Elsevier

Biological Psychiatry

Volume 61, Issue 10, 15 May 2007, Pages 1187-1194
Biological Psychiatry

Original article
Three-Dimensional Laser Surface Imaging and Geometric Morphometrics Resolve Frontonasal Dysmorphology in Schizophrenia

https://doi.org/10.1016/j.biopsych.2006.08.045Get rights and content

Background

Although a role for early developmental disturbance(s) in schizophrenia is postulated, it has proved difficult to identify hard, biological evidence. The brain and face emerge in embryologic intimacy, such that in neurodevelopmental disorders, brain dysmorphogenesis is accompanied by facial dysmorphogenesis.

Methods

Three-dimensional (3D) laser surface imaging was used to capture the facial surface of patients and control subjects in 37 male and 32 female patients who satisfied DSM-IV criteria for schizophrenia in comparison with 58 male and 34 female control subjects. Surface images were analyzed using geometric morphometrics and 3D visualizations to identify domains of facial shape that distinguish patients from control subjects.

Results

Both male and, particularly, female patients evidenced significant facial dysmorphology. There was narrowing and reduction of the mid to lower face and frontonasal prominences, including reduced width and posterior displacement of the mouth, lips, and chin; increased width of the upper face, mandible, and skull base, with lateral displacement of the cheeks, eyes, and orbits; and anterior displacement of the superior margins of the orbits.

Conclusions

The frontonasal prominence, which enjoys the most intimate embryologic relationship with the anterior brain and also orchestrates aspects of development in maxillary and mandibular domains, evidences a characteristic topography of dysmorphogenesis in schizophrenia.

Section snippets

Subjects

Approval for this study protocol was obtained from the Research Ethics Committee of the North Eastern Health Board; all subjects gave written, informed consent to their participation in the study. Patients were drawn from attendees of Cavan–Monaghan Mental Health Service who were under age 65; each satisfied Diagnostic and Statistical Manual of Mental Diseases (4th edition) criteria (American Psychiatric Association 1994) for schizophrenia or schizoaffective disorder as described previously (

Facial Surface Analysis

Centroid size was slightly but significantly larger in female patients (2705.0 [SD 105.9] mm; +1.8%) than in female control subjects (2656.1 [SD 78.0] mm; t = 2.14, p < .05) but did not differ between male patients (2878.9 [SD 106.3] mm) and male control subjects (2878.1 [SD 87.2] mm; +.03%, p = .97). All subsequent analyses of shape are independent of centroid size.

Among female subjects, 12 PCs, describing 84.5% of the total shape variance, were selected. Both Goodall’s test (p < .005) and

Discussion

In this study, we captured, quantified and visualized, for the first time, subtle abnormalities of 3D morphology over the whole facial surface in schizophrenia.

Regarding facial size, a slight (1.8%) increase was found in female but not in male patients. Previous studies have involved linear evaluation of “hat size” using a tape measure or derived from neuroimaging; although some have reported a slight reduction in cranial circumference, others have found either no difference or a slight

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