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An investigation of criteria used to indicate cranial CT in males with schizophrenia

Published online by Cambridge University Press:  24 June 2014

Daniel J Rock*
Affiliation:
Centre for Clinical Research in Neuropsychiatry, Mount Claremont, Western Australia
Peter Wynn Owen
Affiliation:
Centre for Clinical Research in Neuropsychiatry, Mount Claremont, Western Australia Graylands Hospital, Mount Claremont, Western Australia
*
Centre for Clinical Research in Neuropsychiatry, Locked Bag no. 1, Claremont, Western Australia, 6910, Australia. Tel. +61 93476429; Fax: +61 93845128; E-mail: [email protected]

Abstract

Background:

With the increased accessibility of the CT scanner, psychiatrists managing schizophrenia and first-episode psychosis have incorporated this imaging technique into their diagnostic work-up. This practice has been reinforced by published criteria for CT scanning in psychiatric patients suggesting that cranial CT should be used as a screening tool to exclude intracranial pathology in all patients with a first presentation of schizophrenia or first psychotic episode.

Objectives:

This study reviews the performance of these criteria.

Method:

This consisted of a 3-year retrospective case-note audit, using published criteria, of all male in-patients with an established diagnosis of schizophrenia who had a cranial CT during the review period.

Results:

The efficacy of the published criteria is not supported. In addition, non-specific abnormalities on cranial CT are related to duration of illness and not age in this sample.

Conclusions:

There is a need to establish new and clinically meaningful approaches for the use of cranial CT and similar technologies in clinical psychiatry. Cranial CT performs poorly as a universal screening tool in this population. The decision to use such imaging techniques should be made on a case-by-case basis using all available clinical evidence.

Type
Research Article
Copyright
Copyright © 2003 Blackwell Munksgaard

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References

Kraepelin, E. Dementia Praecox and Paraphrenia. (translated by R.M. Barklay). Edinburgh: Livingstone, 1919. Google Scholar
Shenton, ME, Dickey, CC, Frumin, M, McCarley, RW. A review of MRI findings in schizophrenia. Schizophr Res 2001;49: 152.CrossRefGoogle Scholar
Haug, JO. Pneumoencephalographic studies in mental disease. Acta Psychiatrica Scand 1962;38: 1114. Google ScholarPubMed
Copolov, D, Crook, J. Biological markers and schizophrenia. Aust NZ J Psychiatry 2000;34: S108S112. CrossRefGoogle Scholar
Abrams, HL, McNeil, BJ. Medical implications of computed tomography (‘CAT’ scanning). N Engl J Med 1978;298: 255261.CrossRefGoogle Scholar
Johnstone, EC, Crow, TJ, Frith, CD, Husband, J, Kreel, L. Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet 1976;2: 924926.CrossRefGoogle ScholarPubMed
Owens, DG C, Johnstone, EC, Bydder, GM, Kreel, L. Unsuspected organic disease in chronic schizophrenia demonstrated by computed tomography. J Neurol Neurosurg Psychiatry 1980;43: 10651069.CrossRefGoogle Scholar
Larson, EB, Mack, LA, Watts, B, Cromwell, LD. Computed tomography in patients with psychiatric illnesses. Advantage of a “rule-in” approach. Ann Intern Med 1981;95: 360364.CrossRefGoogle ScholarPubMed
Holt, RE, Rawat, S, Beresford, TP, Hall, RCW. Computed tomography of the brain and the psychiatric consultation. Psychosomatics 1982;23: 10071019.CrossRefGoogle ScholarPubMed
Weinberger, DR. Brain disease and psychiatric illness. When should a psychiatrist order a CAT scan? Am J Psychiatry 1984;141: 15211527.Google Scholar
Johnstone, EC, Macmillan, JF, Crow, TJ. The occurrence of organic disease of aetiological significance in a population of 268 cases of first episode schizophrenia. Psychol Med 1987;17: 371379.CrossRefGoogle Scholar
Falkai, P. Differential diagnosis in acute psychotic episode. Int Clin Psychopharmacol 1996;11: 1317.CrossRefGoogle ScholarPubMed
Tsai, L, Tsuang, MT. How can we avoid unnecessary CT scanning for psychiatric patients? J Clin Psychiatry 1981;42: 452454.Google ScholarPubMed
Ananth, J, Gamal, R, Miller, M, Wohl, M, Vandewater, S. Is the routine CT head scan justified for psychiatric patients? A prospective study. J Psychiatry Neurosci 1993;18: 6973.Google ScholarPubMed
Bain, BK. CT scans of first-break psychotic patients in good general health. Psychiatr Serv 1998;49: 234235.CrossRefGoogle ScholarPubMed
Marik, PE, Rakusin, A, Sandhu, SS. The impact of the accessibility of cranial CT scans on patient evaluation and management decisions. J Int Med 1997;241: 237243. CrossRefGoogle ScholarPubMed
Gewirtz, G, Squires-Wheeler, E, Sharif, Z, Honer, WG. Results of computerised tomography during first admission for psychosis. Br J Psychiatry 1994;164: 789795.CrossRefGoogle Scholar
Colohan, H, O'Callaghan, E, Larkin, C, Waddington, JL. An evaluation of cranial CT scanning in clinical psychiatry. Irish J Med Sci 1989;158: 178181.CrossRefGoogle ScholarPubMed
Goodstein, RK. Guide to CAT scanning in hospital psychiatry. Overview of clinical practice and criteria for use. General Hosp Psychiatry 1985;7: 367376. CrossRefGoogle ScholarPubMed
National Center for Health Statistics (US). International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Ann Arbor: The Center, 1987. Google ScholarPubMed
Kirkby, KC, Hay, DA, Daniels, BA, Jones, IH, Mowry, BJ. Comparison between register and structured interview diagnoses of schizophrenia: a case for longitudinal diagnostic profiles. Austr N Zealand J Psychiatry 1998;32: 410414. CrossRefGoogle ScholarPubMed
National Health and Medical Research Council. National. Statement of Ethical Conduct in Research Involving Humans. Canberra: Commonwealth of Australia, 1999. Google ScholarPubMed
Medcalc Software. Medcalc (Computer Program), Version 6.12. Mariakerke (Belgium): Medcalc Software, 2000. Google Scholar