Neuropsychological functioning and neuromorphometry in non-Kraepelinian and Kraepelinian schizophrenia.
Item
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Title
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Neuropsychological functioning and neuromorphometry in non-Kraepelinian and Kraepelinian schizophrenia.
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Identifier
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AAI3144082
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identifier
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3144082
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Creator
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Brickman, Adam M.
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Contributor
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Adviser: Joan C. Borod
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Date
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2004
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Language
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English
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Publisher
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City University of New York.
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Subject
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Biology, Neuroscience | Health Sciences, Mental Health | Psychology, Clinical
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Abstract
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The clinical heterogeneity of schizophrenia has prompted many attempts to establish valid subtypes. One classification system characterizes patients as either "Kraepelinian" or "non-Kraepelinian" based on longitudinal analysis of self-care deficits. Kraepelinian patients have poor outcome, defined as unremitting symptomatology and dependence on others for food, clothing, and shelter over a continuous five-year period or more. Non-Kraepelinian patients have better functional outcome and are independent for these needs. Preliminary neuroimaging studies demonstrated that Kraepelinian patients have enlarged ventricles, reduced posterior cortex, and diminished posterior anisotropy compared to non-Kraepeinian patients and normal controls. Non-Kraepelinian patients have reduced frontal matter and anisotropy compared to normal controls. These findings suggest a "two-hit" model for poor functional outcome: circuitry involving both anterior and posterior systems is characteristic of Kraepelinian patients.;The purpose of the current three-part series of studies was to extend these findings by examining neurocognition and neuromorphometry of the thalamus and internal capsule with high-resolution structural magnetic resonance imaging. In Study 1, neuropsychological functioning was examined in Kraepelinian and non-Kraepelinian patients. Kraepelinian patients were more impaired on most measures, including immediate memory, executive functioning, and intrusive errors. Impairments in these domains were the best predictors of Kraepelinian status, correctly classifying close to 80% of the patients. For Study 2, the thalamus was traced at five axial levels in dorsal-to-ventral directions. Compared to controls, schizophrenia patients had smaller thalami at ventral levels, and these effects were most marked in Kraepelinian patients. Thalamic size was positively associated with frontal and temporal lobe size. For Study 3, a new protocol was developed to measure the size of the anterior limb of the internal capsule at five levels. Size of the structure was similar between normal controls and non-Kraepelinian patients, and significantly reduced in the Kraepelinian group, particularly at dorsal levels. Significant correlations emerged between internal capsule size in normal controls and surrounding size of subcortical brain regions. These associations tended to be progressively weaker in the two patient groups. Taken together, these findings support the validity of the Kraepelinian/non-Kraepelinian distinction and provide further evidence for involvement of both anterior and posterior brain circuits in poor outcome.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
