Structural Brain Changes in First-Episode Schizophrenia: A 4-5 Year Follow-Up Study Using MRI

Abstract

Background: The presence of progressive structural brain changes over the first years of disease in first-episode schizophrenia (FES) patients is still controversial. The supposed progression of brain abnormalities in these patients may be associated with outcome and with antipsychotic exposure. Methods: Longitudinal population-based study performed in São Paulo - Brazil. Longitudinal analysis of GM matter volume using SPM was performed in 32 FES and 34 controls 4-5 years after baseline. Outcome measures were assessed by clinical course of symptoms (DSM-IV) and by global functioning (GAF scores). Results: FES did not differ from controls regarding GM changes over time, but those that remained psychotic and had lower global functioning over the follow-up period had GM concentration reduction in the left insula and in the left superior temporal gyrus in comparison to controls. Medication status had no effect on GM volumetric changes. Conclusions: Our findings suggest that a poor outcome, with chronic symptoms and a poor global functioning over 4-5 years after the first episode of psychosis is associated with brain abnormalities progression in brain regions which showed GM reduction at baseline (Schaufelberger et al, 2007). These results suggest that the progressive hypothesis in schizophrenia is probably not valid to all subjects that suffer from this illness.