Structural brain abnormalities in first-episode psychosis: differences between affective psychoses and schizophrenia and relationship to clinical outcome.
OBJECTIVE
Several studies have described volumetric brain abnormalities in first-episode psychosis. The extent to which these differ in patients with schizophrenia and affective psychoses, or are related to subsequent clinical outcome, is unclear. We examined volumetric magnetic resonance imaging (MRI) abnormalities in young patients with a first episode of psychosis, and compared these volumetric abnormalities in patients with schizophrenia versus affective psychosis. We then assessed whether baseline MRI abnormalities in the entire sample predicted subsequent clinical outcome.


METHODS
A total of 28 adolescent patients with first-episode psychosis and 20 age-matched healthy volunteers were scanned using a 1.5 T scanner. MRI data were processed and analysed using voxel-based morphometry (VBM). We assessed clinical outcome three years after the initial scan.


RESULTS
Patients had smaller grey matter (GM) volumes than controls in frontal, insular, parietal, and cerebellar cortex. Patients with an affective psychosis had greater GM volume in the right posterior cingulate than both controls and patients with schizophrenia, but less GM volume in the left cerebellum and insula. In the sample as a whole, smaller right hippocampus GM volume was associated with poor clinical outcome at three-year follow-up.


CONCLUSIONS
Volumetric brain abnormalities are evident in young adults presenting with a first episode of both affective psychoses and schizophrenia, but there are also significant differences between these two patient groups. Clinical outcome after the first episode may be related to the severity of volumetric abnormalities at presentation.
Section of Neurobiology of Psychosis, NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Instituteof Psychiatry, Kings College London, London, UK. pcastro@unav.es
Pilar
P
de Castro-Manglano
Andrea
A
Mechelli
Cesar
C
Soutullo
Ignacio
I
Landecho
Jose Manuel
JM
Gimenez-Amaya
Felipe
F
Ortuño
Philip
P
McGuire
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis*; D055815:Young Adult