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A five-year longitudinal study of the regional cerebral metabolic changes of a schizophrenic patient from the first episode using Tc-99m HMPAO SPECT

  • R. Y. L. Chen
  • E. Chen
  • W. Y. Ho
Original paper

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 under-activity 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.

Key words Schizophrenia Treatment resistant SPECT Clozapine 

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Copyright information

© Steinkopff Verlag 2000

Authors and Affiliations

  • R. Y. L. Chen
    • 1
  • E. Chen
    • 1
  • W. Y. Ho
    • 1
  1. 1.Department of Psychiatry, Room 219, J2 Block, Queen Mary Hospital, Pokfulam, Hong Kong, e-mail: rylchen@hkucc.hku.hkCN

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