engleski

Regional cerebral blood flow changes in acute and transient psychotic disorders

Aim: The aim of this study was to assess and evaluate brain perfusion single-photon computerized tomography (SPECT), as part of a continuing effort to understand the pathophysiology of the brain in acute and transient psychotic disorders (ATPD) and to correlate any abnormalities in the regional blood flow 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: Twenty (11 male, 55%) newly referred patients with an ATPD diagnosis underwent regional cerebral blood flow (rCBF) examination brain SPECT. Their mean age was 30.5 years, range 18-52. 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 our patients, 85%, had brain perfusion changes, from small regions of decreased perfusion to widespread global cortical hypoperfusion and disseminated cerebral blood flow defects. Seven patients had globally hypoperfused cerebral cortex. In four patients hypoperfusion was found exclusively in only one region, three left frontal, 1 right temporal. Thirteen patients (76%) had two or more hypoperfused areas, 11 in the prefrontal lobes (55%), mostly in the left lobe (n=6) and bilaterally (n=4). Seven patients had hypoperfusion reported in temporal lobes, four in the right hemisphere and two bitemporal. Additional, detailed neurologic and laboratory examinations, including EEG and CT, 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 areas of decreased rCBF, in part as the consequence of neurophysiological changes which reflects dysfunction in neuronal activity responsible for psychotic symptoms such as hallucinations and delusions, and/or the result of some associated symptoms such as associated acute stress. However, perfusion imaging findings may be used as an additional diagnostic tool to guide psychiatrists searching for a definite diagnosis.

cerebral blood flow, psychotic disorders, imaging

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