Letters to the Editor |

Structural Brain Changes in Schizophrenia—Reply

Robert B. Zipursky, MD, FRCPC; Shitij Kapur, MD, PhD, FRCPC
Arch Gen Psychiatry. 1999;56(2):195-196. doi:.
Text Size: A A A
Published online


In reply

DeLisi correctly points out that our study does not establish that the brain abnormalities found in schizophrenia are neurodevelopmental in origin or due to a fixed lesion. We cannot, however, agree with the suggestion made by DeLisi that "reduction in gray matter was probably a continuous process since it was not as great as that seen when similar patients were scanned in the chronic phase of illness." First, it is not at all clear that our first episode subjects from Toronto, Ontario, were similar to chronically ill subjects recruited from a veterans' hospital in California1; for this reason, we highlighted the possibility that the smaller effect size found in first episode patients might be due to a selection bias. Second, the structural brain abnormalities found in schizophrenia have not generally been found to be associated with the duration of illness in studies of either chronic13 or first episode patients.4,5 Third, despite recent evidence that progression of ventricular enlargement may take place over some part of the course of the illness,6 there is no evidence that this is a process that is continuous over the entire course of the illness. Finally, there is no reason to assume that all structural brain findings in schizophrenia relate to a single pathophysiology. Woods et al7 have suggested that the brain abnormalities found in schizophrenia might be best explained by a 2-process model involving both static and progressive abnormalities. Progressive ventricular enlargement during the course of schizophrenia might also be due to the effects of aging, alcohol, nutrition, medication, or an impoverished environment.8


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...