Brain volume changes in first-episode schizophrenia: a 1-year follow-up study.
BACKGROUND
Imaging studies of patients with schizophrenia have demonstrated that brain abnormalities are largely confined to decreases in gray matter volume and enlargement of the lateral and third ventricles. Global gray matter volume has been reported to progressively decrease in childhood-onset and chronic schizophrenia. Global gray matter volumes have not been examined longitudinally in patients with first-episode schizophrenia. One would expect global gray matter to decrease progressively, particularly in first-episode patients, because clinical deterioration is greatest in the early stages of the disease.


METHODS
Patients with first-episode schizophrenia who had taken antipsychotic medication for 0 to 16 weeks (n = 34) and matched healthy comparison subjects (n = 36) were included in the study. For all subjects, magnetic resonance imaging scans of the whole brain were obtained at inclusion and after 1 year (mean [SD], 12.7 [1.1] months). Outcome was measured 2 years after inclusion. To compare morphological changes over time between patients and healthy comparison subjects, multiple repeated-measures analyses of variance were conducted with intracranial volume as a covariate. Outcome and cumulative antipsychotic medication were related to changes in patients' brain volumes.


RESULTS
Total brain volume (-1.2%) and gray matter volume of the cerebrum (-2.9%) significantly decreased and lateral ventricle volume significantly increased (7.7%) in patients. The decrease in global gray matter volume significantly correlated with outcome and, independently of that, with higher cumulative dosage of antipsychotic medication.


CONCLUSIONS
The loss of global gray matter in schizophrenia is progressive, occurs at an early stage of the illness, and is related to the disease process and antipsychotic medication.
Cahn
Wiepke
W
Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. w.cahn@psych.azu.nl
Hulshoff Pol
Hilleke E
HE
Lems
Elleke B T E
EB
van Haren
Neeltje E M
NE
Schnack
Hugo G
HG
van der Linden
Jeroen A
JA
Schothorst
Patricia F
PF
van Engeland
Herman
H
Kahn
René S
RS
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D004292:Dominance, Cerebral / Q000502:physiology; D017352:Echo-Planar Imaging; D005260:Female; D005500:Follow-Up Studies; D005583:Fourier Analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012016:Reference Values; D012559:Schizophrenia / Q000188:drug therapy / Q000473:pathology*; D012565:Schizophrenic Psychology
D014150:Antipsychotic Agents