Comparison of Classical and Clozapine Treatment on Schizophrenia Using Positive and Negative Syndrome Scale of Schizophrenia (PANSS) and SPECT Imaging

Mohammad Sharafi, Mohammad Sharafi

Abstract

Many neuroimaging studies of schizophrenia have shown abnormalities in the frontal cortex, limbic system, basal ganglia, temporal and parietal lobes. These findings are not specific or consistent enough to build up a coherent theory of the origin of the brain abnormality in schizophrenia. This paper describes a state-of-the-art approach of SPECT to correlate neuropsychological evaluation. PANSS scores and different brain focal abnormalities of two groups of patients receiving Clozapine and classical antipsychotic treatments were observed. A total of 20 drug-free patients, actively psychotic schizophrenic, were selected according to the DSM-IV criteria. Pre-Post-treatment was designed using PANSS and 99mTc- ECD-SPECT to assess regional Cerebral Blood Flow (rCBF). The results showed that after treatment, differences in PANSS scores were significant in both groups, with superior scores resulting from the Clozapine therapy. Results were supported by SPECT, which showed a greater improvement in the Clozapine group. Both positive and negative symptoms were improved with Clozapine as well. Before treatment, hypofrontality was the most common (85%) finding, whereas after treatment hypofrontality was mostly cleared. However, in some areas like temporal and caudate, hyperfrontality was induced. Negative symptoms showed linkage to hypofrontality in both groups before and after treatment, and both positive and negative symptoms were improved more with Clozapine therapy than with classical treatment.

Conflict of interest statement

Conflict of interest: The author has declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
Quantification of regional involvement in schizophrenia; a sample of 99mTc-ECD-Brain SPECT data analysis in a schizophrenic patient. Data was processed by a DSX computer vision (revision-7.0) and picture reconstruction was performed by using Butterworth filter with automatic attenuation correction. Single-photon-emission-computed-tomography, as its name might suggest, relies heavily on computers to acquire, process and display the SPECT image. As image processing software and hardware become smaller, faster and just "better", SPECT will adapt and incorporate those advances it can use. It is hoped that improvements in parallel processing and computer architectures will make Bayesian reconstruction faster and take less computer memory, and thus make it more attractive for potential use in the clinic.
Figure 2
Figure 2
SPECT by 99mTc-ECD in a 39 year-old drug naïve schizophrenia, pre (up) and post (down) treatment with Clozapine. A severe hypo-perfusion in right occiputo-posteroparietal (upper transverse cuts # 9-15) has been nearly removed after 3 months of consistent treatment.

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