A Cross-Sectional and Longitudinal Magnetic Resonance Imaging Study of Cingulate Gyrus Gray Matter Volume Abnormalities in First-Episode Schizophrenia and First-Episode Affective Psychosis

M. Koo, J.Levitt, D. F. Salisbury, M. Nakamura, M. E. Shenton, R. McCarley
Arch Gen Psychiatry
Volume 65, Pages 746-760

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Context: Previous magnetic resonance imaging findings (MRI) have demonstrated psychopathological symptom•¡¹related smaller gray matter volumes in various cingulate gyrus subregions in schizophrenia and bipolar disorder. However, it is unclear whether these gray matter abnormalities show a subregional specificity to either disorder and whether they show postonset progression.

Objective: To determine whether there are initial and progressive gray matter volume deficits in cingulate gyrus subregions in patients with first-episode schizophrenia (FESZ) and patients with first-episode affective psychosis (FEAFF, mainly manic) and their specificity to FESZ or FEAFF.

Main Outcome Measures: Cingulate gyrus gray matter volumes in 3 anterior subregions (subgenual, affective, and cognitive) and 1 posterior subregion, and whether there was a paracingulate sulcus.

Results: At first hospitalization, patients with FESZ showed significantly smaller left subgenual (P=.03), left (P=.03) and right (P=.005) affective, right cognitive (P=.04), and right posterior (P=.003) cingulate gyrus gray matter subregions compared with HCs. Moreover, at the 1 and 1/2 year follow-up, patients with FESZ showed progressive gray matter volume decreases in the subgenual (P=.002), affective (P less than .001), cognitive (P less than .001), and posterior (P=.02) cingulate subregions compared with HCs. In contrast, patients with FEAFF showed only initial (left, P less than .001; right, P=.002) and progressive subgenual subregion abnormalities (P less than .001). Finally, patients with FESZ showed a less asymmetric paracingulate pattern than HCs (P=.02).

Conclusions: Patients with FEAFF and FESZ showed differences in initial gray matter volumes and in their progression. Initial and progressive changes in patients with FEAFF were confined to the subgenual cingulate, a region strongly associated with affective disorder, whereas patients with FESZ evinced widespread initial and progressively smaller volumes.


Koo M, JLevitt, Salisbury DF, Nakamura M, Shenton ME, McCarley R. A cross-sectional and longitudinal magnetic resonance imaging study of cingulate gyrus gray matter volume abnormalities in first-episode schizophrenia and first-episode affective psychosis. Arch Gen Psychiatry 2008;65:746-760.


Veterans Affairs Schizophrenia Center Award, VA Middleton Award, KO2 MH 01110, RO1 MH 50747, RO1 MH 40799, RO1MH052807, CIDAR P50MHO8O272, NIMH RO1MH58704, grants from MIND and NARSAD

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