Summary

This longitudinal MRI study found that relapse in schizophrenia is associated with brain shrinkage, suggesting the importance of treatment with antipsychotics. However, intensity of treatment with antipsychotics is also associated with brain shrinkage, suggesting using the lowest dose possible. The authors note that changes in brain volume from either relapse or treatment are relatively small.

Design

• N=202, drawn from Iowa Longitudinal Study of first-episode schizophrenia.
• MRI scans obtained at regular intervals over an average of 7 years.
• Mean number of scans per patient = 3.

Results

• Relapse duration was related to significant decreases in brain volume. Total cerebral tissue loss associated with relapse duration is 1.55 cc/year, while frontal lobe loss is 0.99 cc/year.
• Number of relapses unrelated to brain measures.
• Treatment intensity also related to decreased brain volume. Total cerebral tissue loss associated with treatment intensity are based on dose-years in haloperidol equivalents. Example: total cerebral tissue loss is 0.56 cc/year in patients receiving 4 mg of haloperidol over one year.
• Effects of treatment on brain tissue loss are distributed diffusely, while effects of disease relapse are most strongly associated with frontal lobe tissue loss.
• Effects of both relapse and treatment on brain volume are relatively small.

Reference

Andreasen NC, Liu D, Ziebell S, Vora A, Ho BC. Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study. Am J Psychiatry. 2013 Jun;170(6):609-15.