Journal of The American Academy of Child and Adolescent Psychiatry, 2008
Adult-onset schizophrenia has repeatedly been associated with disturbances in the temporal lobes ... more Adult-onset schizophrenia has repeatedly been associated with disturbances in the temporal lobes and alterations in cortical folding, which are thought to reflect neurodevelopmental impairment. Early-onset schizophrenia (EOS; onset before 18 years) is considered to involve even more pronounced neurodevelopmental deviance across a wide range of brain structural measures. We hypothesized that overall alteration of cortical folding also applies to EOS, and EOS involves prominent structural aberrations in superior temporal and collateral sulci. Magnetic resonance T1 images of 51 patients with EOS and 59 healthy participants were investigated. A fully automated method was applied to the images to extract, label, and measure the sulcus area in the whole cortex. Cortical folding was assessed by computing global sulcal indices (the ratio between total sulcal area and total outer cortex area) for each hemisphere and local sulcal indices (the ratio between the area of labeled sulcus and total outer cortex area in the corresponding hemisphere) for superior temporal and collateral sulci. Relative to healthy individuals, patients with EOS had significantly lower global sulcal indices in both hemispheres and a lower local sulcal index in the left collateral sulcus. Reduced hemispheric sulcation appears to be a feature of schizophrenia, irrespective of age at onset. Structural aberration involving the left collateral sulcus may contribute to neurobiological substrate of EOS.
Put simply, case formulation is a process by which a set of hypotheses is generated about the eti... more Put simply, case formulation is a process by which a set of hypotheses is generated about the etiology and factors that perpetuate a patient's presenting problems and translates the diagnosis into specific, individualized treatment interventions. It is central to the practice of child and adolescent psychiatry. Even if not articulated explicitly, the case formulation guides all clinical activity. For example, how one understands a child's biologic vulnerabilities and how they interact with personality or family factors and the importance assigned to each clearly influence choices made in the assessment process and the treatment plan. Despite the widely acknowledged importance of case formulation, it is often taught cursorily in residency programs, and residents often perceive it as too challenging to actually perform [1]. Consequently, case formulation is often relegated to secondary status behind the DSM-IV-TR differential diagnosis. Such attitudes are manifested in the American Board of Psychiatry and Neurology Child and Adolescent Psychiatry certification examinations. When asked to formulate the case just presented, candidates generally return a perfunctory statement and transition quickly to discussion of DSM-IV-TR diagnoses.
Journal of The American Academy of Child and Adolescent Psychiatry, 2008
Adult-onset schizophrenia has repeatedly been associated with disturbances in the temporal lobes ... more Adult-onset schizophrenia has repeatedly been associated with disturbances in the temporal lobes and alterations in cortical folding, which are thought to reflect neurodevelopmental impairment. Early-onset schizophrenia (EOS; onset before 18 years) is considered to involve even more pronounced neurodevelopmental deviance across a wide range of brain structural measures. We hypothesized that overall alteration of cortical folding also applies to EOS, and EOS involves prominent structural aberrations in superior temporal and collateral sulci. Magnetic resonance T1 images of 51 patients with EOS and 59 healthy participants were investigated. A fully automated method was applied to the images to extract, label, and measure the sulcus area in the whole cortex. Cortical folding was assessed by computing global sulcal indices (the ratio between total sulcal area and total outer cortex area) for each hemisphere and local sulcal indices (the ratio between the area of labeled sulcus and total outer cortex area in the corresponding hemisphere) for superior temporal and collateral sulci. Relative to healthy individuals, patients with EOS had significantly lower global sulcal indices in both hemispheres and a lower local sulcal index in the left collateral sulcus. Reduced hemispheric sulcation appears to be a feature of schizophrenia, irrespective of age at onset. Structural aberration involving the left collateral sulcus may contribute to neurobiological substrate of EOS.
Put simply, case formulation is a process by which a set of hypotheses is generated about the eti... more Put simply, case formulation is a process by which a set of hypotheses is generated about the etiology and factors that perpetuate a patient's presenting problems and translates the diagnosis into specific, individualized treatment interventions. It is central to the practice of child and adolescent psychiatry. Even if not articulated explicitly, the case formulation guides all clinical activity. For example, how one understands a child's biologic vulnerabilities and how they interact with personality or family factors and the importance assigned to each clearly influence choices made in the assessment process and the treatment plan. Despite the widely acknowledged importance of case formulation, it is often taught cursorily in residency programs, and residents often perceive it as too challenging to actually perform [1]. Consequently, case formulation is often relegated to secondary status behind the DSM-IV-TR differential diagnosis. Such attitudes are manifested in the American Board of Psychiatry and Neurology Child and Adolescent Psychiatry certification examinations. When asked to formulate the case just presented, candidates generally return a perfunctory statement and transition quickly to discussion of DSM-IV-TR diagnoses.
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