title: Greater clinical and cognitive improvement with clozapine and risperidone associated with a thinner cortex at baseline in first-episode schizophrenia.
abstract: Cortical thickness may be useful as a treatment response predictor in first-episode (FE) patients with schizophrenia, although this possibility has been scarcely assessed. In this study we assessed the possible relation between cortical thickness in regions of interest selected because of previously reported structural alterations in schizophrenia and clinical and cognitive changes after two years of treatment with risperidone or clozapine in 31 neuroleptic-naïve FE patients with schizophrenia (16 of them treated with clozapine and 15 with risperidone). Using the last-observation-carried-forward (LOCF), a larger improvement in positive, negative and total symptoms was predicted by the amount of baseline cortical thinning in the right prefrontal cortex (pars orbitalis). After two years of treatment, cognitive status was reassessed in the 17 patients (11 on clozapine) who had not dropped out. Working memory improvement after reassessment was associated with a greater baseline cortical thinning in the left prefrontal cortex (pars orbitalis), and verbal memory improvement with a greater baseline cortical thinning in the left pars triangularis. Significant but weak cortical thickness decrease from baseline to follow-up was observed in patients in comparison to controls (left pars triangularis and opercularis, and left caudal middle frontal areas). These results may support a positive predictive role for cortical thinning in the frontal region with regard to clinical and cognitive improvement with clozapine and risperidone in FE patients with schizophrenia.
authors.affiliation: Department of Psychiatry, Clinical University Hospital of Valladolid, University of Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. Electronic address: vmolina@med.uva.es.
authors.forename: Vicente
authors.initials: V
authors.lastname: Molina
authors.affiliation: Department of Psychiatry, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Taboada
authors.affiliation: Department of Psychiatry, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Aragüés
authors.affiliation: University Rey Juan Carlos, Medical Imaging Laboratory, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Hernández
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz-Fuentenebro
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000187:drug effects; D009929:Organ Size / Q000187:drug effects; D017397:Prefrontal Cortex / Q000187:drug effects / Q000473:pathology*; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D013067:Speech Perception / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D018967:Risperidone
keywords: Clozapine; Cognitive improvement; Cortical thickness; First-episode schizophrenia; Response prediction; Risperidone