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Antipsychotics and structural brain changes: could treatment adherence explain the discrepant findings?
1Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Tygerberg Campus, Cape Town 8000, South Africa.
Therapeutic Advances in Psychopharmacology
|September 13, 2023
Summary
Antipsychotic treatment may increase basal ganglia and white matter volumes in schizophrenia patients. However, relapse and poor medication adherence can lead to brain volume reductions, worsening illness progression.
Area of Science:
- Neuroscience
- Psychiatry
- Radiology
Background:
- Schizophrenia is characterized by progressive structural brain changes.
- These changes are associated with illness progression and antipsychotic treatment exposure.
Purpose of the Study:
- To review longitudinal changes in brain structure in schizophrenia.
- To assess the roles of illness, antipsychotic treatment, adherence, and relapse in these changes.
Main Methods:
- Narrative review of literature on longitudinal brain structural changes in schizophrenia.
- Focus on cortex, basal ganglia, and white matter changes.
- Inclusion of studies on medication non-adherence, relapse, and long-acting injectable antipsychotics.
Main Results:
- Antipsychotic treatment is associated with increased basal ganglia and white matter volumes.
- Relapse episodes correlate with illness progression and brain volume reduction.
- Medication adherence may mitigate brain volume loss and improve treatment response.
Conclusions:
- Temporal brain changes in schizophrenia are influenced by both treatment and illness factors.
- Relapse and non-adherence are critical factors in disease progression.
- Improving adherence through long-acting injectables and psychosocial interventions may protect against brain changes.
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