8,10,11 Over the past, decade, there have been several short-term longitudinal studies. First, there are the studies beginning with an initial scan at the first episode (Table I) with varying results.10-14,16-26 In the studies from our own cohort, we found ventricular enlargement over time and whole hemispheric volume decreases over a 5- to 10-year period12-14 some independent investigative groups support, this as well (Table I),
while other studies support variable regional changes. However, whether these progressive changes are correlated with outcome, and are thus clinically Inhibitors,research,lifescience,medical relevant, remains unclear. Table I. Brain changes over time in first-episode schizophrenia. Inhibitors,research,lifescience,medical Interestingly, the studies of chronic than patients more consistently show ventricular increases over time, particularly in the more severely ill patients (Table II).27-38 This discrepancy could be explained if ventricular enlargement is secondary to underlying changes in the cortex that may begin earlier (Table III) 39-42 and, when they are extensive enough, are detected indirectly by progressive ventricular enlargement. Thus, ventricular enlargement, would more consistently be seen Inhibitors,research,lifescience,medical later in the course of the illness. We further hypothesize that the cortical brain regions most, affected are those
involved in language processing (ie, superior temporal gyrus and its connections) and that, the symptoms of schizophrenia develop on the basis that
these pathways are anomalous. Table II. Brain changes over time in chronic schizophrenia Table III. Studies of brain changes in prodromal patients. The questions that then remain are: Is the progression is an artifact of neuroleptic medication Inhibitors,research,lifescience,medical or some other physiological process unrelated to the illness pathology; or is it central to the process and begin Inhibitors,research,lifescience,medical prior to the clinical syndrome? Is the progression due to decreased myelination or a faulty pruning process during adolescence? Is the progression sufficient to explain all the brain changes seen in schizophrenia? Neuroleptics and progressive brain Carfilzomib change Lieberman and colleagues recently published a paper in the Archives in General. Psychiatry from a study comparing olanzapine with haloperidol in first-episode patients and comparing any brain changes to control changes over time.“13 They claim that, over a 2-year period, whole gray matter volume decreases significantly more in patients administered haloperidol than in controls or patients on olanzapine. However, the time of the follow-up MRI scans was short; there were many dropout subjects in this study and disproportionately among the groups; and some time periods were missing in one group entirely, thus hampering interpretation of these results. There have now been several other studies attempting to examine the question of neuroleptic effects on brain structure.