engleski

Regional cerebral blood flow, prolactin and cortisol levels changes in acute and transient psychotic disorders

To assess and evaluate brain perfusion single- photon computerized tomography (SPECT), together with stress-related biomarkers prolactin and cortisol, as part of a continuing effort to understand the pathophysiology of the brain in acute and transient psychotic disorders (ATPD) and to correlate any found abnormalities with psychopathology of these disorders. They present as an acute psychosis associated with acute stress, with sudden onset and polymorphous symptomatology, including psychotic symptoms such as hallucinations and delusions. Method: 45 newly referred patients with an ATPD diagnosis underwent regional cerebral blood flow (rCBF) examination brain SPECT (25 female, mean age 30, 8, range 18-63). Brain rCBF SPECT data from age- and sex-matched healthy volunteers were used as controls. Patients were diagnosed following ICD-10 criteria and were off psychoactive medication. SPECT scans were started 30 minutes after administration of 740 MBq of 99mTc-HMPAO in resting state, eyes closed and with low ambient noise. Tomograms were normalized to the mean brain activity and analyzed visually by two independent observers, unaware of clinical diagnosis. Results: Majority of scanned patients - 39 pt - 86, 7% had brain perfusion changes, from small regions of decreased perfusion to widespread global cortical hypoperfusion and disseminated cerebral blood flow defects. Almost half (48, 8%) had right/left asymmetries, and most (88.8%) had more than one region affected, predominantly prefrontal cortex and the temporal lobes. Half had frontal lobe hypoperfusion ( 53, 3%). We had prolactin and cortisol measurments for 38 patients - 33 patients (86.84%) had elevated levels of prolactine, mean 64, 5 ug/l, 12 patients (32.43%) had elevated cortisol levels, and 12 patients had both, cortisol and prolactin levels elevated. All 12 patients with elevated prolactin and cortisol levels had pathological rCBF. All but one patients with elevated prolactine levels had pathological rCBF. Additionally, detailed neurologic and laboratory examinations were within normal limits in all patients. Conclusions: Compared with the normals, majority of patients with ATPD were characterized by abnormal rCBF, predominantly affecting prefrontal cortex and the temporal lobes, and, in some cases, whole cerebral cortex. Different factors might explain pathological brain rCBF, partially as the consequence of neurophysiological changes which reflects dysfunction in neuronal activity responsible for psychotic symptoms - hallucinations and delusions, and/or the result of some associated symptoms such as acute stress. Our study also underscores the role of stress-related biomarkers in the pathogenesis of psychosis and their correlation with changes in rCBF.

Cerebral blood flow ; cortisol levels ; Tc-99m-HMPAO

nije evidentirano