Tomografia cerebral computadorizada e esquizofrenia: revisão crítica da literatura

Hübner, Carlos Von Krakauer; Gattaz, Wagner F.

doi:10.1590/S0004-282X1988000300015

Resumos

Vários estudos sobre tomografia cerebral computadorizada (CT) relatam alteração da estrutura cerebral em esquizofrenia. A grande variação da prevalência e da localização das anomalias pode estar relacionada à heterogenidade da amostra estudada, à escolha das medidas de CT ou ao uso de diferentes critérios diagnósticos. Apesar de alguns achados contraditórios, parece estabelecido que um subgrupo de pacientes esquizofrênicos apresenta atrofia cerebral discreta ou moderada; esse subgrupo se caracterizaria por apresentar cronicidade da doença, pior resposta ao tratamento neuroléptico e pela presença de outros sinais de disfunção cerebral difusa, como distúrbios neuropsicológicos, anormalidades no EEG e «soft signs» neurológicos. Sinais de atrofia na CT foram observados em pacientes esquizofrênicos jovens, no primeiro surto psicótico, indicando que o desenvolvimento das anomalias estruturais não é conseqüência do tratamento ou da cronicidade da doença. Nos diferentes estudos, pacientes com atrofia apresentaram menor carga genética (história familiar para a esquizofrenia) e se observou com maior freqüência história de complicações na gestação, no parto e trauma craniano nos primeiros anos do desenvolvimento. Em face da possibilidade de que doentes esquizofrênicos com atrofia cerebral formem um subgrupo homogêneo quanto à clínica e à etiopatologia da doença, é importante identificar e estudar as alterações da CT e caracterizar esse subgrupo de pacientes.

Structural brain abnormalities in schizophrenia have been reported by several computertomographic (CT) studies. However the prevalence and the, localization of the abnormalities vary widely among studies. These differences might stem from samples heterogeneity, from the choice of the CT parameter to be investigated and from the use of different criteria for defining abnormalities. In spite of some contradictory findings, it seems stablished that at least one subgroup of schizophrenic patients shows mild or moderate brain atrophy; this subgroup might be characterized by a chronic course of the disease, poor response to neuroleptic therapy, and the presence of other neurodiagnostic signs of a diffuse brain dysfunction such as neuropsychological impairment, EEG abnormalities and neurological «soft signs». Atrophic findings have been observed in young schizophrenic patients at the first onset of the disease, indicating that the development of the structural abnormalities are not a consequence of a chronic disease and treatment. Schizophrenics with atrophy are unlikely to have a genetic loading (family history) with schizophrenia and they present more frequently pregnancy and birth complications as well as brain trauma in the first years of development. Because schizophrenics with brain atrophy might represent a more homogeneous subgroup with regard to clinical and aetiopathological variables, it is still an important task to identify more precisely these patients on the basis of CT data and then to study the features that could characterize this subgroup.

Carlos Von Krakauer Hübner^I; Wagner F. Gattaz^II

^IPsiquiatra Bolsista - Instituto Central de Saúde Mental de Mannheim (Diretor: Prof. Dr. Heinz Häfner)

^IIProfessor e Chefe de Enfermaria - Instituto Central de Saúde Mental de Mannheim (Diretor: Prof. Dr. Heinz Häfner)

RESUMO

Vários estudos sobre tomografia cerebral computadorizada (CT) relatam alteração da estrutura cerebral em esquizofrenia. A grande variação da prevalência e da localização das anomalias pode estar relacionada à heterogenidade da amostra estudada, à escolha das medidas de CT ou ao uso de diferentes critérios diagnósticos. Apesar de alguns achados contraditórios, parece estabelecido que um subgrupo de pacientes esquizofrênicos apresenta atrofia cerebral discreta ou moderada; esse subgrupo se caracterizaria por apresentar cronicidade da doença, pior resposta ao tratamento neuroléptico e pela presença de outros sinais de disfunção cerebral difusa, como distúrbios neuropsicológicos, anormalidades no EEG e «soft signs» neurológicos. Sinais de atrofia na CT foram observados em pacientes esquizofrênicos jovens, no primeiro surto psicótico, indicando que o desenvolvimento das anomalias estruturais não é conseqüência do tratamento ou da cronicidade da doença. Nos diferentes estudos, pacientes com atrofia apresentaram menor carga genética (história familiar para a esquizofrenia) e se observou com maior freqüência história de complicações na gestação, no parto e trauma craniano nos primeiros anos do desenvolvimento. Em face da possibilidade de que doentes esquizofrênicos com atrofia cerebral formem um subgrupo homogêneo quanto à clínica e à etiopatologia da doença, é importante identificar e estudar as alterações da CT e caracterizar esse subgrupo de pacientes.

SUMMARY

Structural brain abnormalities in schizophrenia have been reported by several computertomographic (CT) studies. However the prevalence and the, localization of the abnormalities vary widely among studies. These differences might stem from samples heterogeneity, from the choice of the CT parameter to be investigated and from the use of different criteria for defining abnormalities. In spite of some contradictory findings, it seems stablished that at least one subgroup of schizophrenic patients shows mild or moderate brain atrophy; this subgroup might be characterized by a chronic course of the disease, poor response to neuroleptic therapy, and the presence of other neurodiagnostic signs of a diffuse brain dysfunction such as neuropsychological impairment, EEG abnormalities and neurological «soft signs». Atrophic findings have been observed in young schizophrenic patients at the first onset of the disease, indicating that the development of the structural abnormalities are not a consequence of a chronic disease and treatment. Schizophrenics with atrophy are unlikely to have a genetic loading (family history) with schizophrenia and they present more frequently pregnancy and birth complications as well as brain trauma in the first years of development. Because schizophrenics with brain atrophy might represent a more homogeneous subgroup with regard to clinical and aetiopathological variables, it is still an important task to identify more precisely these patients on the basis of CT data and then to study the features that could characterize this subgroup.

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Agradecimentos - C.v.K.H. é financiado em parte pelo Deutscher Akademischer Austauschdienst (DAAD), do qual é bolsista, e por ajudas de custo do Hospital Psiquiátrico Vera Cruz (Sorocaba, SP) e da Associação Cultural de Renovação Tecnológica Sorocabana (A.C.R.T.S.).

Zentralinstitut für Seelische Gesundheit - Postfach 5970 - D-6800 Mannheim - DBR.

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