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Quantitative Magnetic Resonance Imaging Volumetry Distinguishes Delusional Disorder from Late-Onset Schizophrenia

Published online by Cambridge University Press:  02 January 2018

Robert J. Howard ,
Osvaldo Almeida ,
Raymond Levy ,
Phillipa Graves  and
Martin Graves
Robert J. Howard*
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
Osvaldo Almeida
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
Raymond Levy
Affiliation:
Section of Old Age Psychiatry, Institute of Psychiatry, London
Phillipa Graves
Affiliation:
Phillip Harris Magnetic Resonance Centre, Department of Radiological Sciences, Guy's Hospital, London Bridge, London SE3 9RT
Martin Graves
Affiliation:
Phillip Harris Magnetic Resonance Centre, Department of Radiological Sciences, Guy's Hospital, London Bridge, London SE3 9RT
*
Dr R. J. Howard, Institute of Psychiatry, De Crespigny Park, Camberwell, London SE5 8AF
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Abstract

Background

Late paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life.

Method

Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces.

Results

No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n = 31) and delusional disorder (n = 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls.

Conclusions

Structural brain differences underly diagnostic heterogeneity within late paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 4 , October 1994 , pp. 474 - 480
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

Almeida, O., Howard, R., Forstl, H., et al (1992) Should the diagnosis of late paraphrenia be abandoned? Psychological Medicine, 22, 11–14.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
American Psychiatric Association (1993) DSM-IV Draft Criteria. Task Force on DSM-IV. Washington, DC: APA.Google Scholar
Besson, J. A. O., Corrigan, F. M., Cherryman, G. R., et al (1987) Nuclear magnetic resonance brain imaging in chronic schizophrenia. British Journal of Psychiatry, 150, 161–163.CrossRefGoogle ScholarPubMed
Breitner, J. C. S., Husain, M. M., Figiel, G. S., et al (1990) Cerebral white matter disease in late-onset paranoid psychoses. Biological Psychiatry, 28, 266–274.CrossRefGoogle Scholar
Brown, R., Colter, N., Corsellis, N., Corsellis, J. A. N., et al (1986) Postmortem evidence of structural brain changes in schizophrenia. Differences in brain weight, temporal horn area and parahippocampal gyrus compared with affective disorder. Archives of General Psychiatry, 43, 36–42.Google Scholar
Castle, D. & Howard, R. (1992) What do we know about the aetiology of late-onset schizophrenia? European Psychiatry, 7, 99–108.Google Scholar
Crow, T. J. (1990) Temporal lobe asymmetries as the key to the etiology of schizophrenia. Schizophrenia Bulletin, 16, 433–443.CrossRefGoogle Scholar
Flint, A. J., Rifat, S. L. & Eastwood, M. R. (1991) Late-onset paranoia: distinct from paraphrenia. International Journal of Geriatric Psychiatry, 6, 103–109.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–197.Google Scholar
Herbert, M. E. & Jacobson, S. (1967) Late paraphrenia. British Journal of Psychiatry, 113, 461–469.CrossRefGoogle ScholarPubMed
Holden, N. L. (1987) Late paraphrenia or the paraphrenias? A descriptive study with a 10-year follow-up. British Journal of Psychiatry, 150, 635–639.CrossRefGoogle ScholarPubMed
Howard, R. J., Almeida, O. & Levy, R. (1994) Phenomenology, demography and diagnosis in late paraphrenia. Psychological Medicine, 24, 397–410.Google Scholar
Howard, R. J., Castle, D., Wessely, S., et al (1993) A comparative study of 470 cases of early- and late-onset schizophrenia. British Journal of Psychiatry, 163, 352–357.CrossRefGoogle ScholarPubMed
Howard, R. J., Forstl, H., Almeida, O., et al (1992a) Computer-assisted in late paraphrenics with and without Schneiderian first rank symptoms. International Journal of Geriatric Psychiatry, 7, 35–38.CrossRefGoogle Scholar
Howard, R. J., Forstl, H., Naguib, M., et al (1992b) First rank symptoms of Schneider in late paraphrenia: Cortical structural correlates. British Journal of Psychiatry, 160, 108–109.CrossRefGoogle ScholarPubMed
Kay, D. W. K. & Roth, M. (1961) Environmental and hereditary factors in the schizophrenias of old age (late paraphrenia) and their bearing on the general problem of causation in schizophrenia. Journal of Mental Science, 107, 649–686.CrossRefGoogle ScholarPubMed
Kelsoe, J. R., Cadet, J. L., Pickar, D., et al (1988) Quantitative neuroanatomy in schizophrenia: A controlled magnetic resonance imaging study. Archives of General Psychiatry, 45, 533–541.Google Scholar
Kendler, K. S. (1980) The nosological validity of paranoia (simple delusional disorder): A review. Archives of General Psychiatry, 37, 699–706.Google Scholar
Kraepelin, E. (1919) Dementia Praecox and Paraphrenia. (Trans. Barclay, R. M., 1971.) New York: Kreiger Huntington.Google Scholar
Miller, B. L., Lesser, I. M., Boone, K., et al (1991) Brain lesions and cognitive function in late-life psychosis. British Journal of Psychiatry, 158, 76–82.Google Scholar
Miller, B. L., Lesser, I. M., Mena, I., et al (1992) Regional cerebral blood flow in late-life-onset psychosis. Neuropsychiatry, Neuropsychology and Behavioural Neurology, 5, 132–137.Google Scholar
Munro, A. (1988) Delusional (paranoid) disorders: Etiological and taxonomic considerations. 1. The possible significance of organic brain factors in the etiology of delusional disorders. Canadian Journal of Psychiatry, 33, 171–174.Google Scholar
Naguib, M. & Levy, R. (1987) Late paraphrenia: Neuropsychological impairment and structural brain abnormalities on computed tomography. International Journal of Geriatric Psychiatry, 2, 83–90.CrossRefGoogle Scholar
Nelson, H. E. (1982) The National Adult Reading Test. Windsor: NFER-Nelson.Google Scholar
Norusis, M. (1990) SPSS/PC + Statistics 4.0 for the IBM PC/XT/AT and PS/2. Netherlands: SPSS International BV, PO Box 115, 4200 AC Gorinchem.Google Scholar
Pakkenberg, B. (1987) Post-mortem study of chronic schizophrenic brains. British Journal of Psychiatry, 151, 744–752.Google Scholar
Pearlson, G. D., Garbacz, D., Tompkins, R. H., et al (1987) Lateral cerebral ventricular size in late-onset schizophrenia. In Schizophrenia and Aging (eds Miller, N. E. & Cohen, G. D.). New York: Guilford Press.Google Scholar
Post, F. (1966) Persistent Persecutory States of the Elderly. Oxford: Pergamon.Google Scholar
Quintal, M., Day-Cody, D. & Levy, R. (1991) Late paraphrenia and ICD-10. International Journal of Geriatric Psychiatry, 6, 111–116.Google Scholar
Rabins, P., Pearlson, G., Jayaram, G., et al (1987) Increased ventricle-to-brain ratio in late-onset schizophrenia. American Journal of Psychiatry, 144, 1216–1218.Google Scholar
Reveley, A. M., Reveley, M. A., Clifford, C. A., et al (1982) Cerebral ventricular size in twins discordant for schizophrenia. Lancet, 1, 540–541.CrossRefGoogle ScholarPubMed
Roth, M. (1955) The natural history of mental disorder in old age. Journal of Mental Science, 101, 281–301.Google Scholar
Shrout, P. E. & Fleiss, J. L. (1979) Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420–428.CrossRefGoogle ScholarPubMed
Suddath, R. L., Christison, G. W., Torrey, E. F., et al (1990) Anatomical abnormalities in the brains of monozygotic twins discordant for schizophrenia. New England Journal of Medicine, 322, 789–794.CrossRefGoogle ScholarPubMed
Watt, J. A. (1985) The relationship of paranoid states to schizophrenia. American Journal of Psychiatry, 142, 1456–1458.Google ScholarPubMed
Weinberger, D. R., Torrey, E. F., Neophytides, A. N., et al (1979) Lateral cerebral ventricular enlargement in chronic schizophrenia. Archives of General Psychiatry, 36, 735–739.CrossRefGoogle ScholarPubMed
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.Google Scholar
Young, A. H., Blackwood, D. H., Roxborough, H., et al (1991) A magnetic resonance imaging study of schizophrenia: Brain structure and clinical symptoms. British Journal of Psychiatry, 158, 158–164.CrossRefGoogle ScholarPubMed
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