title: Proton magnetic resonance spectroscopy of the anterior cingulate gyrus, insular cortex and thalamus in schizophrenia associated with idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome).
abstract: OBJECTIVE
  To examine whether patients with schizophrenia associated with idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome [GS]) have specific changes in brain metabolism.
  
  
  METHODS
  We applied proton magnetic resonance spectroscopy (H-MRS) to the anterior cingulate gyrus, insular cortex and thalamus of patients with schizophrenia and GS (n = 15) or without GS (n = 15), all diagnosed with schizophrenia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and healthy subjects (n = 20).
  
  
  RESULTS
  In the anterior cingulate gyrus, patients with schizophrenia and GS showed significant decreases in N-acetyl aspartate/creatine-phosphocreatinine (NAA/Cr), choline/creatine-phosphocreatinine (Cho/Cr) and myoinositol/creatine-phosphocreatinine (ml/Cr) ratios compared with healthy subjects and compared with patients with schizophrenia without GS. Patients with schizophrenia without GS also showed significant decreases in NAA/Cr, Cho/Cr and ml/Cr compared with healthy subjects. In the insular cortex, patients with schizophrenia and GS showed significant decreases in NAA/Cr, Cho/Cr and ml/Cr compared with healthy subjects and compared with patients with schizophrenia without GS. Patients with schizophrenia without GS also showed significant decreases in NAA/Cr, Cho/Cr and ml/Cr compared with healthy subjects. In the thalamus, patients with schizophrenia and GS showed significant decreases in NAA/Cr, Cho/Cr and ml/Cr compared with healthy subjects, whereas patients with schizophrenia without GS only showed a significant decrease in ml/Cr compared with healthy subjects.
  
  
  CONCLUSIONS
  Our findings suggest that brain metabolism is more severely compromised in the subtype of schizophrenia with GS.
authors.affiliation: Department of Psychiatry, Shimane University School of Medicine, Izumo, Japan. rei@med.shimane-u.ac.jp
authors.forename: Rei
authors.initials: R
authors.lastname: Yasukawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Miyaoka
authors.forename: Shoichi
authors.initials: S
authors.lastname: Mizuno
authors.forename: Takuji
authors.initials: T
authors.lastname: Inagaki
authors.forename: Jun
authors.initials: J
authors.lastname: Horiguchi
authors.forename: Kazushige
authors.initials: K
authors.lastname: Oda
authors.forename: Hajime
authors.initials: H
authors.lastname: Kitagaki
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D002540:Cerebral Cortex / Q000737:chemistry / Q000378:metabolism*; D002794:Choline / Q000378:metabolism; D005260:Female; D005878:Gilbert Disease / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D006179:Gyrus Cinguli / Q000737:chemistry / Q000378:metabolism*; D006801:Humans; D007294:Inositol / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012559:Schizophrenia / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D013788:Thalamus / Q000737:chemistry / Q000378:metabolism*
chemical_list: D001224:Aspartic Acid; D007294:Inositol; C000179:N-acetylaspartate; D002794:Choline