Progressive Grey Matter Volume Changes in Patients with Schizophrenia over 6 Weeks of Antipsychotic Treatment and Their Relationship to Clinical Improvement

Abstract

Cross-sectional and longitudinal studies have identified widespread and progressive grey matter volume (GMV) reductions in schizophrenia, especially in the frontal lobe. In this study, we found a progressive GMV decrease in the rostral medial frontal cortex (rMFC, including the anterior cingulate cortex) in the patient group during a 6-week follow-up of 40 patients with schizophrenia and 31 healthy controls well-matched for age, gender, and education. The higher baseline GMV in the rMFC predicted better improvement in the positive score on the Positive and Negative Syndrome Scale (PANSS), and this might be related to the improved reality-monitoring. Besides, a higher baseline GMV in the posterior rMFC predicted better remission of general symptoms, and a lesser GMV reduction in this region was correlated with better remission of negative symptoms, probably associated with ameliorated self-referential processing and social cognition. Besides, a shorter disease course and higher educational level contributed to better improvement in the general psychopathological PANSS score, and a family history was negatively associated with improvement of the negative and total PANSS scores. These phenomena might be important for understanding the neuropathological mechanisms underlying the symptoms of schizophrenia and for making clinical decisions.

Antipsychotic Effects on Cortical Morphology in Schizophrenia and Bipolar Disorders

“…In this study, cortical thinning in medicated patients relative to unmedicated patients provided preliminary evidence indicating negative effects of mid- to long-term atypical antipsychotic treatment on cortical thickness. Our results were consistent with studies showing the contribution of atypical antipsychotics to cortical thinning in the frontal, temporal, and parietal lobes, which has been repeatedly reported ( Lesh et al, 2015 ; Zhang et al, 2018 ; Guo et al, 2019 ; Liu et al, 2020 ), and in the lateral orbitofrontal cortex ( Gjerde et al, 2018 ; Akudjedu et al, 2020 ). Mid- to long-term treatment effects may be negative as a result of cumulative pharmacologic effects ( Xiao et al, 2018 ).…”

Altered Peripheral Immune Profiles in First-Episode, Drug-Free Patients With Schizophrenia: Response to Antipsychotic Medications

“…Growth factors including HGF, EGF, G-CSF, and FGF-2 also possess neurotrophic and/or neurogenic properties of the nervous system ( 26 – 29 ). These results suggest a detrimental effect of antipsychotics in patients, and may partially explain the observed brain structural changes in patients with SCZ after antipsychotic treatment ( 30 ). Additionally, EGF and the pro-inflammatory cytokine MIP-1α were downregulated in patients with FEDF, and antipsychotic treatment further decreased their levels.…”

Reconsidering brain tissue changes as a mechanistic focus for early intervention in psychiatry

“…The presence of lower grey matter volume at the outset of the first episode, even before treatment initiation, has been shown to be predictive of poor subsequent response. [27][28][29] Additionally, patients who have a longer duration of active symptoms show more longitudinal volume loss than those who are in remission. [30][31][32] Despite these reports, a causal relationship between postonset tissue loss and subsequent cognitive, functional or symptomatic decompensation is weakened by several observations.…”