Progressive brain changes in children and adolescents with first-episode psychosis.
BACKGROUND
Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses.


OBJECTIVE
To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up.


METHODS
Prospective, multicenter, naturalistic, 2-year follow-up study.


METHODS
Six child and adolescent psychiatric units in Spain.


METHODS
A total of 110 patients and 98 healthy controls were recruited between March 1, 2003, and November 31, 2005. Magnetic resonance imaging of the brain was performed for 61 patients with schizophrenia (n = 25), bipolar disorder (n = 16), or other psychoses (n = 20) and 70 controls (both at baseline and after 2 years of follow-up). Mean age at baseline was 15.5 years (patients) and 15.3 years (controls).


METHODS
The GM and cerebrospinal fluid (CSF) volumes in the total brain and frontal, parietal, and temporal lobes.


RESULTS
Compared with controls, patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up (left: -3.3 vs -0.6 cm(3), P = .004; right: -3.7 vs -0.8 cm(3), P = .005) and left frontal CSF volume increase (left: 6.7 vs 2.4 cm(3), P = .006). In addition to frontal volume, changes for total GM (-37.1 vs -14.5 cm(3), P = .001) and left parietal GM (-4.3 vs -2.2 cm(3), P = .04) were significantly different in schizophrenic patients compared with controls. No significant differences emerged for patients with bipolar disease. Greater left frontal GM volume loss was related to more weeks of hospitalization, whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia.


CONCLUSIONS
Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls. Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder. These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis.
Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain. carango@hggm.es
Celso
C
Arango
Marta
M
Rapado-Castro
Santiago
S
Reig
Josefina
J
Castro-Fornieles
Ana
A
González-Pinto
Soraya
S
Otero
Inmaculada
I
Baeza
Carmen
C
Moreno
Montserrat
M
Graell
Joost
J
Janssen
Mara
M
Parellada
Dolores
D
Moreno
Nuria
N
Bargalló
Manuel
M
Desco
D000293:Adolescent; D001714:Bipolar Disorder / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology*; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology*; D012559:Schizophrenia / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000473:pathology*; D012720:Severity of Illness Index; D013030:Spain