Hippocampal volume change relates to clinical outcome in childhood-onset schizophrenia.
BACKGROUND
Fixed hippocampal volume reductions and shape abnormalities are established findings in schizophrenia, but the relationship between hippocampal volume change and clinical outcome has been relatively unexplored in schizophrenia and other psychotic disorders. In light of recent findings correlating hippocampal volume change and clinical outcome in first-episode psychotic adults, we hypothesized that fewer decreases in hippocampal volume would be associated with better functional outcome and fewer psychotic symptoms in our rare and chronically ill population of childhood-onset schizophrenia (COS) patients.


METHODS
We prospectively obtained 114 structural brain magnetic resonance images (MRIs) from 27 COS subjects, each with three or more scans between the ages of 10 and 30 years. Change in hippocampal volume, measured by fit slope and percentage change, was regressed against clinical ratings (Children's Global Assessment Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms) at last scan (controlling for sex, time between scans and total intracranial volume).


RESULTS
Fewer negative symptoms were associated with less hippocampal volume decrease (fit slope: p = 0.0003, and percentage change: p = 0.005) while positive symptoms were not related to hippocampal change. There was also a relationship between improved clinical global functioning and maintained hippocampal volumes (fit slope: p = 0.025, and percentage change: p = 0.043).


CONCLUSIONS
These results suggest that abnormal hippocampal development in schizophrenia can be linked to global functioning and negative symptoms. The hippocampus can be considered a potential treatment target for future therapies.
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
A A
AA
Anvari
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
L A
LA
Friedman
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
D
D
Greenstein
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
P
P
Gochman
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
N
N
Gogtay
Child Psychiatry Branch,National Institute of Mental Health, National Institutes of Health,Bethesda,MD,USA.
J L
JL
Rapoport
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009315:National Institute of Mental Health (U.S.); D011446:Prospective Studies; D012561:Schizophrenia, Childhood / Q000188:drug therapy / Q000503:physiopathology*; D014481:United States; D055815:Young Adult
D014150:Antipsychotic Agents
Childhood-onset schizophrenia; hippocampus; magnetic resonance imaging; negative symptoms; psychosis