The regional cerebral blood flow changes in major depressive disorder with and without psychotic features Ali Saffet Gonul a, * , Mustafa Kula b , Arzu Guler Bilgin c , Ahmet Tutus b , Aslan Oguz c a Department of Psychiatry, Ege University, School of Medicine, 35100-Izmir, Turkey b Department of Nuclear Medicine, Erciyes University School of Medicine, Kayseri, Turkey c Department of Psychiatry, Erciyes University School of Medicine, Kayseri, Turkey Accepted 10 May 2004 Available online 30 July 2004 Abstract Depressive patients with psychotic features demonstrate distinct biological abnormalities in the hypothalamic–pituitary–adrenal axis (HPA), dopaminergic activity, electroencephalogram sleep profiles and measures of serotonergic function when compared to nonpsychotic depressive patients. However, very few functional neuroimaging studies were specifically designed for studying the effects of psychotic features on neuroimaging findings in depressed patients. The objective of the present study was to compare brain Single Photon Emission Tomography (SPECT) images in a group of unmedicated depressive patients with and without psychotic features. Twenty-eight patients who fully met DSM- IV criteria for major depressive disorder (MDD, 12 had psychotic features) were included in the study. They were compared with 16 control subjects matched for age, gender and education. Both psychotic and nonpsychotic depressed patients showed significantly lower regional cerebral blood flow (rCBF) values in the left and right superior frontal cortex, and left anterior cingulate cortex compared to those of controls. In comparison with depressive patients without psychotic features (DwoPF), depressive patients with psychotic features (DwPF) showed significantly lower rCBF perfusion ratios in left parietal cortex, left cerebellum but had higher rCBF perfusion ratio in the left inferior frontal cortex and caudate nucleus. The present study showed that DwPF have a different rCBF pattern compared to patients without psychotic features. Abnormalities involving inferior frontal cortex, striatum and cerebellum may play an important role in the generation of psychotic symptoms in depression. D 2004 Elsevier Inc. All rights reserved. Keywords: Caudate nucleus; Cerebellum; Psychotic depression; SPECT 1. Introduction Functional neuroimaging studies of major depressive disorder (MDD) have provided valuable information about abnormal neurophysiological activity in several brain structures that have been shown by other types of evidence to participate in modulation of emotional behavior. Although there are discrepancies between the studies, different studies demonstrate consistent abnormalities in the regional cerebral blood flow (rCBF) or glucose metabolism in the prefrontal cortex, anterior cingulate cortex, amygdala and basal ganglia of patients with MDD (Drevets, 2000; Videbech, 2000). However, it has been reported that a number of factors play an important role in the imaging abnormalities among depressed patients such as unipolar or bipolar course (Baxter et al., 1989; Tutus et al., 1998), symptom severity (Drevets et al., 1992), age of onset (Kumar et al., 1993; Vasile et al., 1996) and use of psychotrophic medication (Maes et al., 1993). The presence of psychotic symptoms (i.e., delusions or hallucinations) is another clinical dimension of depression. 0278-5846/$ - see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.pnpbp.2004.05.036 Abbreviations: CSF, cerebrospinal fluid; DwoPF, depressive patients without psychotic features; DwPF, depressive patients with psychotic features; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Scale; HPA, hypothalamic–pituitary–adrenal; HVA, homovalinic Acid; MDD, major depressive disorder; OM, orbitomeatal; rCBF, regional cerebral blood flow; ROI, regions of interest; SPECT, single photon emission tomography. * Corresponding author. Tel./fax: +90 232 339 8804. E-mail address: saffet@med.ege.edu.tr (A.S. Gonul). Progress in Neuro-Psychopharmacology & Biological Psychiatry 28 (2004) 1015 – 1021 www.elsevier.com/locate/pnpbp