Association between excessive frontal cerebrospinal fluid and illness duration in males but not in females with schizophrenia

Abstract

Objective. – Excessive cortical cerebrospinal fluid (CSF) has been acknowledged as a possible marker of a gray matter loss. This excess in schizophrenia is found predominantly in the prefrontal and temporal regions. We hypothesized that the poorer global outcome and treatment response in males with schizophrenia are related to a greater cortical volume loss as compared to females. Subjects and methods. – In order to test this hypothesis we have used magnetic resonance imaging (MRI) to study the cortical (prefrontal, temporal, and hemispheric) CSF values in a group of 85 patients with schizophrenia, of whom 56 were males and 29, females. We calculated the residual values of CSF in the patients based on the data pertaining to 45 control subjects and linear regression, from which the normal effects of age and intracranial volume were discounted. These residual scores constitute a quantitative measurement of the excess of CSF due to the disease. Results. – Males, but not females, presented a trend-level significant excess of left prefrontal CSF. The prefrontal and temporal residual values were significantly associated with illness duration in males, but not in females. Discussion. – These results conform to the worse outcome and the higher severity of structural abnormalities generally found in schizophrenia in male subjects. Conclusion. – Our data support the hypothesis of accelerated prefrontal cortical loss in males, but not in females with schizophrenia.