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Evidence for a distinct depression-type schizophrenia: a pilot study

Liying Liu1#, Ce Chen1#, Gongying Li2, Xiaodong Lin1, Deguo Jiang1, Hongjun Tian3, Xu Lang4*, Chuanjun Zhuo1,2,3*, Lixue Qiu1*, 1 Wenzhou Seventh People’s Hospital, Wenzhou, China.

2 Department of Psychiatry, Institute of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University, Jining, China.

3 Psychiatric-Neuroimaging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Anding Hospital, Mental Healthy Teaching Hospital of Tianjin Medical University, Tianjin, China.

4 Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.

# These authors contributed equally to this work.

* These authors are the co-correspondence authors of this work.

Received: 07/26/2019 – Accepted: 09/09/2019

DOI: 10.1590/0101-60830000000238

Address for correspondence: Chuanjun Zhuo. Department of Psychiatry, Institute of Mental Health, Psychiatric Genetics Laboratory (PSYG-Lab), Jining Medical University. Jining 272191, China. Telephone/Fax: 86-537-6666444. E-mail: [email protected]; [email protected]

Liu L et al. / Arch Clin Psychiatry. 2020;47(3):87-8

Dear Editor,

Reciprocity of depressive and psychotic symptoms in patients with schizophrenia and major depression disorder (MDD), respectively, complicates differential psychiatric diagnosis. Notably, 60%-70% of schizophrenia patients experience moderate to severe depressive symptoms1-3. Indeed, schizophrenia and MDD have been proposed to be variants of the same disorder, namely major psychiatric disorder1. Notwithstanding, distinct functional brain characteristics of these two patient groups have been demonstrated2. Additionally, patients with schizophrenia and MDD have been reported to have reduced and increased corpus callosum (CC) sizes, respectively3-5. Thus, we have hypothesized that there may be a depressive-type schizophrenia.

This study was approved by the ethical committee of The Tianjin Mental Health Center. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from participants and their guardians.

Figure 1. TBSS-based comparison of MRI examinations of white matter structures, especially CC connections, between a HC reference group (A), FE-SCZ-D patients (B), and FE-SCZ-nD patients (C).

Figure 1. TBSS-based comparison of MRI examinations of white matter structures, especially CC connections, between a HC reference group (A), FE-SCZ-D patients (B), and FE-SCZ-nD patients (C).

We used magnetic resonance imaging (MRI) and tract-based spatial statistics (TBSS) to compare the CCs of first-episode drug-naïve schizophrenia patients with (FE-SCZ-D) versus without (FE-SCZ-nD) depressive symptoms (N = 15/group), matched for demographics and symptom severity, and 20 healthy controls (HCs) who served as a reference group. None of the participants had a family history of mental illness. Their mean ages ± standard deviations (SDs) by group were: FE-SCZ-D, 24.5 ± 4.5 years; FE-SCZ-nD, 23.5 ± 2.5 years; and HC, 24.5 ± 3.5 years (R = 0.557; p = 0.405). The gender ratios of the groups were (males/females): FE-SCZ-D, 8/7; FE-SCZ-nD, 9/6; and HC, 7/8 (p = 0.265). The FE-SCZ-D and FE-SCZ-nD groups had mean (±SD) illness durations of 2.3 ± 1.2 months and 2.8 ± 1.4 months, respectively (R = 0.362; p = 0.265). The FE-SCZ-D and FE-SCZ-nD groups had mean (±SD) Positive and Negative Syndrome Scale scores of 80.0 ± 19.0 and 82.6 ± 17.7, respectively (R = 0.523; p = 0.799), and they had mean (±SD) Calgary Depression Scale for Schizophrenia scores of 15.5 ± 1.5 and 0.0 ± 0.0, respectively. This pilot study was completed from January 1st to December 31st of 2018. All participants volunteered and gave written informed consent; the Wenzhou Seventh People’s Hospital provided ethics approval.

TBSS analysis of MRI data showed more pronounced CC reductions in the FE-SCZ-nD group than in the FE-SCZ-D group; both schizophrenic patient groups had reduced CCs relative to HCs (Figure 1). Hence, the presence of depressive symptoms seemed to counter, or perhaps be a protective factor against, CC reduction in patients with schizophrenia. These findings are consistent with our hypothesis that there may be a distinct depression-type schizophrenia.

Limitations of this study included a small sample size, all patients being inpatients (due to imperative auditory hallucinations) who refused antipsychotic treatment prior to hospitalization, participant loss (6 per patient group) due to MRI noncompliance, and limited-resolution images. Larger-cohort and multi-center studies with more subtle neuroimaging are needed to clarify brain alterations related to psychosis and depressiveness.

Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (81871052 to C.Z., 81801679 and 81571319 to Y.X.), the Key Projects of the Natural Science Foundation of Tianjin, China (17JCZDJC35700 to C.Z.), the Tianjin Health Bureau Foundation (2014KR02 to C.Z.), the National Key Research and Development Program of China (2016YFC1307004 to Y.X.), the Shanxi Science and Technology Innovation Training Team’s Multidisciplinary Team for Cognitive Impairment (201705D131027 to Y.X.), Zhejiang Public Welfare Fund Project (LGF18H090002 to D.J), Tianjin Anding Hospital Outstanding Award rewarding 300000* to C.Z., and the key project of Wenzhou Science and Technology Bureau (ZS2017011 to X.L)

Conflict of interests

None.

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