The disabilities of chronic schizophrenia: A search for neurological correlates

Owens, David G. C (1985) The disabilities of chronic schizophrenia: A search for neurological correlates. MD thesis, University of Glasgow.

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This study was designed to define in standardised fashion, the deficits of chronic schizophrenia and the correlates of these, and to evaluate two neurological parameters - spontaneous involuntary movements and lateral ventricular enlargement - in relation to the illness and its treatment. The study population comprised all those schizophrenics receiving long-term care in the one mental hospital who conformed to the St. Louis criteria for schizophrenia and who had been in-patients for at least 1 year continuously. This basic group consisted of 510 subjects. Analysis of standardised assessments covering mental state, cognition, neurological status and behaviour showed these patients to be extremely impaired. While historical correlates of functioning in particular spheres could be identified, the present clinical picture was in general related to the form of the initial illness and to factors reflecting the passage of time. Past physical treatment was not related to present deficits. Two broad patterns of disability were established. While the presence of prominent productive features in the mental state was not associated with the presence of deficits in other areas examined, prominent 'negative' features were related to the presence of cognitive impairment, extrapyramidal neurological signs and behavioural deterioration. Involuntary movements were assessed in 411 subjects using two standardised recording schedules. Abnormality was extremely common. The base-line prevalence of disorder in those with no history of neuroleptic exposure was comparable with that of those treated with neuroleptics, although with factors reflecting the passage of time accounted for, movement disorder was associated with past neuroleptic treatment. In addition however, the presence of abnormal movements related to features of the illness itself - namely 'negative' mental state features, cognitive impairment and behavioural deterioration. C.T. scans from 110 of the total population described above and controls representing non-institutionalised out-patient (18) and first episode (8) schizophrenics, institutionalised and out-patient manic-depressives (10 and 22 respectively) and neurotic out-patients (19), demonstrated that schizophrenia is associated with enlargement of the lateral ventricles, although only the institutionalised schizophrenics differed significantly from the neurotic controls. The group mean differences were not great and there was considerable overlap between groups. There was no evidence of a characteristic radiological change associated with schizophrenia. Lateral ventricular enlargement in schizophrenia was not consequent upon physical treatments administered in the past. The historical and examination variables which related to increased ventricular size in the long-stay schizophrenic population were few and the nature of certain relationships surprising. While behavioural deterioration and involuntary movements were significantly and linearly associated with ventricular enlargement, 'negative' mental state features, cognitive impairment and an absence of hallucinations were more commonly found in those at both extremes of ventricle size. The results suggest that although brain structure is genuinely altered in certain schizophrenics, the relationship between cerebral structure and clinical aspects of the condition is not straightforward. This study indicates that both neurological abnormality and structural brain change can be related to certain clinical features of established schizophrenia when other potentially relevant historical and treatment variables are accounted for. Such a general conclusion refers to statistical associations within large groups of patients and the relationship between neurology and psychopathology is complex. Nonetheless, the findings lend support to the view that in some patients at least, schizophrenia is a brain disorder whose cerebral basis can be inferred from the nature of some of the associated multiple deficits.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Clinical psychology, Neurosciences, Disability studies
Date of Award: 1985
Depositing User: Enlighten Team
Unique ID: glathesis:1985-76579
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 14:07
Last Modified: 19 Nov 2019 14:07

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