There is now increasing evidence derived from many in-vivo brain imaging studies that a substantial proportion of schizophrenics and patients suffering from affective disorders have a mild degree of brain atrophy or hypoplasia. Moreover, several controlled morphometric postmortem and in-vivo brain studies reported morphological alterations in limbic and paralimbic structures of schizophrenics, whereas no such studies of affective disorders exist. The proposed study aims to compare brain morphology in magnetic resonance scans of patients suffering from schizophrenia, schizoaffective and bipolar affective disorder with and without psychotic symptoms, by characterizing brain morphology through volumetric assessment with special attention to limbic and paralimbic brain structures. The study will address the following questions: -can different clinical subgroups of schizophrenia and affective disorders be related to different types of neuropathology? -is the Kraepelinian dichotomy of endogenous psychoses (schizophrenic vs affective disorders) paralleled by a morphological dichotomy? or is there an anatomical continuum or overlap of brain anomalies? -what is the relationship between psychotic and affective episodes on one hand and distinct types of abnormal brain morphology on the other? Five groups of patients (35 patients per group, total N = 175) will be ascertained and undergo psychopathologic and MR assessment. These groups include first episode schizophrenia, chronic multiepisode schizophrenia, schizoaffective disorder and bipolar disorder with and without psychotic symptoms (DSM III-R). Volumes of large brain structures such as frontal, temporal and parietooccipital lobes will be measured in 3.1 mm coronal sections whereas smaller limbic structures, e.g. hippocampus, amygdala, and septum will be measured in 1.6 mm sections to enhance the accuracy of measurements. MR data will be compared with structure volumes obtained from post mortem serial brain sections provided from the University of Dusseldorf.
