Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-19T14:24:32.597Z Has data issue: false hasContentIssue false
  • English
  • Français

Schizophrenia and the brain: a prospective clinico-neuropathological study

Published online by Cambridge University Press:  09 July 2009

C. J. Bruton ,
T. J. Crow ,
C. D. Frith ,
E. C. Johnstone ,
D. G. C. Owens  and
G. W. Roberts
C. J. Bruton*
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
T. J. Crow
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
C. D. Frith
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
E. C. Johnstone
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
D. G. C. Owens
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
G. W. Roberts
Affiliation:
Department of Neuropathology, Runwell Hospital, Wickford, Essex and Division of Psychiatry, Clinical Research Centre, Harrow, Middlesex
*
1Address for correspondence: Dr C. J. Bruton, Department of Neuropathology, Runwell Hospital, Wickford, Essex SS11 7QE.
Get access Rights & Permissions [Opens in a new window]

Synopsis

The neuropathological results from a prospective, systematically assessed, series of 56 schizophrenic patients and 56 age- and sex-matched normal controls have been presented.

When compared with the normal controls, the brains of the schizophrenic subjects showed a significant reduction in brain weight and brain length with a concomitant increase in ventricular size. (All findings relate to measurements made after formalin fixation). In addition, the brains of the schizophrenic patients contained significantly more non-specific focal pathology and fibrillary gliosis than the controls.

After exclusion of cases with moderate and severe Alzheimer-type change, cerebro-vascular disease and all forms of focal pathology, the structural brain changes (i.e. decrease in brain weight and brain length) continued to distinguish the schizophrenia group from the controls. Furthermore, an analysis of the clinical data showed that the structural brain changes were correlated in the schizophrenic patients with a measurement of pre-morbid function.

The findings and their possible aetiological implications have been discussed.

Type
Original Articles
Information
Psychological Medicine , Volume 20 , Issue 2 , May 1990 , pp. 285 - 304
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer, A. (1897). Beitrage zür pathologischen Anatomie der Hirnrinde und zür anatomischen Grundlage der Psychosen. Monatsschrift für Psychiatrie und Neurologie 2, 82–120.CrossRefGoogle Scholar
Alzheimer, A. (1913). Beitrage zür pathologischen Anatomie der Dementia Praecox, Allgemeine Zeitschrift für Psychiatrie 70, 810–812.Google Scholar
Bogerts, B., Meerts, E. & Schonfeldt-Bausch, R. (1985). Basal ganglia and limbic system pathology in schizophrenia: a morpho-metric study of brain volume and shrinkage. Archives of General Psychiatry 42, 784–791.CrossRefGoogle Scholar
Bonin, G. von (1950). Essay on the Cerebral Cortex. Charles C. Thomas: Springfield, Illinois.CrossRefGoogle Scholar
Broser, K. (1949). Hirngewicht und Hirnprozess bei Schizophrenie Archiv für Psychiatrie und Nervenkrankheiten, vereinigt mit Zeitschrift für die gesämte Neurologie und Psychiatrie 182, 439–449.CrossRefGoogle Scholar
Brown, R., Colter, N., Corsellis, J. A. N., Crow, T. J., Frith, C. D., Jagoe, R., Johnstone, E. C. & Marsh, L. (1986). Postmortem evidence of structural brain changes in schizophrenia: differences in brain weight, temporal horn area, and parahippocampal gyrus compared with affective disorder. Archives General Psychiatry 43, 36–42.CrossRefGoogle ScholarPubMed
Bruetsch, W. L. (1952). Specific structural neuropathology of the central nervous system in schizophrenia. In Proceedings of First International Congress of Neuropathology, Rome. 1 487–499. Rosenberg & Sellier: Turin.Google Scholar
Bruton, C. J. (1988). The neuropathology of temporal lobe epilepsy. Maudsley Monograph No. 31 Oxford University Press: Oxford.Google Scholar
Chi, Je G., Dooling, E. C. & Gilles, F. H. (1977). Gyral development of the human brain. Annals of Neurology 1, 86–93.CrossRefGoogle ScholarPubMed
Colter, N., Bruton, C. J., Johnstone, E. C., Roberts, G. W., Brown, R. & Crow, T. J. (1987). Neuropathology of schizophrenia: II lateral ventricle. Neuropathology & Applied Neurobiology 13, 499–500.Google Scholar
Corsellis, J. A. N. (1976). Psychoses of obscure pathology. In Greenfield's Neuropathology, 3rd edn (ed. Blackwood, W. and Corsellis, J. A. N.), pp. 903–915. Edward Arnold: London.Google Scholar
Corsellis, J. A. N. & Janota, I. (1985). Neuropathology in relation to psychiatry. In Handbook of Psychiatry 5, The Scientific Foundations of Psychiatry (ed. Shepherd, M.), pp. 206–221. Cambridge University Press: Cambridge.Google Scholar
Crichton-Browne, J. (1879). On the weight of the brain and its component parts in the insane. Brain 2, 42–67.CrossRefGoogle Scholar
Crome, L. (1960). The brain and mental retardation. British Medical Journal i, 897–904.CrossRefGoogle Scholar
Crome, L. & Stern, J. (1972). Pathology of Mental Retardation, 2nd edn p. 122. Churchill & Livingstone: Edinburgh.Google ScholarPubMed
Crow, T. J. & Johnstone, E. C. (1987). Schizophrenia: nature of the disease process and its biological correlates. In Handbook of Physiology – The Nervous System V (ed. Plum, F.), pp. 843–869. American Physiological Society: Baltimore.Google Scholar
Crow, T. J., Colter, N., Brown, R., Bruton, C. J. & Johnstone, E. C. (1988). Lateralised asymmetry of temporal horn enlargement in schizophrenia. Schizophrenia Research 1, 155–156.Google Scholar
Crow, T. J., Ball, J., Bloom, S. R., Brown, R., Bruton, C. J., Colter, N., Frith, C. D., Johnstone, E. C., Owens, D. G. C. & Roberts, G. W. (1989). Schizophrenia as an anomaly of development of cerebral asymmetry: a post mortem study and a proposal concerning the genetic basis of the disease. Archives of General Psychiatry 46, 1145–1150.CrossRefGoogle Scholar
David, G. B. (1957). The pathological anatomy of the schizophrenias. In Schizophrenia: Somatic Aspects (ed. Richter, D.), pp. 93–130. Pergamon Press: Oxford.Google Scholar
Davison, K. & Bagley, C. R. (1969). Schizophrenia-like psychoses associated with organic disorders of the central nervous system: a review of the literature. In Current Problems in Neuropsychiatry, Schizophrenia, Epilepsy, the Temporal Lobe (ed. Herrington, R. N.), pp. 113–184. Headley: Kent.Google Scholar
Dide, M. (1936). Anomalies morphologiques des cornes par méningomyélite chronique chez certains hébéphréniques. Revue Neurologique 65, 1434–1437.Google Scholar
Dunlap, C. B. (1924). Dementia praecox: some preliminary observations on brains from carefully selected cases and a consideration of certain sources of error. American Journal of Psychiatry 80, 403–421.CrossRefGoogle Scholar
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, A., Winokur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
Goodall, E. (1932). The exciting cause of certain states, at present classified under ‘Schizophrenia’, may well be infection. Journal of Mental Science 78, 746–755.Google Scholar
Haug, J. O. (1962). Pneumo-encephalographic studies in mental disease. Acta Psychiatrica Scandinavica 38, Suppl 165, pp. 1–114.Google Scholar
Illowsky, B. N., Juliano, D. M., Bigelow, L. B. & Weinberger, D. R. (1988). Stability of CT scan findings in schizophrenia: results of an 8 year follow-up study. Journal of Neurology, Neurosurgery and Psychiatry 51, 209–213.CrossRefGoogle ScholarPubMed
Jakob, H. & Beckmann, H. (1986). Prenatal developmental disturbances in the limbic allocortex in schizophrenics. Journal of Neural Transmission 65, 303–326.CrossRefGoogle ScholarPubMed
Jacobi, W. & Winkler, H. (1927). Encephalographische Studien auf chronischen Schizophrenen; Archiv für Psychiatrie Nervenkrankheiten 81, 299–332.CrossRefGoogle Scholar
Jellinger, K. (1980). Zür Neuropathologie schizophrener Psychosen. Current Topics in Neuropathology 6, 85–99.Google Scholar
Jellinger, K. (1985). Neuromorphological background of pathochemical studies in major psychoses. In Pathochemical Markers in Major Psychoses (ed. Beckmann, H. and Riederer, P.), pp. 1–23. Springer: Heidelberg.Google Scholar
Johnstone, E. C., Crow, T. J., Frith, C. D., Husband, J. & Kreel, L. (1976). Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet ii, 924–926.CrossRefGoogle Scholar
Klippel, M. & Lhermitte, J. (1909). Un cas de Démence Précoce à type catatonique, avec autopsie. Revue Neurologique 17, 157–158.Google Scholar
Kovelman, J. A. & Scheibel, A. B. (1984). A neurohistological correlate of schizophrenia. Biological Psychiatry 19, 1601–1621.Google ScholarPubMed
Lewis, N. D. C. (1923). The Constitutional Factors in Dementia Praecox Nervous and Mental Disease Publishing Company: New York.Google Scholar
Menninger, K. A. (1928). The schizophrenic syndrome as a product of acute infectious disease. Archives of Neurology and Psychiatry 20, 464–481.CrossRefGoogle Scholar
Meyer, A. (1952). Critical evaluation of histopathological findings in schizophrenia. In Proceedings of the First International Congress of Neuropathology Rome 1, pp. 649–666. Rosenberg Sellier: Turin.Google Scholar
Meynert, T. (1884). Psychiatrie. W. Braumuller: Wien.Google Scholar
Miller, A. K. H. & Corsellis, J. A. N. (1977). Evidence for a secular increase in human brain weight during the past century. Annals of Human Biology 4, 253–257.CrossRefGoogle ScholarPubMed
Murray, R. M., Lewis, S. W. & Reveley, M. A. (1985). Towards an aetiological classification of schizophrenia. Lancet i, 1023–1026.CrossRefGoogle Scholar
Murray, R. M., Lewis, S. W., Owen, M. J. & Foerster, A. (1988). The neurodevelopmental origins of dementia praecox. In Schizophrenia – The Major issues (ed. McGuffin, P. and Bebbington, P.), pp. 90–107. Heinemann: London.Google Scholar
Nieto, D. & Escobar, A. (1972). Major psychoses. In Pathology of the Nervous System vol. 3, (ed. Minckler, J.), pp. 2654–2665. McGraw Hill: New York.Google Scholar
Nissl, R. & Alzheimer, A. (1921). Histologie und Histopathologie Arbeiten über die Grosshirnrinde mit besonderen Berucksichtigungen der pathologischen Anatomie der Geisteskrankheiten. Fisher: Jena.Google Scholar
Norman, R. M. (1958). Malformations of the nervous system, birth injury and diseases of early life. In Greenfields Neuropathology 1st edn (ed. Greenfield, J. G., Blackwood, W., McMenemey, W. A., Meyer, A. and Norman, R. M.), pp. 300–408. Edward Arnold: London.Google Scholar
Owens, D. G. C. & Johnstone, E. C. (1980). The disabilities of chronic schizophrenia: their nature and the factor contributing to their development. British Journal of Psychiatry 136, 384–395.CrossRefGoogle Scholar
Owens, D. G. C., Johnstone, E. C. & Frith, C. D. (1982). Spontaneous involuntary disorders of movement: their prevalence, severity and distribution in chronic schizophrenics with and without treatment with neuroleptics. Archives of General Psychiatry 39, 452–461.CrossRefGoogle ScholarPubMed
Pakkenberg, B. (1987). Post mortem study of chronic schizophrenic brains. British Journal of Psychiatry 151, 744–752.CrossRefGoogle ScholarPubMed
Peters, G. (1937). Zür Frage der pathologischen Anatomie der Schizophrenie. Zeitschrift für die gesämte Neurologie und Psychiatrie 160, 361–380.Google Scholar
Peters, G. (1956). Dementia Praecox und Manisch-Depressives Irresein. In Handbuch der speziellen pathogischen Anatomie und Histologie (ed. Henke, F.), XIII/ 4, pp. 1–57. Springer-Verlag: Berlin.Google Scholar
Plum, F. (1972). Prospects for research on schizophrenia. 3. Neurophysiology. Neuropathological Findings. Neurosciences Research Program Bulletin 10, 384–388.Google ScholarPubMed
Rawlings, E. (1920). The histopathologic findings in dementia praecox. American Journal of Insanity 76, 265–284.Google Scholar
Reveley, M. A. & Trimble, M. R. (1987). Application of imaging techniques British Medical Bulletin 43, 616–633.CrossRefGoogle ScholarPubMed
Roberts, G. W. & Crow, T. J. (1987). The neuropathology of schizophrenia – a progress report. British Medical Bulletin 43, 599–615.CrossRefGoogle ScholarPubMed
Roberts, G. W., Colter, N., Lofthouse, R., Bogerts, B., Zech, M. & Crow, T. J. (1986). Gliosis in schizophrenia. Biological Psychiatry 21, 1043–1050.CrossRefGoogle ScholarPubMed
Roberts, G. W., Colter, N., Lofthouse, R., Johnstone, E. C. & Crow, T. J. (1987). Is there gliosis in schizophrenia? Investigation of the temporal lobe. Biological Psychiatry 22, 1459–1468.CrossRefGoogle ScholarPubMed
Roberts, G. W., Bruton, C. J. & Crow, T. J. (1988). Gliosis in schizophrenia. Biological Psychiatry 24, 729–730.CrossRefGoogle Scholar
Rubinstein, L. J. (1972). Atlas of Tumour Pathology 2nd Series, 6, Tumours of the Central Nervous System (ed. Rubinstein, L. J.). American Armed Forces Institute of Pathology: Washington, DC.Google Scholar
Skullerud, K. (1985). Variations in the size of the human brain. Influence of age, sex, body length, body mass index, alcoholism, Alzheimer changes and cerebral atherosclerosis. Acta Neurologica Scandinavica 71 Suppl. no. 102, 1–90.Google Scholar
Southard, E. E. (1910). A study of the dementia praecox group in the light of certain cases showing anomalies or scleroses in particular brain regions. American Journal of Insanity 67, 119–176.Google Scholar
Spielmeyer, W. (1930). The problem of the anatomy of schizophrenia. Journal of Nervous and Mental Disease 72, 241–244.CrossRefGoogle Scholar
Stevens, J. R. (1982). Neuropathology of schizophrenia. Archives of General Psychiatry 39, 1131–1139.CrossRefGoogle ScholarPubMed
Stevens, J., Casanova, M. & Bigelow, L. (1988). Gliosis in schizophrenia. Biological Psychiatry 24, 727–729.CrossRefGoogle ScholarPubMed
Storey, P. B. (1966). Lumbar air encephalography in chronic schizophrenia: a controlled experiment. British Journal of Psychiatry 112, 135–144.CrossRefGoogle ScholarPubMed
Tobias, P. V. (1970). Brain size, grey matter and race–fact or fiction? American Journal of Physical Anthropology 32, 3–25.CrossRefGoogle ScholarPubMed
Torrey, E. F. (1973). Slow and latent viruses in schizophrenia. Lancet ii, 22–24.CrossRefGoogle Scholar
Vries, E. de (1952). In Proceedings of the First International Congress of Neuropathology, Rome, 1, pp. 579–583. Rosenberg Sellier: Turin.Google Scholar
Weinberger, D. R. (1984). Computed tomography (CT) findings in schizophrenia: speculations on the meaning of it all. Journal of Psychiatric Research 18, 477–490.CrossRefGoogle Scholar
Weinberger, D. R. (1988). Premorbid neuropathology in schizophrenia. Lancet ii, 959–960.Google Scholar
Weinberger, D. R., Torrey, E. F., Neophytides, A. N. & Wyatt, R. J. (1979). Structural abnormalities of the cerebral cortex in chronic schizophrenia. Archives in General Psychiatry 36, 935–939.CrossRefGoogle Scholar
Wernicke, C. (1900). Grundriss der Psychiatric Johannes Barth: Leipzig.Google Scholar
Wertham, F. & Wertham, F. (1934). The Brain as an Organ: Its Postmortem Study and Interpretation. Macmillan: New York.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Instruction Manual for the PSE and Catego Program. Cambridge University Press: London.Google Scholar
Winkelman, N. W. & Book, M. H. (1949). Observations on the histopathology of schizophrenia. American Journal of Psychiatry 105, 889–896.Google Scholar
Wolf, A. & Cowen, D. (1952). The Biology of Mental Health and Disease. Hoeber: New York.Google Scholar
Woody, R. C., Bolyard, K., Eisenhauer, G. & Altschuler, L. (1987). CT Scan and MRI findings in a child with schizophrenia. Journal of Child Neurology 2, 105–110.Google Scholar