title: A multimodal analysis of antipsychotic effects on brain structure and function in first-episode schizophrenia.
abstract: OBJECTIVE
  Recent data suggest that treatment with antipsychotics is associated with reductions in cortical gray matter in patients with schizophrenia. These findings have led to concerns about the effect of antipsychotic treatment on brain structure and function; however, no studies to date have measured cortical function directly in individuals with schizophrenia and shown antipsychotic-related reductions of gray matter.
  
  
  OBJECTIVE
  To examine the effects of antipsychotics on brain structure and function in patients with first-episode schizophrenia, using cortical thickness measurements and administration of the AX version of the Continuous Performance Task (AX-CPT) during event-related functional magnetic resonance imaging.
  
  
  METHODS
  This case-control cross-sectional study was conducted at the Imaging Research Center of the University of California, Davis, from November 2004 through July 2012. Participants were recruited on admission into the Early Diagnosis and Preventive Treatment Clinic, an outpatient clinic specializing in first-episode psychosis. Patients with first-episode schizophrenia who received atypical antipsychotics (medicated patient group) (n = 23) and those who received no antipsychotics (unmedicated patient group) (n = 22) and healthy control participants (n = 37) underwent functional magnetic resonance imaging using a 1.5-T scanner.
  
  
  METHODS
  Behavioral performance was measured by trial accuracy, reaction time, and d'-context score. Voxelwise statistical parametric maps tested differences in functional activity during the AX-CPT, and vertexwise maps of cortical thickness tested differences in cortical thickness across the whole brain.
  
  
  RESULTS
  Significant cortical thinning was identified in the medicated patient group relative to the control group in prefrontal (mean reduction [MR], 0.27 mm; P < .001), temporal (MR, 0.34 mm; P = .02), parietal (MR, 0.21 mm; P = .001), and occipital (MR, 0.24 mm; P = .001) cortices. The unmedicated patient group showed no significant cortical thickness differences from the control group after clusterwise correction. The medicated patient group showed thinner cortex compared with the unmedicated patient group in the dorsolateral prefrontal cortex (DLPFC) (MR, 0.26 mm; P = .001) and temporal cortex (MR, 0.33 mm; P = .047). During the AX-CPT, both patient groups showed reduced DLPFC activity compared with the control group (P = .02 compared with the medicated group and P < .001 compared with the unmedicated group). However, the medicated patient group demonstrated higher DLPFC activation (P = .02) and better behavioral performance (P = .02) than the unmedicated patient group.
  
  
  CONCLUSIONS
  These findings highlight the complex relationship between antipsychotic treatment and the structural, functional, and behavioral deficits repeatedly identified in schizophrenia. Although short-term treatment with antipsychotics was associated with prefrontal cortical thinning, treatment was also associated with better cognitive control and increased prefrontal functional activity. This study adds important context to the growing literature on the effects of antipsychotics on the brain and suggests caution in interpreting neuroanatomical changes as being related to a potentially adverse effect on brain function.
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Tyler A
authors.initials: TA
authors.lastname: Lesh
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Costin
authors.initials: C
authors.lastname: Tanase
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Geib
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Tara A
authors.initials: TA
authors.lastname: Niendam
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Jong H
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Minzenberg
authors.affiliation: Department of Psychiatry, University of California, Davis.
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Ragland
authors.affiliation: Department of Psychiatry, University of California, Davis2MIND (Medical Investigation of Neurodevelopmental Disorders) Institute, University of California, Davis.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Solomon
authors.affiliation: Department of Psychiatry, University of California, Davis3Department of Psychology, University of California, Davis4Imaging Research Center, University of California, Davis.
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Carter
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000494:pharmacology*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents