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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Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study.
Sidhant Chopra,Alex Fornito,Shona M. Francey,Brian O'Donoghue,Vanessa Cropley,Barnaby Nelson,Jessica Graham,Lara Baldwin,Steven Tahtalian,Hok Pan Yuen,Kelly Allott,Mario Alvarez-Jimenez,Susy Harrigan,Susy Harrigan,Kristina Sabaroedin,Christos Pantelis,Stephen J. Wood,Stephen J. Wood,Patrick D. McGorry +18 more
TL;DR: In this article, the authors found that a greater increase in pallidal grey matter volume over 3 months was associated with a greater reduction in symptom severity in patients with first-episode psychosis.
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Cortical thinning and caudate abnormalities in first episode psychosis and their association with clinical outcome
Cathy Scanlon,Heike Anderson-Schmidt,Liam Kilmartin,Shane McInerney,Joanne Kenney,John McFarland,Mairead Waldron,Srinath Ambati,Anna Fullard,Sam Logan,Brian Hallahan,Gareth J. Barker,Mark A. Elliott,Peter McCarthy,Dara M. Cannon,Colm McDonald +15 more
TL;DR: In this article, the structural integrity of grey matter in first-episode psychosis patients and assess whether these relate to patient clinical and functional outcome at 3-year follow-up was investigated.
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Brain Biomarkers of Vulnerability and Progression to Psychosis
TL;DR: A selective review of findings on risk prediction algorithms and potential mechanisms of onset in youth at clinical high-risk for psychosis, focusing principally on recent findings of the North American Prodrome Longitudinal Study (NAPLS).
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Neural correlates of delusion in bipolar depression.
Daniele Radaelli,Sara Poletti,Irene Gorni,Clara Locatelli,Enrico Smeraldi,Cristina Colombo,Francesco Benedetti +6 more
TL;DR: A reduction of gray matter volume in the dorsolateral prefrontal cortex and in the insula of delusional patients is found, which supports the hypothesis of abnormalities in salience and executive-control networks of delusion patients, which could be associated with an aberrant assignment of salience to the elements of one's own experience that is linked to delusion and psychotic symptoms.
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A volumetric MRI study of limbic, associative and sensorimotor striatal subregions in schizophrenia
James J. Levitt,James J. Levitt,Laura Rosow,Paul G. Nestor,Paula E. Pelavin,Talis M. Swisher,Robert W. McCarley,Martha E. Shenton,Martha E. Shenton +8 more
TL;DR: By parcellating the striatum into functional subregions, this work demonstrated significant positive correlations between the volume of the associative striatum and executive functioning in schizophrenia, adding further support to the importance of its role in the pathophysiology of schizophrenia.
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