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Internal Capsule Size in Good-Outcome and Poor-Outcome Schizophrenia

Received December 14, 2004; revised June 28, 2005; accepted August 19, 2005. Dr. Brickman is affiliated with the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, and the Neuroscience PET Laboratory, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York. Drs. Buchsbaum, Ivanov, Hahn, Mitelman, Hazlett, Lincoln, Newmark, and Shihabuddin are affiliated with the Neuroscience PET Laboratory, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York. Dr. Borod is affiliated with the Department of Psychology, Queens College, Flushing, New York, The Graduate Center of the City University of New York, New York, and the Department of Neurology, Mount Sinai School of Medicine, New York, New York. Dr. Foldi is affiliated with the Department of Psychology, Queens College, Flushing, New York, The Graduate Center of the City University of New York, New York, and the Division of Geriatrics, Department of Medicine, Winthrop-University Hospital, Stony Brook School of Medicine, Stony Brook, New York. Address correspondence to Dr. Brickman, Taub Institute, P&S 16, Columbia University Medical Center, 630 West 168th St., New York, NY 10032; amb2139{at}columbia.edu or ambrickman@gmail.com (E-mail).

Converging lines of research suggest that white matter abnormalities may be central to the pathophysiology of schizophrenia. The purpose of this study was to examine regional white matter in the anterior limb of the internal capsules in patients with schizophrenia. The authors obtained high-resolution magnetic resonance imaging in 106 patients with schizophrenia and 42 age and sex-matched healthy comparison subjects. The area of the anterior limb of the internal capsule was measured at five proportionately spaced dorsal-to-ventral levels. Schizophrenia patients were divided into good-outcome and poor-outcome groups, based on longitudinal analysis of self-care deficits. Patients with poor-outcome had significantly smaller dorsal areas than healthy comparison subjects, but good-outcome patients did not differ from healthy comparison subjects. Larger relative volumes of the caudate, putamen, and thalamus tended to be associated with relatively larger volumes of the internal capsule in healthy comparison subjects and good-outcome patients, consistent with the known frontal-striatal-thalamic pathways. Larger ventricles were associated with smaller internal capsules, particularly in healthy comparison subjects. The findings suggest disruption of internal capsule fibers in poor-outcome patients with schizophrenia. These abnormalities may be independent of other structural changes in schizophrenia.

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