title: A systematic review and meta-analysis of the effects of antipsychotic medications on regional cerebral blood flow (rCBF) in schizophrenia: association with response to treatment.
abstract: Evaluating the short- and long-term effects of antipsychotics on brain physiology is a key factor in advancing our understanding of neurophysiological changes in psychosis and improving prediction of treatment response. Understanding the nature of such changes is crucial to the interpretation of neuroimaging findings in patients with schizophrenia and psychoses in general. This review has systematically appraised existing evidence on resting cerebral blood flow (rCBF) in schizophrenia, before and after antipsychotic treatment, relating the findings to symptom severity. The review shows that antipsychotics exert regional effects on rCBF, particularly in frontal and basal ganglia regions, and that different antipsychotic generations have differential effects on rCBF. These findings are supported by an exploratory meta-analysis of a subset of studies. The review also highlights the relative lack of studies that use a priori definitions of treatment response, which is an important step in identifying testable hypotheses and ensuring clinical relevance of remission criteria. Finally, the review highlights important considerations for future psychopharmacological studies investigating the potential for rCBF to predict symptomatic improvement, which could inform the management of treatment in schizophrenia.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK. Electronic address: rhianna.goozee@kcl.ac.uk.
authors.forename: Rhianna
authors.initials: R
authors.lastname: Goozée
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK.
authors.forename: Rowena
authors.initials: R
authors.lastname: Handley
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kempton
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK; NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, London, UK.
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001921:Brain / Q000098:blood supply* / Q000187:drug effects / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D011237:Predictive Value of Tests; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic; Neuroimaging; Neurophysiology; Psychosis; Resting cerebral blood flow (rCBF); Schizophrenia; Treatment response