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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Cortical structural abnormalities in deficit versus nondeficit schizophrenia
Bernard A. Fischer,Bernard A. Fischer,William R. Keller,Celso Arango,Godfrey D. Pearlson,Robert P. McMahon,Walter Meyer,Alan N. Francis,Brian Kirkpatrick,William T. Carpenter,William T. Carpenter,Robert W. Buchanan +11 more
TL;DR: People with deficit schizophrenia are characterized by selective reductions in the prefrontal and temporal cortex, which were significantly smaller in the deficit versus the nondeficit group and normal control groups.
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Structural correlates of formal thought disorder in schizophrenia: An ultra-high field multivariate morphometry study.
Lena Palaniyappan,Jenaid Mahmood,Vijender Balain,Olivier Mougin,Penny A. Gowland,Peter F. Liddle +5 more
TL;DR: It is suggested that concomitant increase and decrease in grey matter occur in association with persistent negative thought disorder in clinically stable individuals with schizophrenia.
Journal ArticleDOI
Gray matter volume in schizophrenia and bipolar disorder with psychotic features
Cagri Yuksel,Julie M. McCarthy,Julie M. McCarthy,Ann K. Shinn,Ann K. Shinn,Danielle Pfaff,Justin T. Baker,Justin T. Baker,Stephan Heckers,Perry F. Renshaw,Dost Öngür,Dost Öngür +11 more
TL;DR: It is concluded that GM abnormality as measured by VBM analysis is less pronounced in psychotic BD compared to SZ, due to disease-specific factors or medications used more commonly in BD.
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Hippocampal Shape and Volume Changes with Antipsychotics in Early Stage Psychotic Illness
TL;DR: The results suggest that OLZ is associated with less longitudinal hippocampal surface deformation than HAL, however the hippocampal regions affected appear to be variable across patients, and surface analysis provides supplementary information to volumetry in detecting differential treatment effects of the hippocampus.
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Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: a machine-learning study.
Pavol Mikolas,Tomas Melicher,Antonin Skoch,Martin Matejka,Andrea Slovakova,Eduard Bakštein,Tomas Hajek,Filip Spaniel +7 more
TL;DR: The results support the role of the anterior insula/salience network in the pathophysiology of FES and show that seed-based functional connectivity maps can be utilized for diagnostic classification, even early in the course of schizophrenia.
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