Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia
TLDR
It is suggested that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.Abstract:
Context Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain. Objective To evaluate relative contributions of 4 potential predictors (illness duration, antipsychotic treatment, illness severity, and substance abuse) of brain volume change. Design Predictors of brain volume changes were assessed prospectively based on multiple informants. Setting Data from the Iowa Longitudinal Study. Patients Two hundred eleven patients with schizophrenia who underwent repeated neuroimaging beginning soon after illness onset, yielding a total of 674 high-resolution magnetic resonance scans. On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years). Main Outcome Measure Brain volumes. Results During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted. Conclusions Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.read more
Citations
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Journal ArticleDOI
Gray matter volume reductions in patients with schizophrenia: A replication study across two cultural backgrounds
Katja Koelkebeck,Udo Dannlowski,Patricia Ohrmann,Thomas Suslow,Toshiya Murai,Jochen Bauer,Anya Pedersen,Noriko Matsukawa,Shuraku Son,Theresa Haidl,Jun Miyata +10 more
TL;DR: The investigation of clinical characteristics revealed the strongest effects for chlorpromazine equivalents on GM volume reductions primarily in the Japanese sample, indicating GM may be affected differently at the two sites in patients with schizophrenia.
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Effects of psychotropic drugs on brain plasticity in humans.
TL;DR: The evidence for neuroplastic effects of psychotropic drugs in humans is focused on, despite the fact that most of the data are derived from animals and that volumetric studies in humans can only indicate structural plasticity and not necessarily functional plasticity.
Journal ArticleDOI
Impact on the Onset of Psychosis of a Polygenic Schizophrenia-Related Risk Score and Changes in White Matter Volume.
Fabienne Harrisberger,Renata Smieskova,Tobias Egli,Andor E. Simon,Anita Riecher-Rössler,Paolo Fusar-Poli,Andreas Papassotiropoulos,Stefan Borgwardt +7 more
TL;DR: It is suggested that at-risk mental state patients with a transition and first-episode psychosis patients have a higher genetic risk for schizophrenia than at- risk mental state Patients with no transition to psychosis; this risk was associated with psychopathological symptoms.
Dissertation
A Neuroimaging Perspective of Schizotypy
TL;DR: The overall aim of the current thesis was to investigate schizotypy using multiple behavioural and neuroimaging methods within the same sample of participants, in order to build a more comprehensive profile of a nonclinical individual with schizotypesal personality.
Journal ArticleDOI
The Controversy Over Antidepressant Drugs in an Era of Evidence-Based Practice
Jill Littrell,Jeffrey R. Lacasse +1 more
TL;DR: Information on the efficacy of antidepressants for both the short and long term is presented, which covers adverse effects and withdrawal symptoms.
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