By U. Zarkos.
Hawthorne effect: tendency for patients to fare better in research study than in clinical practice; may be related to selection criteria or increased personal attention discount zanaflex 2 mg. The term was coined in 1955 by Henry A Landsberger who examining earlier research work performed at the Hawthorne (electricity) Works near Chicago: almost any intervention increased workers’ productivity by virtue of the attention offered by researchers discount 2mg zanaflex with amex. Halo effect: the observer tends to answer in a way that conforms with his initial impressions; if a student has handed up a poorly written exam paper the assessor may fail to detect any good in its content purchase zanaflex 2mg. Proximity: if two items are placed closely together in a scale the rating given to one may psychologically affect the rating given to the one beside it. Defensiveness: answers are given in such a way that certain information is not revealed. Von Domarus error: considering 2 different things as equal because of a single shared property. Effort after meaning: people with a disorder remember events imagined to be causative rather than giving an objective account of all pertinent details. Social desirability: a further cause of error, leading to a reduction in accuracy at the expense of what is deemed to be acceptable. Reactivity: degree to which behaviour changes as a result of being assessed; potential problem for naturalistic observation studies and self-recording techniques; difficult to overcome, even with unobtrusive measures. Carry-over effect: drug continues to exert some effect after administration is discontinued; may contaminate results in a crossover trial. Three main sections: structured clinical interview with patient; range of objective cognitive tests; and structured interview with informant. Acceptable to patients; has a high inter-rater reliability; and cognitive section has high sensitivity and specificity. Combat Exposure Scale (Keane ea, 1989a): subjective, quantitative assessment of wartime stressors, from light (1) to heavy (5) exposure. Ten self-report statements looking at how woman felt in the past 7 days, not just today. While it has a cut-off point, the authors suggest an accompanying clinical assessment. A scaled version exists with symptom subscales for somatic symptoms, anxiety and insomnia, depression, and social dysfunction. Minimum score = 3, maximum score = 15 (there is no zero score):- Eye opening: spontaneous (4), to speech (3), to pain (2), none (1). Best motor response: obeys commands (6), moves within general locality (5), withdraws (4), abnormal bending & flexing of muscles (3), involuntary straightening and extending of muscles (2), none (1). Verbal response: orientated (5), confused in conversation (4), use of inappropriate words (3), incomprehensible (2), none (1). Scores of 11 or over on either scale suggest the presence of the relevant disorder and a total score of at least 18 means that the patient is likely to be distressed. Affective flattening includes unchanging facial expression, decreased spontaneous movements, paucity of expressive gestures, poor eye contact, affective non-responsivity, lack of vocal inflections, and a global score. Alogia includes poverty of speech, poverty of content of speech, blocking, increased latency of response, and a global score. Avolition - apathy involves grooming and hygiene, impersistence at work on school, physical anergia, and a global rating. Anhedonia-Asociality includes recreational interests and activities, sexual interest and activity, ability to feel intimacy and closeness, relationships with friends and peers, and a global score. Attention, apart from a global rating, involves social inattentiveness and inattentiveness during mental status testing. Circumstances score was high in men, older patients and physically ill patients, while self-report scores were high in patients with a past history of psychiatric therapy or previous attempted suicide. Pierce (1981) found that, in a 5-year follow-up, future suicides tended to have high scores on a scale for their original self-injury episodes and had very high scores for the penultimate self-injury before suicide. The fact that suicides had made an average of nearly 3 non-fatal attempts emphasises the importance of repetition along with high intent in predicting at least some suicides. Harriss ea(2005) found that suicide intent scores appeared to have most value in assessing short-term suicide risk. Tower of London Test275: the test involves moving coloured beads on three upright poles in order to produce a pattern determined by the examiner; the subject must be able to plan moves (break down the task into parts and follow a sequence of moves); worst results are found with left frontal lobe damage; not surprisingly, patients with schizophrenia also perform poorly here. In organic cerebral disease those tests reliant on memorisation of recent events and on perceptual motor control will exhibit greater deterioration in scores than tests that depend on vocabulary and general knowledge. Grey areas in clinical certainty usually correspond with shortcomings in psychological reporting. The dominant hemisphere is the left hemisphere in most people, including left-handed (sinistral = left-handed, dextral = right-handed). The Bender-Gestalt Test for Geometric Designs and the Graham-Kendall Memory for Designs are other useful procedures; the latter, as with the Bender, measures visuo-motor control and it also examines immediate visual memory. The Halstead Category Test that addresses conceptual thinking detects damage to the frontal lobes. The Rey- Osterreth Test looks for dysfunction of the dominant frontal and temporal areas. Indeed, a meta-analysis294 (Laws, 1999) suggests that really what is being picked up is only part of a general intellectual dysfunction. The Mill Hill Vocabulary Scale, an 276 Gale ea (2007) suggest that bright children often turn out to be adult vegetarians! Therefore, what appears to be due to change due to age may actually stem from inherent ability. Useful sources of information on this subject are Mittler(1973) and Lishman(1978). Zung Self-Rating Depression Scale: devised by W Zung, 1960s; patient asked to quantitate 20 sentences; poorly correlated with observer ratings; insensitive to change with treatment; fallen into disfavour. Despite anatomical proximity, these areas may have very different connectivity patterns’. The ‘non-dreaming’ part of the sleep cycle may be involved in body tissue restoration. The dreaming component may entail brain tissue restoration, non-specific casting off of excess neuronal load, or intrusion of events from the previous day (day residue) to influence dream content. Thalamo-cortical arousal branch – contains cholinergic neurones from laterodorsal tegmental pedunculopontine tegmental nuclei → thalamus → cortex 2. Basal forebrain cholinergic magnocellular neurones project througout the cortex and appear to play an important part in the maintenance of cortical arousal. Animals seldom attacked, such as horses, sleep 302 much longer than those in constant danger, like bats. When much growth is required slow wave sleep and the overall amount of sleep are increased. When less sleep is needed, as in hypothyroidism, the amount of slow wave sleep is diminished.
Primary angle-closure glaucoma - pathogenesis: relative papillary block cheap zanaflex 2mg without prescription, narrowing anterior chamber angle order cheapest zanaflex, plateau iris buy cheap zanaflex line, vitreo-lenticular block - clinical features 297 - differential doagnosis 2. Primary open-angle glaucoma - pathogenesis: dystrophic changes in different parts of the aqueous drainage system, combined with partial block of the anterior chamber angle by the iris’ root or goniosynechiae. Retinal detachment - Rhegmatogenouse retinal detachment - Exudative retinal detachment - Tumour retinal detachment 10. Classification of ocular traumatism - contusions - injures: penetrating and non-penetrating – with or without foreign body - combustions A. Globe trauma - contusions - injures: non-penetrating and penetrating, with or without foreign bofy - explosive injures D. Types of blindness -absolute 300 -practic -work -professional -pedagogical -monolateral and bilateral -reversible and irreversible 4. Visit to the outdoor patients office: methods of examination of the anterior and posterior segments of the eye, visual charts, correction lenses, direct and indirect ophthalmoscopes, perimeter, tonometer, bio-microscope, instruments. Static and dynamic anomalies in the lids position: entropion, ectropion, blepharospasmus, lagophthalmus, ptosis of the eyelids. Pathologic changes in the conjunctiva: hyperemia- conjunctival and cilliary, edema, follicules, papillas, phlyctenas, secretion – catarrhal, purulent, fibrin. Inflammation of the conjunctiva ( conjunctivitis ) – acute, mild, chronic conjunctivitis, catarrhal, purulent, membranous, pseudo membranous, chlamidial, allergic conjunctivitis, conjunctiva-corneal damage in skin diseases, other conjunctivitis. Examination of the lachrymal pathway: - Canalicule test - nasal test - Anel test – demonstration. Pathologic changes in the cornea: opacities – infiltration, cicatrix, degeneration, pathologic vessels: superficial, deep. Inflammatory diseases of the cornea: - superficial, non purulent keratitis - superficial purulent keratitis - deep ( parenchimal ) keratitis - trophic keratitis 4. Pathologic changes in iridocyclitis – changes of the structure of the iris, precipitates, Tyndall effect, posterior synechiae, opacities. Differential diagnosis between iridocyclitis, conjunctivitis, keratitis and acute closure angle glaucoma. Examination of a patient with a cataract in one eye and transparent lens in the other eye by focal illumination, trans illumination and bio microscopy. Demonstration of patients and differential diagnosis between open angle glaucoma and cataract. Optic nerve head edema, optic neuritis, retrobulbar neuritis – ophthalmoscopy, clinical picture, treatment. What do we do when there is a trauma of the eye and the accessory structures of the eye. Demonstration of patients with ocular traumas: blunt trauma, penetrating traumas of the eyeball. First aid in acute closure angle glaucoma, occlusion of the central retinal artery or vein. Note: During practice including the anterior and posterior segment of the eye, patients are demonstrated and practical skills developed, depending on the theme of the practice. Inflamatory diseases of the conjunctiva - objective symptoms and subjective complaints. Deep (stromal) keratitis - in congenital lues, tuberculosis keratitis in sclerosing keratitis. Anomalies in size and curvature of the cornea - keratoconus keratoglobus, megalocornea, mikrocornea. Anterior uveitis / iridocyclitis / - clinical features, complications, differential diagnosis, treatment. Inflamatory diseases of the whole uvea - tubercular, syphilitic, Toxoplasma, sarcoidosis. Retinal changes in vascular diseases - atherosclerosis, hypertension and diabetes mellitus. Eyeglasses - definition of spectacle lenses, magnifying glasses, telescopic spectacles. Emergency in ophthalmology: traumas, acute glaucoma attack, acute occlusion of retinal arteries and veins. Arrange by anatomical principle the structures of the eyeball and its accessory organs ( systemic examination ): - vitreous - anterior chamber - lens - orbit - conjunctiva 308 - ocular fundus - eyelids - cornea - iris - pupil - lachrymal apparatus ІІІ. Function of the cornea: transmits light, participates in accommodation, insures dark chamber, participates in the production of aqueous humor. Function of the lens: participates in accommodation, preserves the form of the eye, insures a dark chamber, transforms the light stimulus into a nerve impulse. Function of the iris: transmits light, refracts light, preserves the form of the eye, regulates the quantity of light entering the eye. Function of the choroids: transmits light, preserves the form of the eye, produces aqueous humor. Function of the retina: participates in accommodation, produces aqueous humor, preserves the form of the eye, regulates the light beam entering the eye, transforms the light stimulus into a nerve impulse. Function of the sclera: transmits light, participates in accommodation, preserves the form of the eye, produces aqueous humor. Write down: - correct perception and projection of light - correct perception of light and lack of perception and projection of light - ІІ. Examination of the anterior segment of the eye: focal illumination, transillumination, direct ophthalmoscopy, indirect ophthalmoscopy, skiascopy. Examination of the posterior segment of the eye: mirror image, focal illumination, transillumination, ophthalmoscopy, skiascopy, tonometry. Methods of examination of the refraction of the eye: biomicroscopy, focal illumination, transillumination, skiascopy. Anatomy of the lachrymal gland: - position - dimensions - openings of the channels - types of secretion 2. Differential diagnosis between conjunctival and cilliary hyperemia: diseases, position, color, blood vessels. Examination of the anterior segment of the eye: focal illumination, transillumination, direct ophthalmoscopy, indirect opthalmoscopy, skiascopy. Examination of the posterior segment of the eye: mirror images, focal illumination, transillumination, ophthalmoscopy, skiascopy, tonometry. Methods of examination of the refraction: biomicroscopy, focal illumination, transillumination, skiascopy. Function of the cornea: transmits light, participates in accommodation, secures a dark chamber, participates in intraocular liquid secretion. Function of the lens: participates in accommodation, secures a dark chamber, transforms the light stimulus into a nerve impulse. Function of the iris: transmits light, refracts light, regulates the quantity of light entering the eye.
However cheap 2mg zanaflex amex, the diagnosis of hypertension and its treatment may account for much of the excess of psychiatric symptoms described in this population purchase online zanaflex. Findings of ‘positive affect’ in hypertensive community-based elders were based on a single evaluation of small numbers order 2 mg zanaflex visa. Extrapolations from studies showing a correlation between moderate drinking and better health may be hazardous, e. Also, associated physical symptoms, like dizziness, were attributed to mental disturbance. Barrett-Connor and Palinkas (1994) found an association between low diastolic blood pressure in older community-dwelling males and non-drug-related depression but the direction of causation was unclear. Hildrum ea (2007) found an association between low blood pressure and anxiety and depression in elderly people regardless of whether they had cardiovascular disease. Postural hypotension and electrolyte imbalance in the infirm elderly during hot weather may respond to a reduction in diuretic dosage. Paradoxical hypotension may occur when adrenaline is given with a low potency antipsychotic drug: the beta-adrenergic stimulating vasodilator action of adrenaline is unopposed by its expected pressor action because the antipsychotic drug is occupying alpha-1 adrenergic receptors. The same result occurs when a low potency antipsychotic drug is given to a patient with phaeochromocytoma. Low potency antipsychotic drugs may cause hypotension when combined with various anaesthetics, e. Urinary system Numerous psychological issues can affect the patient with renal disease: losses (e. Should a patient in renal failure require sedation a drug that is chiefly metabolised by the liver should be used, such as nitrazepam or chloral betaine (cloral betaine). In cases of benign prostatic hypertrophy, sudden urinary retention with a distended and painful bladder can follow excess alcohol intake (or constipation or prostatic infection). Balkan nephropathy, found in the flooded plains of the Balkans, probably has the same aetiology although the acid probably comes from shallow wells in this instance. Uroepithelial tumours are associated with cigarette smoking, phenacetin, cyclophosphamide, bilharzia, industrial (e. The urine of chronic stimulant abusers may have a stale smell due to the ammonia used in illegal manufacturing processes. Haematology 2184 Non-specific symptoms of anaemia may mimic psychiatric or neurological disorder. Macrocytic anaemia, which may be associated with dementia, may be due to vitamin deficiency, hypothyroidism, or 2185 alcohol. Bicarbonate levels are decreased due to hyperventilation, panic disorder, and abuse of anabolic steroids. The level of alkaline phosphatase is raised in various bone, liver, and cardiac disorders and in patients taking phenothiazines and it is decreased in pernicious anaemia. Of course, significant anaemia may follow bruising due to falling, particularly if warfarin or anti-platelet drugs are being taken. The effects of haemophilia A are usually only noticed when children start to move about and can easily be mistaken for child abuse. Liver failure Asterixis involves a sudden loss of muscle tone followed by its quick recovery. It can occur with encephalopathic states, neurodegenerative diseases, and with drug (e. Steatosis (fat deposition in hepatic cells) is nearly always present in heavy drinkers of alcohol, even those with liver function tests with normal limits. Alcoholic hepatitis, even in the absence of cirrhosis, can lead to fatal hepatic or renal failure or bleeding from varices. Haemochromatosis is an autosomal recessive disorder characterised by excessive absorption of iron. Abuse of alcohol, which is said to be common in patients with haemochromatosis, increases iron absorption 2187 further. A combination of melanin and iron confers a slate-grey discolouration on the skin. Complications include hepatic cirrhosis, diabetes mellitus (bronze diabetes), gynaecomastia, atrophy of the testes, hypopituitarism, loss of body hair, cardiac failure and arrhythmias, and (in 30% of cirrhotic cases) hepatocellular carcinoma. Clozapine, which should be avoided in cases of severe hepatic failure, may cause reversible hepatitis, eosinophilia, and a rise in aspartate aminotransferase levels. Lithium distribution is affected by ascites, and higher doses of lithium are needed to produce desired plasma levels. It can cause an asymptomatic increase in liver enzymes or, in 2% of patients, an unpredictable and perhaps autoimmune fulminant liver failure. Nefazodone (withdrawn, 2003) caused catastrophic hepatic failure in a few people with no known risk factors. Lower protein levels associated with hepatic disease may increase (unbound) drug potency; venlafaxine is relatively safe in this regard because relatively little is protein bound. Conjugation – sulphatation, acetylation, glucuronidation, methylation, etc Oxidation by microsomal enzymes decreases with increasing age. Glucuronide conjugation (spared in most liver disease) renders compounds water soluble and hence excretable by the kidneys. It is classified into simple fatty liver disease (relatively good prognosis) and non-alcoholic steatohepatitis (associated with fibrosis and cirrhosis). Because patients with liver transplants do as 2188 well as other transplant patients , Lloyd (2007, p. However, allocation of transplant liver should be on the basis of likelihood of best outcome. Most centres require 6 months abstinence from alcohol before transplantation, which sometimes makes transplantation unnecessary. Previous substance misuse or current methadone maintenance, as long as the patient can be expected to stick to the immunosuppressive regimen, are not contraindications. It is important to ensure that the liver tissue is freely given: no threats and no payment. Thyroid Globally, iodine deficiency is among the most common preventable causes of intellectual disability (mental retardation: Hetzel, 1988; Haddow ea, 1999) Loss of weight is common to primary anxiety and hyperthyroidism but appetite is usually increased and reduced in hyperthyroidism and primary anxiety respectively. Rarely, cases of hyperthyroidism in middle age or the elderly may present with lassitude, slowed mentation, depression (apathetic or lethargic hyperthyroidism), weight loss, atrial fibrillation and congestive cardiac failure. The tremulous patient with unstable emotions may be mistakenly assumed to be drinking to excess. The psychiatric manifestations are likely to result from central metabolic effects of excess T4 and the actions of catecholamines since beta-blockers alleviate psychiatric symptoms without affecting thyroid hormone concentrations. In the presence of hypothyroidism plus depression, antidepressants tend not to be effective. In the case of gravid women taking lithium, a foetal goitre may compress the trachea during delivery. While it is usually transient it can give rise to permanent under-activity of the thyroid gland when antibodies are present. Parathyroid glands Depression is found in about a third of cases of primary hyperparathyroidism, severity of depression and 2191 cognitive problems roughly correlating with serum calcium level. In most cases depression abates on 2192 correcting the calcium level , but an antidepressant is sometimes required.
Greenwood ea (2007) looked at 183 families containing probands with schizophrenia and calculated heritability for pre-pulse inhibition of startle response generic 2 mg zanaflex overnight delivery, P50 event-related potential suppression discount zanaflex 2 mg on-line, antisaccade task for eye movements buy cheap zanaflex 2mg on-line, Continuous Performance Test, California Verbal Learning Test (second edition), and Letter Number Sequencing Test; all showed significant heritability but also significant environmental correlations. Sánchez-Moria ea (2008) found evidence supporting the presence of a P50 sensory gating deficit in both schizophrenia and euthymic bipolar disorder, implying that this deficit represents vulnerability to psychosis across diagnoses. Symond ea (2005) reported that first-episode schizophrenia patients had decreased magnitude and delayed latency for global gamma 1 synchrony relative to controls, but no difference to controls in gamma 2 synchrony. Wynn ea (2005) found decreased gamma activity and failure of lateralisation of activity to the right hemisphere during masking. Adler ea (2004) found that clozapine improved P50 gating more than did olanzapine, risperidone, quetiapine or typical antipsychotic drugs. It should be noted, however, that Arnfred ea,(2003) in a controlled study of auditory evoked potentials in 12 unmedicated schizophrenic outpatients, found P50 gating to be normal. Doninger ea (2002) tested the ability of schizophrenic patients to recognise complete objects based on fragmentary information (i. The patients were significantly impaired in this ability; there was impaired generation of the Nc1, significantly reduced amplitude of visual P1 (especially over dorsal stream sites), and intact generation of visual N1. Work in Dublin by Yeap ea (2006) demonstrated a deficit in early visual processing (P1 amplitude reductions) in well first-degree relatives of people with schizophrenia. Kéri ea (2005) suggest that multiple visual information processing deficits derive from dysfunction of the magnocellular pathway, leading to impaired attentional modulation of perceptual organisation and of natural image organisation. Hong ea (2008) found that gating of the theta-alpha-band responses of controls were significantly different from schizophrenia patients and their first-degree relatives. Thus, the authors suggest that this measure may be a superior one for genetic studies of the gating deficit in schizophrenia, Excitatory lateral connections in early stage visual cortical processing may be specifically impaired in schizophrenia, but not in bipolar disorder. In chronic schizophrenia there is some evidence of increased skin conductance activity at rest, and in socially demanding conditions the skin conductance level and variability was increased in the right hand. Asymmetry of skin conductance may therefore be a characteristic of the chronic from of the illness (White ea, 1987). Holt ea (2009) reported increased neural response to innocuous stimuli and increased arousal levels in schizophrenic subjects. Over 80% of people with schizophrenia do however have abnormal smooth pursuit tracking with about one in three of their relatives 1054 having similar problems. There may be an abnormal frontostriatal network that normally suppresses automatic eye movements (Raemaekers ea, 2002) and/or an abnormality of the frontal eye field. Lencer ea (2008) found that second generation (atypical) antipsychotic drugs impaired already abnormal smooth pursuit performance in antipsychotic-naive patients with schizophrenia. In a study conducted by Landgraf ea (2008) schizophrenic patients and their siblings showed 1051 Input from magnocellular division of lateral geniculate nucleus and extends from early visual areas through the occiptoparietal cortex. Not all studies support saccadic problems in relatives of patients of schizophrenic cases (de Wilde ea, 2008) or an association with genetic risk rather than disorder status. Schizophrenic individuals find it more difficult than do normals to identify the first (target) stimulus (Del Cul ea, 2006) and this may be due to failure to adequately activate the lateral occipital complex. Murray (2002) has suggested that schizophrenic patients are ‘developmentally impaired manics’, i. Such impaired connectivity might also explain negative and persistent cognitive symptoms. Neuroimaging is best confined to the investigation of atypical cases (Lawrie, 2006) and for research. Variations in the type of patients (and control subjects: Blakemore, 2002) employed and their medication status between studies complicate interpretation, as does the state versus trait dilemma. Twins affected by schizophrenia may have smaller anterior hippocampi than have their co- twins. Younger patients had larger hippocampi if they were treated with atypical antipsychotics rather than haloperidol. The authors concluded that the hippocampus of male schizophrenics is progressively reduced in size. Genetic risk for bipolar affective disorder was specifically associated with grey matter deficits only in the right anterior cingulate gyrus and ventral striatum. Genetic risk for both disorders was associated with reduced volume of white matter in left frontal and temporo-parietal regions. Koch ea (2009) found that schizophrenia was associated with increased fractional anisotropy in corpus callosum, cerebral peduncle, left inferior fronto-occipital fasciculus, anterior thalamic radiation, right posterior corona radiata, middle cerebellar peduncle, and right superior longitudinal fasciculus; increased fractional anisotropy was detectable in inferior sections of the cortico-pontine circuit; and the authors suggest that their findings indicate extended cortical-subcortical changes in white matter integrity in schizophrenia and that their results corroborate earlier work that demonstrated white matter structural deficits in mainly long-ranging association fibres. Because the illness was at an early stage and because medication received was minimal Pérez- Iglesias ea (2010b) felt that such findings were not due to chronicity or treatment. Honea ea (2005) performed a meta-analysis of voxel-based morphometry studies (15 studies, 390 schizophrenic patients, 364 healthy volunteers) and found that the most consistent differences were relative deficits in the left superior temporal gyrus (see Kuroki ea, 2006) and the left medial temporal lobe. Their results suggest progressive gray matter reductions of the superior temporal gyrus during transition to psychosis. Weinberger ea, 1992) but certainly not all authors have found 1063 diminished blood flow in these areas while the task is being performed (‘hypofrontality’ ). Typical neuroleptics have been associated with larger caudate nuclei, reversing with a switch to atypical drugs. Alcohol dependence on its own was associated with volume deficits in thalamus and pons. However, Hill ea (2004) in their meta-analytic study found no hypofrontality in first-episode/illness-duration-under-2 years cases but that it became more evident in studies looking at mixed acute and chronic subjects and even more so in chronic patients. Blakemore (2002) discussed the evidence for a temporo-frontal disconnection or a dysfunctional cortico-cerebellar circuit in schizophrenia and concluded that whilst the evidence is largely indirect there may be a basis in reality for such findings. Meyer-Lindenberg ea (2005) found evidence for altered hippocampal formation-dorsolateral prefrontal cortex connectivity during working memory activation in schizophrenia. Achim and Lepage (2005) conducted a meta-analysis of 18 studies and found that schizophrenia is associated with abnormal patterns of brain activation during both encoding and retrieval of memories; the prefrontal cortex and hippocampus, amongst other regions, are implicated in the abnormal memory functions. Another meta-analysis (Ragland ea, 2009) found prefrontal activation deficits during episodic encoding and retrieval in patients with schizophrenia. Andreone ea (2007) found microstructural disruption of white matter in frontal, temporal and occipital white matter. However, the authors admit that their findings will require to be tested by following such cases. Kanaan ea (2009), in a relatively large study comprising 76 patients with schizophrenia and 76 matched controls, found widespread clusters of reduced fractional anisotropy affecting most major white matter tracts in patients and these were not associated with duration of illness or duration of treatment. In one study (Kyriakopoulos ea, 2009), adolescent-onset schizophrenia was associated with decreases fractional anisotropy in parietal regions but adult-onset cases also had such decreases in frontal, temporal and cerebellar areas. The 40 relevant studies revealed an overall decrease in whole brain by 3%, temporal lobe by 6% on left and 9. There was increased size of the lateral ventricles (44% left, 36% right), being greatest in the body and occipital horns.