title: An MRI study of midbrain morphology in patients with schizophrenia: relationship to psychosis, neuroleptics, and cerebellar neural circuitry.
abstract: BACKGROUND
  The midbrain contains the perikarya of all the dopamine neurons in the human brain. Although other neurochemicals may well be involved, dopamine dysregulation is central in the pathophysiology of psychosis. Despite this, few imaging studies have evaluated the morphology of the midbrain.
  
  
  METHODS
  Using high-resolution magnetic resonance imaging, morphology of three posterior fossa and brain stem structures were measured: midbrain, pons, and medulla. The patient sample consisted of 50 men with schizophrenia, matched by gender and age to 50 healthy control subjects.
  
  
  RESULTS
  Patients had significantly smaller midbrain measures compared with control subjects. There were no differences between groups in measures of pons or medulla. Furthermore, midbrain size was significantly and inversely correlated with positive symptoms and cumulative neuroleptic exposure, but not with negative or disorganized symptoms. After controlling for the effect of cumulative neuroleptic exposure, the relationship between midbrain morphology and positive symptoms remained significant.
  
  
  CONCLUSIONS
  Midbrain morphology of patients with schizophrenia is abnormal, being smaller in patients compared with control subjects. Although this appears to be specifically related to psychotic symptoms, there is also a robust medication effect, with greater exposure to neuroleptics being associated with greater morphologic abnormality. We discuss the role of dopaminergic dysregulation and possible neural circuit involvement.
authors.affiliation: University of Iowa College of Medicine, Psychiatry Research, 1-180 Medical Education Building, 500 Newton Road, Iowa City, IA 52242, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Nopoulos
authors.forename: J W
authors.initials: JW
authors.lastname: Ceilley
authors.forename: E A
authors.initials: EA
authors.lastname: Gailis
authors.forename: N C
authors.initials: NC
authors.lastname: Andreasen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology*; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D012559:Schizophrenia / Q000188:drug therapy / Q000473:pathology*; D012565:Schizophrenic Psychology
chemical_list: D014150:Antipsychotic Agents