Early striatal hypertrophy in first-episode psychosis within 3 weeks of initiating antipsychotic drug treatment.
BACKGROUND
We and others have reported that patients experiencing their first episode of psychosis already have significant structural brain abnormalities. Antipsychotics seem to reverse subcortical volume deficits after months of treatment. However, the early impact of medication on brain morphology is not known.


METHODS
Forty-eight individuals in their first episode of psychosis underwent magnetic resonance imaging (MRI) brain scanning. Twenty-six were antipsychotic naive and 22 were newly treated with antipsychotic medication for a median period of 3 weeks. In each group, 80% of subjects received a diagnosis of schizophrenia. The two groups were balanced for age, sex, handedness, ethnicity, height, years of education, paternal socio-economic status (SES) and Positive and Negative Syndrome Scale (PANSS) score. Group differences in whole-brain grey matter were compared voxel by voxel, using Brain Activation and Morphological Mapping (BAMM) software. We also conducted testing of group differences with region-of-interest (ROI) measurements of the caudate nucleus.


RESULTS
Relative to the untreated group, those receiving antipsychotic medication for 3-4 weeks had significantly greater grey-matter volumes in the bilateral caudate and cingulate gyri, extending to the left medial frontal gyrus. ROI analysis confirmed that, in treated patients, the right and left caudate nuclei were significantly larger by 10% (p<0.039, two-tailed) and 9% (p<0.048, two-tailed) respectively.


CONCLUSIONS
Early striatal grey-matter enlargement may occur within the first 3-4 weeks of antipsychotic treatment. Possible reasons for putative striatal hypertrophy and its implications are discussed.
Chua
S E
SE
Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, S.A.R. China.
Deng
Y
Y
Chen
E Y H
EY
Law
C W
CW
Chiu
C P Y
CP
Cheung
C
C
Wong
J C H
JC
Lienenkaëmper
N
N
Cheung
V
V
Suckling
J
J
McAlonan
G M
GM
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002421:Caudate Nucleus / Q000187:drug effects / Q000473:pathology; D003342:Corpus Striatum / Q000187:drug effects* / Q000473:pathology; D004292:Dominance, Cerebral / Q000187:drug effects; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000473:pathology; D006179:Gyrus Cinguli / Q000187:drug effects / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D055815:Young Adult
D014150:Antipsychotic Agents