Antipsychotic Drug Effects on Brain Morphology in First-Episode Psychosis

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Abstract
Structural brain abnormalities have been extensively and consistently described in patients with schizophrenia.1-3 This pathomorphologic finding has been most commonly demonstrated as brain volume differences involving the ventricular system and cortical and subcortical gray matter regions in patients with schizophrenia compared with matched healthy volunteers. Longitudinal studies using high-resolution magnetic resonance imaging (MRI) to examine brain structure have found that MRI volume (hereafter referred to simply as “volume”) changes were progressive over time and related to the illness course and treatment outcome of patients with first-episode,4-9 chronic,10,11 and childhood-onset12,13 schizophrenia. These findings suggest that although schizophrenia may arise from a neurodevelopmental diathesis, its pathophysiology may be progressive after the onset of illness.14,15 They also raise the question of what role medication may have in mitigating schizophrenia-associated pathomorphologic changes or, alternatively, contributing to such changes. Preclinical studies have suggested the possibility of specific atypical antipsychotic drugs having pharmacologic properties that could produce neurotrophic, neurogenetic, or neuroprotective effects.16-22