Gray matter abnormalities associated with duration of untreated psychosis.
OBJECTIVE
A long duration of untreated psychosis (DUP) is associated with relatively poor clinical and social outcomes. In order to identify whether an anatomically mediated mechanism may give rise to poorer outcomes, it is important to identify whether a long DUP is associated with greater brain structural abnormalities.


METHODS
81 patients with first-episode psychosis (schizophrenia, affective, and other psychoses) were scanned using high resolution Magnetic Resonance Imaging. DUP was defined as the number of days between first onset of psychotic symptoms and first contact with mental health services. High-resolution MRI images and voxel-based methods of image analysis were used to investigate brain structure in these patients.


RESULTS
Longer DUP was associated with gray matter reductions in left middle and inferior temporal, left occipital and left fusiform cortices, and with gray matter excess of the left basal ganglia. All findings remained significant when co-varying for exposure to antipsychotic treatment.


CONCLUSIONS
Temporal gray matter reductions are more marked in patients with a long DUP. This could reflect a progressive pathological process that is active prior to treatment. Alternatively, these abnormalities could be associated with a more insidious onset of illness and a later presentation to services.
Lappin
Julia M
JM
Kings College London Institute of Psychiatry, PO63, Division of Psychological Medicine, King's College London, London SE5 8AF, United Kingdom. j.lappin@iop.kcl.ac.uk
Morgan
Kevin
K
Morgan
Craig
C
Hutchison
Gerard
G
Chitnis
Xavier
X
Suckling
John
J
Fearon
Paul
P
McGuire
Philip K
PK
Jones
Peter B
PB
Leff
Julian
J
Murray
Robin M
RM
Dazzan
Paola
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000002:abnormalities* / Q000473:pathology*; D001931:Brain Mapping; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011618:Psychotic Disorders / Q000145:classification / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors