Eur Arch Psychiatry Clin Neurosci (2005) 255 : 236–244 DOI 10.1007/s00406-004-0552-8 ■ Abstract Functional neuroimaging and neuropsy- chological performance indicate a prefrontal dysfunc- tion in schizophrenia patients. Frontal morphological brain abnormalities are also evident in these patients, but the relationship between neuropsychology and neu- roimaging findings remains unclear. In this study, thirty patients with schizophrenia and 30 control participants were assessed using a neuropsychological test battery sensitive to fronto-striatal system dysfunction. Com- puted tomography (CT) scans were used to calculate the distance from the corpus callosum to the frontal pole corrected for brain size (anterioposterior length) in the group of patients and in a group of control participants with negative radiological findings. Schizophrenia pa- tients performed significantly worse than controls in all frontal lobe tests. Corrected length from the corpus cal- losum to the frontal pole was reduced in patients with schizophrenia. This easy-to-perform measurement has not been used in previous studies, and indicates that schizophrenia patients have structural frontal abnor- malities. However, correlations between structural and functional measures fail to show a clear relationship be- tween the prefrontal performance and the main CT measures. As a rule, the trend observed in the correla- tion matrix pointed towards a relationship between CT parameters and a dysfunction on neuropsychological tests sensitive to frontal lobe damage. ■ Key words schizophrenia · frontal lobe · neuropsychology · computerized tomography Introduction Schizophrenia symptoms have been associated with be- havioral sequelae presented by patients with prefrontal lesions (Andreasen etal. 1986; Kurachi 2003). Negative symptoms have been linked with prefrontal cortex pathology (Weinberger et al. 1986, 1988; Wolkin et al. 1992; Velligan et al. 2002). Frontal morphological brain abnormalities identi- fied by computerized tomography (CT) and magnetic resonance imaging (MRI) are consistent findings in schizophrenia research (Andreasen et al. 1986; Shelton et al. 1988; Raine et al. 1992; Gur et al. 1998; Cahn et al. 2002). Linear measurements of ventricular size as a pro- portion of brain width were introduced to evaluate pneumoencephalograms. Evans (1942) by dividing the width of the anterior horns of the lateral ventricles by the maximum width of the brain, created a ratio to as- sess ventricular size. Similarly, Huckman etal. (1975) proposed an anterior horn span/brain width ratio for use with CT. These linear measurements, though are not very sensitive to subtle degrees of enlargement, are quick and simple to determine in clinical settings. In this regard, Shelton and Weinberger (1986) reviewed seven studies of ventricular enlargement size on CT in schizo- phrenia using linear measures, and they found that four (57%) showed significant increase on lateral ventricles. Since 1951, neuropsychological studies have pro- vided clear, broad-ranging evidence of frontal lobe dys- functions in schizophrenia patients (Fey 1951; Levin 1984; Seidman et al. 1992; Liddle and Morris 1991; Raine et al. 1992; Elliot et al. 1995; Hepp et al. 1996; Joyce et al. 1996; Pantelis etal. 1997; Lysaker etal. 2003). Finally, functional neuroimaging research using PET scan (Buchsbaum et al. 1992; Wolkin et al. 1992; Carter et al. 1997; Karlsson et al. 2002), SPECT and fMRI techniques have corroborated the involvement of prefrontal dys- ORIGINAL PAPER Juan Carlos Sanz de la Torre · Maite Barrios · Carme Junqué Frontal lobe alterations in schizophrenia Neuroimaging and neuropsychological findings Received: 13 April 2004 / Accepted: 27 September 2004 / Published online: 22 November 2004 EAPCN 552 M. Barrios Department of Methodology of the Social Sciences University of Barcelona, Spain C. Junqué Department of Psychiatry and Psychobiology University of Barcelona, Spain J. C. Sanz de la Torre, Ph.D. () Hospital Psiquiátrico Provincial Carretera de Valverde Km. 2. 06800 Mérida (Badajoz), Spain Tel.: +34-924/388081 Fax: +34-924/388083 E-Mail: jcsanz@correo.cop.es