Hamer, R. M., & Lieberman, J. A. (2005). Measurement of brain metabolites by (1)Hmagnetic resonance spectroscopy in patients with schizophrenia: A systematic review and metaanalysis.Neuropsychopharmacology, 30(11), 1949–1962.Weinberger, D. R., & Berman, K. F. (1996). Prefrontal function in schizophrenia: Confounds and controversies.Philosophical Transactions of the Royal Society of London: Series B, Biological Sciences,351, 1495–1503.