Structural brain abnormalities in the major psychoses: a quantitative review of the evidence from computerized imaging.

TLDR: This quantitative review focuses on estimating the extent of neuroanatomical abnormalities detected via neuroimaging in schizophrenia and affective disorders, and on examining sample characteristics and methodological factors that may affect study outcome.

Abstract: The neuroimaging literature on structural brain abnormalities in the major psychoses is quantitatively reviewed. The mean effect size for studies of lateral ventriculomegaly in schizophrenia (d = .70) corresponded to 43% nonoverlap between the distributions of schizophrenics and control Ss. Planimetry yielded larger effects than linear methods of ventricular size estimation. Although enlargement of the third ventricle was comparable to that of lateral ventrieulomagaly (d = .66), it was found to be significantly greater after differences in measurement method were taken into account. The average cumulative length of hospitalization, adjusted for patients' age and duration of illness, predicted ventriculomegaly in schizophrenia. Studies on schizophrenia and affecfive disorder differed neither in the extent of reported ventriculomegaly nor in the amount of"cortical atrophy." The notion of schizophrenia as a brain disorder has generated great interest in the structural parameters of its substrate: the schizophrenic brain. Since the 1970s, a revolution in neuroradiology has eliminated many risks and limitations of older brain imaging procedures, thereby allowing systematic exploration of cerebral structure in psychiatric patients. Two radiological techniques--computer-assisted tomography (CAT, or CT) and magnetic resonance imaging (MRI)permit reliable in vivo structural imaging of the brain. Although based on different physical principles, both approaches provide an unprecedented opportunity for noninvasive visualization of gross brain anatomy. Hence, both are well suited for the investigation of putative cerebral abnormalities in psychiatric patients. In this quantitative review, we focus on estimating the extent of neuroanatomical abnormalities detected via neuroimaging in schizophrenia and affective disorders, and on examining sample characteristics and methodological factors that may affect study outcome. The bulk of the evidence is drawn from CT investigations ofcerebrospinal fluid (CSF)-filled cavities-that is, the ventricular system, cortical sulci and fissures, and pericerebellar spaces---in the major psychoses. Whereas CT has been applied to research in neuropsychiatry for more than a decade, since the pioneering study by Johnstone, Crow, Frith, Stevens, and Kreel (1976), the application of MRI to the investigation of gross neuroanatomy in psychotic patients is still in its exploratory phase. Unlike CT studies, MRI investigations--with their great variety of imaging approaches and considerable flexibility in manipulating scanning parame