Abstract
The findings about the progressive brain changes in schizophrenia are controversial, and the potential confounding effect of antipsychotics on brain structure is still under debate. The goal of the current article was to review the existing longitudinal neuroimaging studies addressing the impact of antipsychotic drug treatment on brain changes in schizophrenia. A comprehensive search of PubMed was performed using combinations of key terms distributed into four blocks: “MRI”, “longitudinal”, “schizophrenia” and “antipsychotic”. Studies were considered to be eligible for the review if they were original articles. Studies that examined only changes in brain density were excluded. A total of 41 MRI studies were identified and reviewed. Longitudinal MRI studies did not provide a consistent notion of the effects of antipsychotic treatment on the pattern of brain changes over time in schizophrenia. Overall, most of the included articles did not find a linear relationship between the degree of exposure and progressive brain changes. Further short- and longterm studies are warranted to a better understanding of the influence of antipsychotics in brain structural changes in schizophrenia and also to verify whether first and second generation antipsychotics may differentially affect brain morphometry.
Highlights
Schizophrenia is a common chronic and disabling brain disorder
We systematically reviewed the literature to identify journal articles reporting antipsychotic effects on brain morphometry detected with neuroimaging techniques
We identified 41 longitudinal studies that satisfied the inclusion criteria (Table 1)
Summary
Schizophrenia is a common chronic and disabling brain disorder. The nature of the disease process remains obscure. “Imaging evidence indicates the consistent association between brain structural abnormalities and schizophrenia” [1]. These brain alterations are already present prior to the development of the disease [2, 3]. The pattern of brain changes over time is still under debate, a recent metaanalytic study suggests that these brain alterations may progress over time [4]. “Progressive brain changes could be associated with neurodegenerative or neurotoxic processes” [5], “attributed to a plastic adaptation of the brain to the environment” [6], possible neurotoxic effects of hyperdopaminergia as well as interactions with the glutamatergic system [7], oxidative stress [8], and related to exposure to pharmacological treatment, as antipsychotic drugs [9]
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