الفهرس 
Introductionيوجد فقط 14 صفحة متاحة للعرض العام
 |  | from | 217 |  |  |
| | | from | 217 | | |
المستخلص
Schizophrenia is a chronic disabling mental illness and has been listed as a major public health issue comparable to that of the HIV epidemic. The incidence of schizophrenia is ” " ~ " ”1% worldwide. Its cause, however, remains unclear. There have been advances in the treatment options to control symptoms but the prognosis for the majority of patients remains poor with the majority of patients staying incapacitated for life. Diffusion-tensor imaging (DTI) is a new magnetic resonance imaging (MRI) technology characterized by being non-invasive, not requiring exogenous contrast agents. It can identify abnormalities in the brain white matter microstructure, and is widely used in studies of brain connection structures in schizophrenia. The aim of this study conducted the diffusion tensor imaging (DTI) in schizophrenic patients to evaluate altered structural integrity in grey and white matter. This prospective case control study was conducted on nonrandomized sample of 25 schizophrenic patients selected from psychiatry department and Psychiatry and Neurology Center, Tanta University (inpatients and outpatients). Twenty-five healthy persons with no medical or neurological disorders by history and examinations were selected (correlating to age and sex patients‘ group) as a control group. Schizophrenic patients were drug naïve patients or patients who stopped their medication about 3 months prior to the time conducting the study (not receiving antipsychotic medications). The cases collected starting from January 2022 till December 2022. The study was approved by the Research Ethical Committee, Faculty of Medicine, Tanta University. All patients were subjected to the following: Informed consent obtained from all patients, full history taking, general examination, neurological examination. MRI and DTI were done Inclusion criteria: • Patients clinically diagnosed as primary idiopathic schizophrenia. • Patients clinically diagnosed as organic schizophrenia secondary to other organic lesions in the brain. Exclusion criteria: • Patients who have had metallic devices placed in their body that are incompatible to MRI machine, such as (heart pacemaker and aneurysm clip) • Patient with other mental or psychiatric disorder. • Refusal of patients or their guardians to undergo the examination. • Claustrophobic patients from MRI machine. • Severely agitated and irritable schizophrenic patients. The age of schizophrenic patients in this study ranged from 18-48 years with the median and interquartile range (IQR) 30.5±8.8 years. While, the age of control group ranged from 20-45 years with the median and interquartile range (IQR) 31.6±7.1 years. No significant differences between schizophrenic group and control group. In the current study, no-significant differences were found in sex distribution between studied groups. Schizophrenia male patients were (72%) and female patients (28%). The males of control group were (56%) and females were (44) %. About half of cases were smoker. Most of the studied cases had no family history of psychiatric diseases or history of addiction. Schizophrenic patients in the current study were mainly from Gharbia (40%). Educated patients represented by (44%) and 48% only of schizophrenic group had a job. The majority of cases were single (44%) while both married and divorced represented by 28% for each. The highest percentage of cases suffered from hallucinations, neglected and social & emotional withdrawal, followed by sleeping disorder (insomnia), delusions and aggression and less talkative and anhedonia. Twenty percentage of schizophrenic group had suicidal attempts. Schizophrenic patients showed diminished fractional anisotropy in fornix, corpus callosum, right &left cingula, right & left superior occipitofrontal fasciculi, right inferior occipito-frontal fasciculus and left arcuate fasciculus. No significant differences of apparent diffusion coefficient of all studied areas of the brain. In spite of, there were mild decrease of their measurements. Schizophrenic patients showed increased mean diffusivity in corpus callosum, left superior occipito-frontal fasciculus, right & left inferior occipito-frontal fasciculi. In the current study, there were no significant correlation of fractional anisotropy between white and grey matter in schizophrenic patients. Apparent diffusion coefficient of left cingulum had significant positive correlation with right basal ganglion. Also, apparent diffusion coefficient of right inferior occipito-frontal fasciculus, left inferior occipito-frontal fasciculus and left arcuate fasciculus had significant positive correlation with left thalamus. Only a significant positive correlation of mean diffusivity was observed in left inferior occipito-frontal fasciculus with right basal ganglion and left arcuate fasciculus with right thalamus left basal ganglion. Comparison between newly diagnosed and chronic schizophrenic patients who were admitted at the Neuropsychiatry department at Tanta University Hospitals after stopping treatment for three months showed no significant differences between studied groups regarding to fractional anisotropy, apparent diffusion coefficient and mean diffusivity values of all studied areas of the brain except fractional anisotropy of right cingulum, right arcuate fasciculus and right basal ganglion, also mean diffusivity of right thalamus and left basal ganglion. Receiver operating characteristic curve was plotted for all the measured fractional anisotropy, apparent diffusion coefficient and mean diffusivity in different areas of white and grey matter to predict schizophrenic patients. In the current study, ROC (Receiver operating characteristic) curve of fractional anisotropy revealed significant differences (p: <0.001) of fornix, corpus callosum, right and left cingulum, right and left superior occipitofrontal fasciculi, right inferior occipito-frontal fasciculus and left arcuate fasciculus. These parameters exhibited high accuracy in predicting schizophrenic patients with 96%, 96%, 92%, 90%, 92%, 90%,92% and 82% of Sensitivity (respectively). Receiver operating characteristic curve of apparent diffusion coefficient, there were no significant differences in all parameters for prediction of schizophrenic patients. For prediction of schizophrenic patients by receiver operating characteristic ROC curves, there were significant differences (p: <0.001) of mean diffusivity in corpus callosum, left superior occipito-frontal fasciculus, right and left inferior occipito-frontal fasciculus, right basal ganglion, right and left thalamus. The level of sensitivity and specificity of mean diffusivity were (90% & 84%) in corpus callosum, (72% & 70%) left superior occipitofrontal fasciculus, (96% & 88%) right and (92% & 82%) left inferior occipito-frontal fasciculus, (76% & 70%) right basal ganglion, (96.0% & 72%) right and (72% & 62%) left thalamus.