Posted by SLS on November 20, 2009, at 23:48:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by morganator on November 20, 2009, at 23:05:06
Hi.
Thanks for the heads-up. I'll need to review your links more thoroughly.
> Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy?
Well, I'm not terribly happy to be taking a neuroleptic, but brain shrinkage is not one of the things that has concerned me. Believe it or not, I have some concern about developing tardive akathisia with Abilify.
Schizophrenia is a disease that demonstrates a progressive reduction in brain volume as time passes. Neuroleptics might actually reverse this process in certain brain structures. Also, the degree of tissue loss is positively associated with severity of symptoms and resistance to treatment, particularly in the putamen. It is no wonder that neuroleptic dosage is associated with decreased brain volume. These patients are bound to be treated with higher dosages in an effort to effect any kind of improvement.
I guess I should do some more research.
Thanks again.
- Scott
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Eur Neuropsychopharmacol. 2009 Dec;19(12):835-40. Epub 2009 Aug 29.
Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia.Tomelleri L, Jogia J, Perlini C, Bellani M, Ferro A, Rambaldelli G, Tansella M, Frangou S, Brambilla P; Neuroimaging Network of the ECNP networks initiative.
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Italy.
Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
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Schizophr Res. 2009 Mar;108(1-3):49-56. Epub 2009 Jan 25.
Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia.Takahashi T, Wood SJ, Soulsby B, McGorry PD, Tanino R, Suzuki M, Velakoulis D, Pantelis C.
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia. tsutomu@med.u-toyama.ac.jp
Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
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poster:SLS
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URL: http://www.dr-bob.org/babble/20091117/msgs/926401.html