Hippocampal and superior temporal gyrus volume in first-episode schizophrenia.

T he article by Velakoulis et al 1 reported the important finding of hippocampal volume reduction in first-episode schizophrenia and interpreted it as evidence in support of a neurodevelopmental model of this disorder. The authors stated that " no [pre-vious] studies have examined the specificity of this finding to first-episode schizophrenia, compared with first-episode affective psychosis. " 1(p133) Probably because their article was in press (it was accepted for publication on October 2, 1998), Velakoulis and coworkers did not cite our report 2 in the October 1998 issue of the American Journal of Psychiatry, which, to our knowledge, was the first published report of lack of specificity of hippocampal volume reduction in first-episode schizophrenia relative to first-episode affective psychosis. Our study used a spoiled gradient-recalled acquisition protocol, resulting in 124 contiguous 1.5-mm coronal slices, to evaluate the hip-pocampus in 17 patients with first-episode schizophrenic psychosis compared with 16 first-episode affec-tive psychosis patients and 18 normal control subjects. The first-episode schizophrenic patients showed significant volume reduction in the left, but not right, hippo-campus, compared with control subjects. Moreover, left hippocampal volume in first-episode affective patients did not differ statistically from first-episode schizophrenic patients or normal subjects. Additionally, in our study, both patients with first-episode schizophrenic and affec-tive psychosis demonstrated left less than right asymmetry of hippocampal volume, while controls showed no such asymmetry. We think that the similarity between our findings and those reported by Velakoulis and colleagues reinforce each other in the conclusion that hippocampal volume abnormalities may not be specific to first-episode schizophrenia as compared with affective disorder. Are there any brain regions that show volume reductions specific to schizophrenia, compared with first-episode affective disorder? Our study also evaluated gray matter volume of the superior temporal gyrus (STG), and found that the gray matter volume of the posterior portion of the left STG in first-episode schizophrenia was significantly less than in both first-episode affective disorder and in comparison subjects. Furthermore, patients with first-episode schizophrenia showed a reduced left rather than right asymmetry of this region compared with both first-episode affective psychosis patients and comparison subjects. This finding points to an apparent specificity of left STG volume reduction in first-episode schizophrenia. We think it would be both interesting and important for Velakoulis and colleagues to look at this region in their first-episode subject groups. We are in strong agreement with Velakoulis and coworkers about the importance of first-episode studies, and …