A cross-sectional and longitudinal magnetic resonance imaging study of cingulate gyrus gray matter volume abnormalities in first-episode schizophrenia and first-episode affective psychosis

Abstract

Context: Previous magnetic resonance imaging (MRI) findings have demonstrated psychopathological symptom-related smaller gray matter volumes in various cingulate gyrus subregions in schizophrenia and bipolar disorder. However, it is unclear whether these gray matter abnormalities show a subregional specificity to either disorder and whether they show postonset progression.

Objective: To determine whether there are initial and progressive gray matter volume deficits in cingulate gyrus subregions in patients with first-episode schizophrenia (FESZ) and patients with first-episode affective psychosis (FEAFF, mainly manic) and their specificity to FESZ or FEAFF.

Design: A naturalistic cross-sectional study at first hospitalization for psychosis and a longitudinal follow-up approximately 1(1/2) years later.

Setting and participants: Patients were from a private psychiatric hospital. Thirty-nine patients with FESZ and 41 with FEAFF at first hospitalization for psychosis and 40 healthy control subjects (HCs) recruited from the community underwent high-spatial-resolution MRI, with follow-up scans in 17 FESZ patients, 18 FEAFF patients, and 18 HCs. Individual subjects were matched for age, sex, parental socioeconomic status, and handedness.

Main outcome measures: Cingulate gyrus gray matter volumes in 3 anterior subregions (subgenual, affective, and cognitive) and 1 posterior subregion, and whether there was a paracingulate sulcus.

Results: At first hospitalization, patients with FESZ showed significantly smaller left subgenual (P = .03), left (P = .03) and right (P = .005) affective, right cognitive (P = .04), and right posterior (P = .003) cingulate gyrus gray matter subregions compared with HCs. Moreover, at the 1(1/2)-year follow-up, patients with FESZ showed progressive gray matter volume decreases in the subgenual (P = .002), affective (P < .001), cognitive (P < .001), and posterior (P = .02) cingulate subregions compared with HCs. In contrast, patients with FEAFF showed only initial (left, P < .001; right, P = .002) and progressive subgenual subregion abnormalities (P < .001). Finally, patients with FESZ showed a less asymmetric paracingulate pattern than HCs (P = .02).

Conclusions: Patients with FEAFF and FESZ showed differences in initial gray matter volumes and in their progression. Initial and progressive changes in patients with FEAFF were confined to the subgenual cingulate, a region strongly associated with affective disorder, whereas patients with FESZ evinced widespread initial and progressively smaller volumes.

Figure 1

Cingulate gyrus subregions. Three-dimensional reconstruction (A) of the cingulate gyrus gray matter according to subregions (subgenual, affective [anterorostral], cognitive [anterodorsal], and posterior divisions), seen in sagittal (B) and coronal (C) views. On the sagittal view of the left cingulate gyrus (B), the subgenual subdivision is yellow; the affective subdivision, pink; the cognitive subdivision, blue; and the posterior division, green.

Figure 2

Relative cross-sectional volumes of the cingulate gyrus subregions by hemisphere in patients with first-episode schizophrenia (FESZ) (n=39) or first-episode affective psychosis (FEAFF) (n=41) and healthy control subjects (HCs) (n=40). *P<.05; †P<.01; ‡P<.001, by analysis of variance.

Figure 3

Scattergram of percentage of change for 1½ years in bilateral (left and right) volumes of the cingulate gyrus gray matter in patients with first-episode schizophrenia (FESZ) (n=17) or first-episode affective psychosis (FEAFF) (n=18) and healthy control subjects (HCs) (n=18). Horizontal lines indicate mean. *P<.05; †P<.01; ‡P<.001, by analysis of variance.

Figure 4

Volume changes in 1½ years in absolute bilateral (left and right combined) volumes of the cingulate gyrus gray matter at baseline and the second scan in subjects with first-episode schizophrenia (FESZ) (n=17) or first-episode affective psychosis (FEAFF) (n=18) and healthy control subjects (HCs) (n=18). Values of the baseline and second scan in each subject are connected by lines. The numbers at the top of the graphs indicate the proportion of subjects who showed volume reduction over time (number of subjects/total number of subjects). Horizontal lines indicate the mean at the baseline and second scan. *P<.05; †P<.01; ‡P<.001, in comparison of percentages of change between each of the 2 groups by analysis of variance.