Friday, September 11, 2015

Study Links Antipsychotics to Cortical Loss in Patients With Schizophrenia

Although it is well established that patients with schizophrenia have deficits in cortical gray matter, a meta-analysis published in Biological Psychiatry suggests that cumulative antipsychotic intake and the type of antipsychotic a patient with schizophrenia takes may influence the degree of gray matter loss over time.

Researchers from the University of Brescia School of Medicine in Italy led an retrospective study to determine if changes in cortical gray matter differ between patients with schizophrenia who take first-generation antipsychotics (FGAs) and those who take second-generation antipsychotics (SGAs). The researchers compiled data from 18 longitudinal magnetic resonance imaging studies—published from January 1, 1983, to March 31, 2014—including 1,155 patients with schizophrenia and 911 healthy controls.

The results showed that patients with schizophrenia showed significantly higher loss of total cortical gray matter volume over time than healthy controls, which was related to cumulative antipsychotic intake during the interval between imaging scans among the longitudinal studies. When comparing changes in cortical gray matter volumes in patients who were treated with FGAs with those who were treated with SGAs, the researchers found that participants who were administered FGAs had greater gray matter loss compared with those who took SGAs.

“On the whole, our results indicate that the putative contributory role of antipsychotic treatment in reducing the volume of cortical [gray matter] in schizophrenia cannot be generalized and appears to be less evident for SGAs, which seem to be associated with less loss of brain tissue,” the study authors wrote.

“Although this is a clinically meaningful result, many issues remain to be clarified: for instance, we still do not know whether the effects on the brain of antipsychotics vary as a function of age and stage of illness, or whether they may occur only when a certain threshold of exposure (daily dose or cumulative dose) is reached,” Antonio Vita, M.D., the first author on the study, said in a press release. “Clarification of these issues will have crucial importance in the clinical management of schizophrenia and will allow a better understanding of the mechanisms underlying the progression of structural brain abnormalities in the disease.”

For information about the risks and benefits of first- and second-generation antipsychotics, see the Psychiatric News article “First- and Second-Generation Antipsychotics Compared in Federal Agency Monograph.”

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