title: A five-year longitudinal study of the regional cerebral metabolic changes of a schizophrenic patient from the first episode using Tc-99m HMPAO SPECT.
abstract: This is a naturalistic study of the relationship between cerebral metabolic activity, clinical symptoms and treatment response in a schizophrenic patient for 5 years from the onset of her illness. Serial technetium-99m-HMPAO brain SPECT was used to measure regional cerebral metabolism. The Cambridge Neurological Inventory and neuropsychological tests (WAIS-R verbal subscales, Wisconsin Card Sorting Test, semantic verbal fluency, logical memory in Weschler Memory Scale) were used for neurocognitive assessment. Under-activity of the left temporal area was observed in the course of patient illness despite remission of the psychotic symptoms. Bilateral prefrontal metabolic under-activity was noted at the emergence of negative symptoms, executive neurocognitive dysfunction and the treatment-resistant state. After response to clozapine, the right prefrontal activity returned to a normal level. Our findings suggested that persistent left temporal underactivity detected by SPECT despite clinical remission may indicate a vulnerability for further relapses and development of a treatment-resistant state. Treatment-resistant state, negative symptoms and executive neurocognitive deficit may involve abnormal prefrontal metabolic activity and can be alleviated in clozapine-responsive patients.
authors.affiliation: Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong. rylchen@hkucc.hku.hk
authors.forename: R Y
authors.initials: RY
authors.lastname: Chen
authors.forename: E
authors.initials: E
authors.lastname: Chen
authors.forename: W Y
authors.initials: WY
authors.lastname: Ho
mesh_terms: D000328:Adult; D010054:Brief Psychiatric Rating Scale; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow; D012563:Schizophrenia, Paranoid / Q000175:diagnosis / Q000378:metabolism*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime