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First-episode psychosis (FEP) shows increased free-water (FW) in gray matter (GM) and white matter (WM). In schizophrenia spectrum disorder (SSD), FW decreases over time, while fractional anisotropy (FAt) remains stable.

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Area of Science:

  • Neuroimaging
  • Psychiatry
  • Diffusion MRI

Background:

  • Previous studies indicate altered free-water (FW) and fractional anisotropy (FAt) in psychosis.
  • Longitudinal changes and clinical significance of these diffusion MRI metrics in first-episode psychosis (FEP) are not well understood.
  • Investigating tissue-specific FW and FAt abnormalities is crucial for understanding psychosis progression.

Purpose of the Study:

  • To determine tissue-specific free-water (FW) and fractional anisotropy (FAt) abnormalities in first-episode psychosis (FEP).
  • To examine the longitudinal stability and clinical significance of these findings over two years.
  • To compare findings between schizophrenia spectrum disorder (SSD) and non-SSD within the FEP group.

Main Methods:

  • Multicenter Spanish study including 132 FEP and 108 healthy controls (HC).
  • Diffusion-weighted and structural MRI scans were acquired at baseline and after 2 years for a subset (45 FEP, 41 HC).
  • Voxel-wise and vertex-wise analyses were used to compare tissue-specific FW and FAt measurements between groups.

Main Results:

  • FEP subjects (SSD and non-SSD) exhibited higher baseline FW in temporal gray matter (GM) and overall GM.
  • Lower baseline FAt was observed in white matter (WM) tracts in FEP.
  • Schizophrenia spectrum disorder (SSD) showed higher baseline FW in WM and a significant decrease in GM FW over 2 years; FAt abnormalities were stable.

Conclusions:

  • Increased extracellular free-water (FW) is a consistent finding in first-episode psychosis (FEP).
  • In schizophrenia spectrum disorder (SSD), FW appears to decrease during the early course of the illness.
  • Fractional anisotropy (FAt) abnormalities in white matter (WM) are stable in the initial years of psychosis.