Findings in computed Tomography brain scans of patients referred with first-episode Psychosis

Van Wyk, Matthys Johannes
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Psychosis, the inability to separate subjectivity and reality, can be either functional or organic. Organic psychoses are attributed to physical brain conditions, excluded by imaging. CT scanning requires evaluation regarding the detection of organic pathology in South Africa, with its high TB and HIV prevalence and resource limitations. Aim To determine the prevalence of structural brain abnormalities detected on CT in patients referred with a first-episode psychosis to a tertiary hospital in Johannesburg, South Africa. Materials & Methods One hundred and twelve CT brain scan reports of patients referred over a two-year period, after a first-episode psychosis, were retrospectively reviewed. Demographic data, HIV status, space-occupying lesions (SOL), ventricle size, abnormal calcifications and features of raised intra-cranial pressure were recorded. Results Eighty-eight of 112 patients were included in the sample [46 (52.3%) males; mean age 37 years; range 16 – 67 years]. Eleven (20.8%) of the 53 patients evaluated for HIV tested positive. Of the 77 patients tested for syphilis, three (3.9%) tested positive. Sixteen (18.8%) patients had abnormalities on CT. Only two (2%) were deemed significant findings (a hypodensity in the left cerebral peduncle and features of mesiotemporal sclerosis). Three (3.4%) patients had enlarged ventricles. Seven (8%) patients had age-inappropriate involutional changes. Six patients (6.8%) had old calcified granulomata. No SOLs were detected. None had features of raised intra-cranial pressure. Conclusion The yield of abnormalities in CT brain scans in patients referred with a first-episode psychosis at our institution is high. However, only a small percentage of these are significant, can be attributed to the psychosis or affect management.