Cerebral Blood Flow Velocity in Acute Schizophrenic Patients

Abstract

Background and Purpose-The aim of this study was to determine whether acutely psychotic first-episode schizophrenics show an increased cerebral blood flow velocity and whether this condition is reversible on psychopathological improvement. Methods-In the first of two examinations, transcranial Doppler ultrasonography and assessment with the Positive and Negative Syndrome Scale (PANSS) were performed on 28 acutely psychotic, neuroleptically naive, first-episode schizophrenics. In the second examination, the same patients were assessed psychometrically (PANSS) as well as with Doppler ultrasonography after psychopathological improvement. Results-Acutely psychotic first-episode schizophrenics showed a significant increase of the mean velocity on both sides in the middle and anterior cerebral arteries and in the right posterior cerebral artery. Blood flow showed significant correlations with productive psychotic symptoms. After psychopathological improvement there was a bilateral normalization of the mean velocity in the middle, anterior, and posterior cerebral arteries. Conclusions-Acutely psychotic first-episode schizophrenics show a significantly increased bilateral cerebral blood flow velocity, which normalizes on psychopathological improvement. There were significant correlations of cerebral blood flow velocity with psychopathology. 1-3 Most studies deal mainly with chronic schizophrenia, and the essential finding is hypoperfusion. Using 133 Xe inhalation, Ingvar and Franzén 4 were the first to report hypofrontality in schizophrenics. Some recent imaging studies on acute schizophrenia 5 describe hyperperfusion in the supply areas of the MCA and the ACA, occasionally with a left-side predominance. An investigation of brain activity in schizophrenics depends on the profile of the particular target symptom and on how strongly it is pronounced in the patient group. 6 Hoyer and Ö sterreich 7 found that acutely psychotic schizophrenics show an increase in global cerebral perfusion of about twice the normal value, whereas in chronic schizophrenics this parameter is significantly lower than in acute schizophrenics or healthy control subjects, without a significant difference between control subjects and patients with paranoia or schizophrenia simplex. It should thus be possible to demonstrate a correlation between psychotic state and CBFV.TCD is a standard method in neurology and neurosurgery but is not yet widely used in psychiatry, and no systematic neuropsychiatric studies have used this method. CBFV measurements by TCD show a high reliability 8 -11 and correlation with rCBF.12-15 TCD can locate vessels and quantify blood flow velocity with precision, 16 thus allowing an accurate identification of the vessel irrigating the brain area in question. CBFV is the decisive Doppler parameter since flow velocity varies directly with the diameter of the small resistance vessels, whereas the diameter of the basal cerebral arteries remains essentially constant. 17,18 Given that CBF equals CBFV times vessel diameter, where ve...

Significantly Lower Right Middle Cerebral Artery Blood Flow Velocity in the First Episode of Psychosis During Neurocognitive Testing

“…In few studies described in the literature, where TCD was performed without activation paradigms, authors found increased BFV in a sample of 28 and 20 patients with FEP compared to healthy subjects (Owega et al 1998, Lee et al 2008, or found no differences in BFV in a sample of 55 patients with schizophrenia and 15 patients with FEP in comparison to healthy controls (Lee et al 1999).…”

“…Some of these results were interpreted as results of cerebral hemodynamics in patients with schizophrenia and also with first episode psychosis, although results are inconsistent (Santra & Kumar 2014, Kanahara et al 2013, Tsujino et al 2011, Wake et al 2010, Molina et al 2005, Riehemann et al 2001, Hoptman & Antonius 2011. As well as with other techniques, many studies that included Transcranial Doppler (TCD) ultrasonography to measure cerebral blood flow velocity (BFV) and pulsatility in main intracranial arteries with excellent temporal resolution (Wintermark et al 2005), indicated that patients suffering from schizophrenia or even FEP have different intracranial hemodynamics compared to the healthy population (Owega et al 1998, Lee et al 2008, Lee et al 1999, but the results are overall inconsistent.…”

Impairment of the cardiac ejection fraction by blocking dopamine D2 receptors induced by long-acting injectable antipsychotic treatment

“…The nucleus accumbens together with the thalamus thus become a gateway for the dopamine signal that maintains an excessive cortical level of dopamine, and by stimulating DRD1 increases the secretion of dopamine in the brain’s lower-level structures, including the basal ganglia [ 54 ]. In the acute psychotic episodes, it was demonstrated by transcranial sonography, the increase of CBF and the velocity of blood flow from the posterior pole to the anterior pole, at the level of the Willis polygon, but also in other cerebral areas [ 55 ].…”

The Implications of Adverse Pharmacologic Reactions and Complex Pathogenic Mechanisms in Schizophrenia

“…The variability and intensity of symptoms is dependent on the cerebellar vascular factor and suggest a CBF dysfunction in the posterior vascular territory and a possible alteration of the circulation speed in circle of Willis, unable to ensure the compensation by increase in the blood flow. From the diagnosis point of view, the transcranial echography and echography evaluation of fetal CBF may show a global decrease of the blood circulation speed in circle of Willis (Owega et al, 1998). The decrease in the cerebellar flow in the anterior pole (Figure 6a) is associated with HS while a a decrease in the posterior pole (Figure 6b, 6c) is correlated with anomalies in the CCTCC circuit.…”