Association between altered proton magnetic resonance spectroscopy (1H MRS) findings and clinical symptoms of schizophrenia

Objective: To assess the metabolic alterations of the thalamus in subjects with schizophrenia compared to healthy subjects and to investigate whether specific schizophrenic symptoms are associated with metabolic alterations measured by 1H MRS. Methods: This is a case-control study including patients with schizophrenia diagnosed usingthe Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, DMS-IV and the Operational CriteriaChecklist for Psychotic Illness (OPCRIT). Proton magnetic resonance spectroscopy (1H MRS) was used to assess metabolite concentrations (N-acetylaspartate, choline, creatinine, myoionositol and lactacte) in the left and rightthalamus of 13 patients with schizophrenia and 13 healthy controls. Results: In this study, concentrations of specific metabolites in the thalamus, determined by 1H MRS, were similar for individuals with schizophrenia andcontrols. It was observed that cases with family history of schizophrenia and disorganized speech demonstrated areduction in the ratio of the metabolites NAA /Cho in the thalamic nuclei on the right side. However, those withorganized delusions, hallucinations and non-affective auditory hallucinations had an increase of metabolites on theright side compared to the left thalamus. Decreased thalamic metabolic activity in patients with positive symptomswas observed in contrast with those who had well-organized delusions and auditory non-affective hallucinations,core symptoms of schizophrenia. Conclusion: A lateralized thalamic involvement was verified, suggesting thatorganic and genetic factors compromise the right thalamus and that the disorganization associated with delusionsand hallucinations compromises the left thalamic nuclei. Further studies to investigate the correlation betweensymptoms and thalamic dysfunction are warranted. (Rev Neuropsiquiatr 2011;74:183-190).

Objetivo: Evaluar las alteraciones metabólicas del tálamo en personas con esquizofrenia comparándolas con controles sanos e investigar si los síntomas específicos de la esquizofrenia están vinculados a alteraciones metabólicas medidas por 1H MRS. Métodos: Se realizó la espectroscopía por resonancia magnética (1H-MRS) para estimar concentraciones de metabolitos (N-acetil- aspartato, colina creatinina, mioionositol y lactato) en el tálamo izquierdo y derecho de 13 pacientes con esquizofrenia y 13 controles. Resultados: Las concentraciones de metabolitos específicos en el tálamo fueron iguales para las personas con esquizofrenia y los controles. Se observó que los pacientes con historia familiar de esquizofrenia y aquellos que presentaban lenguaje desorganizado tenían una reducción de los metabolitos NAA/Co en los núcleos talámicos de la derecha. Sin embargo, en aquellos delirios ordenados, alucionaciones no afectivas y alucinaciones auditivas los metabolitos del lado derecho tuvieron cierto aumento con relación a los núcleos talámicos de la izquierda. Se encontró una reducción en la actividad metabólica talámica en los pacientes con síntomas positivos, al contrario de aquellos que presentaron delirios bien ordenados y alucinaciones auditivas no afectivas, los síntomas más nucleares de la esquizofrenia. Conclusión: Se verificó cierta lateralización del envolvimiento talámico, sugiriendo que los factores orgánicos y los genéricos comprometen el tálamo derecho y que la desorganización asociada a los delirios y alucionaciones compromete los núcleos talámicos de la izquierda. Más estudios son necesarios para investigar la validez de la correlación entre síntomas y disfunción talámica.

A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program: positive effect on the social functioning of schizophrenic patients

OBJECTIVES: The present study was designed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten, designated the Integrated Psychological Therapy (IPT) program in English, on cognition, social adjustment and quality of life in schizophrenic outpatients, comparing it to the effect of treating such patients as usual. METHOD: Fifty-six adult outpatients (from 18 to 65 years of age) with ICD-10-based diagnoses of schizophrenia were randomly assigned to two different groups: active intervention (IPT group); and treatment as usual (control group). Outcome measures were quality of life (as determined using the WHOQOL-Bref), cognition (Mini-Mental State Examination and Word Recall Test), global functioning (DSM-IV Global Assessment of Functioning Scale), social functioning (Social and Occupational Functioning Assessment Scale) and social adjustment (Social Adjustment Scale). RESULTS: The findings suggest that, in comparison with treatment as usual (control group), the twelve-session IPT program had a positive effect on several outcome measures: cognition in the domains of spatiotemporal orientation (p = 0.051) and memory (p = 0.031); overall social adjustment (p = 0.037), leisure/social life (p = 0.051) and family relations (p = 0.008); overall functioning (p = 0.000); social-occupational functioning (p = 0.000); and quality of life in the psychological domain (p = 0.021). CONCLUSIONS: The twelve-session cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition, social adjustment and quality of life. Studies involving larger samples, longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning, cognitive functioning and quality of life in patients with schizophrenia.

OBJETIVOS: O presente estudo foi designado para avaliar o efeito de 12 sessões semanais do programa cognitivo-comportamental IPT (Integrated Psychological Therapy - Integriertes psychologisches Therapieprogramm für schizophrene Patienten - Terapia Psicológica Integrada), comparado ao tratamento usual sobre o funcionamento cognitivo, ajustamento social e qualidade de vida em pacientes ambulatoriais com esquizofrenia. MÉTODO: Cinqüenta e seis pacientes ambulatoriais adultos (idade entre 18 e 65 anos) com diagnóstico de esquizofrenia pela CID-10, foram aleatoriamente designados para dois grupos: intervenção ativa (IPT) e tratamento usual (grupo controle). As diferenças de medidas de resultados foram em qualidade de vida (WHOQOL-bref), cognição (Mini-Mental State Examination e word-span), funcionamento global (Global Assessment of Functioning-DMS-IV), funcionamento social (Social and Occupational Functioning Assessment Scale-DSM-IV) e ajustamento social (Social Adjustment Scale). RESULTADOS: Os achados sugerem que 12 sessões do programa IPT mostraram um efeito positivo sobre várias medidas de resultado comparado ao grupo controle (tratamento usual): cognição nos domínios de orientação no tempo e no espaço (p = 0,045) e memória (p = 0,031); ajustamento social geral (p = 0,037), lazer e vida social (p = 0,051), relações familiares (p = 0,008); funcionamento global (p = 0,000); funcionamento sócio-ocupacional (p = 0,000); e qualidade de vida no domínio psicológico (p = 0,021). CONCLUSÃO: A intervenção cognitivo-comportamental de 12 sessões do IPT demonstrou superioridade de efeito sobre cognição, ajustamento social e qualidade de vida comparado ao tratamento usual. Estudos com amostras maiores, maior tempo de seguimento (follow-up) e medidas adicionais de desfechos são necessários para avaliar efeitos específicos sobre dimensões de funcionamento cognitivo, social e qualidade de vida em esquizofrênicos.