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
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Longer lithium exposure is associated with better white matter integrity in older adults with bipolar disorder
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Heritability of multivariate gray matter measures in schizophrenia.
Jessica A. Turner,Jessica A. Turner,Vince D. Calhoun,Vince D. Calhoun,Andrew M. Michael,Theo G.M. van Erp,Stefan Ehrlich,Stefan Ehrlich,Judith M. Segall,Randy L. Gollub,John G. Csernansky,Steven G. Potkin,Beng-Choon Ho,Juan R. Bustillo,S. Charles Schulz,Lei Wang +15 more
TL;DR: It is concluded that structural brain deficits in schizophrenia are replicable, and that SBM can extract unique familial and likely heritable components that may serve as endophenotypes for schizophrenia.
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Structural neuroimaging across early-stage psychosis: Aberrations in neurobiological trajectories and implications for the staging model
Cali F. Bartholomeusz,Vanessa Cropley,Cassandra Wannan,Maria A Di Biase,Patrick D. McGorry,Christos Pantelis +5 more
TL;DR: This review critically examines the structural neuroimaging evidence in psychotic illness, with a focus on longitudinal imaging across the first-episode psychosis and ultra-high-risk of psychosis illness stages, and highlights the advantages of longitudinal designs and the implications such studies have on clinical staging.
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