Effects Of Modified Eletroconvulsive Therapy And Antipsychotics On Brain Structure Of Schizophrenia Patients

Objective To investigate effects of modified electroconvulsive therapy(MECT) and antipsychotics on brain structure of schizophrenia patients by using magnetic resonance imaging and voxel based morphometry method. Comparing the brain structure changes for schizophrenia patients before and after the treatment of MECT and antipsychotics, so as to explore the influence of the treatment on brain structure of patients with schizophrenia and to observe whether or not the changes of brain structure are related to the efficacy and side effects.Method According to International Statistical Classification of Diseases and Related Health Problems 10 th Revision(ICD-10), 44 subjects containing21 schizophrenia patients and 23 healthy controls were included in our study,which consists of two groups of patient group and healthy control group. All patients were treated with combination of MECT and antipsychotics. MRI scans were performed before and after the treatment in all patients and Positive and Negative Symptoms Scale(PANSS) were used for clinical assessment, while the healthy control were scanned only once at baseline.MRI Imaging data were processed and analyzed with VBM and SPM8 software. Volume differences between these two groups were evaluated using two sample t test(p < 0.001(uncorrected), K>100) with covariant variables(total intracranial volume,TIV). Paired t-test was conducted to compare the volume difference between pre-therapy and post-therapy within the patient group.Results At baseline, the gray matter volume(GMV) of left middle temporal gyrus, right inferior temporal gyrus and right anterior cingulum gyrus in schizophrenia patients were significantly less, and larger in right cerebellum than that of the healthy controls. After the treatment of combined MECT and antipsychotics, increased GMV of right parahippocampal and left hippocampal and decreased GVM in right cerebellum for patients with schizophrenia were observed. Right parahippocampa GMV in schizophrenia at baseline were significantly correlated with change ratio of positive score of PANSS(r=0.490, P=0.024), right inferior temporal GMV was apparently correlated with change ratio of general psychopathology score of PANSS(r=-0.434, P=0.049); both left hippocampal and right parahippocampal GMV were obviously correlated with positive score of PANSS at followup(left hippocampal, r=-0.478, P=0.029; right parahippocampal, r=-0.558,P=0.009). Change ratio of left hippocampal GMV was significantly correlated with general psychopathology score of PANSS(r=-0.453,P=0.039).Conclusion Patients with schizophrenia showed gray matter loss of local regions. The treatment of combining MECT with antipsychotics can cause the local GMV changes in patients with schizophrenia, and it can change the correlation of local gray matter volumes and the improvement of disease.Local gray matter volumes of schizophrenia patients displayed correlation with changes of symptom scores; General psychopathology scores have effect on the changes of local gray matter volumes among schizophrenia patients.