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White-matter microstructure in previously drug-naive patients with schizophrenia after 6 weeks of treatment
1Mental Health Centre and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
It is not clear whether the progressive changes in brain microstructural deficits documented in previous longitudinal magnetic resonance imaging (MRI) studies might be due to the disease process or to other factors such as medication. It is important to explore the longitudinal alterations in white-matter (WM) microstructure in antipsychotic-naive patients with first-episode schizophrenia during the very early phase of treatment when relatively 'free' from chronicity.
Method:
Thirty-five patients with first-episode schizophrenia and 22 healthy volunteers were recruited. High-resolution diffusion tensor imaging (DTI) was obtained from participants at baseline and after 6 weeks of treatment. A 'difference map' for each individual was calculated from the 6-week follow-up fractional anisotropy (FA) of DTI minus the baseline FA. Differences in Positive and Negative Syndrome Scale (PANSS) scores and Global Assessment of Functioning (GAF) scores between baseline and 6 weeks were also evaluated and expressed as a 6-week/baseline ratio.
Results:
Compared to healthy controls, there was a significant decrease in absolute FA of WM around the bilateral anterior cingulate gyrus and the right anterior corona radiata of the frontal lobe in first-episode drug-naive patients with schizophrenia following 6 weeks of treatment. Clinical symptoms improved during this period but the change in FA did not correlate with the changes in clinical symptoms or the dose of antipsychotic medication.
Conclusions:
During the early phase of treatment, there is an acute reduction in WM FA that may be due to the effects of antipsychotic medications. However, it is not possible to entirely exclude the effects of underlying progression of illness.
Insights
Early treatment with antipsychotics in schizophrenia patients shows a reduction in white matter integrity, possibly due to medication effects rather than illness progression. Further research is needed to clarify the exact cause of these microstructural changes.
Area of Science:
- Neuroimaging
- Psychiatry
- Neuroscience
Background:
- Longitudinal magnetic resonance imaging (MRI) studies show progressive brain microstructural deficits in schizophrenia.
- Distinguishing between disease progression and medication effects on white matter (WM) integrity is crucial.
- Investigating WM microstructure in antipsychotic-naive, first-episode schizophrenia patients early in treatment is important.
Purpose of the Study:
- To examine longitudinal changes in white-matter (WM) microstructure in antipsychotic-naive patients with first-episode schizophrenia.
- To assess the impact of early treatment on WM integrity using diffusion tensor imaging (DTI).
Main Methods:
- Recruited 35 first-episode schizophrenia patients (antipsychotic-naive) and 22 healthy controls.
- Acquired high-resolution diffusion tensor imaging (DTI) at baseline and 6 weeks.
- Calculated fractional anisotropy (FA) difference maps and assessed clinical symptom changes (PANSS, GAF).
Main Results:
- A significant decrease in WM fractional anisotropy (FA) was observed around the bilateral anterior cingulate gyrus and right anterior corona radiata in patients.
- WM FA reduction occurred despite clinical symptom improvement during the 6-week treatment period.
- No correlation was found between FA changes and clinical symptom improvement or antipsychotic medication dosage.
Conclusions:
- Early treatment in first-episode schizophrenia is associated with an acute reduction in white matter fractional anisotropy (WM FA).
- This reduction may be attributed to the effects of antipsychotic medications.
- The possibility of underlying illness progression contributing to WM changes cannot be entirely ruled out.
