Abstract
Whether there are differential effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) on the brain is currently debated. Although some studies report that FGAs reduce grey matter more than SGAs, others do not, and research to date is limited by a focus on schizophrenia spectrum disorders. To address this limitation, this study investigated the effects of medication in patients being treated for first-episode schizophrenia or affective psychoses. Cortical thickness was compared between 52 first-episode psychosis patients separated into diagnostic (i.e. schizophrenia or affective psychosis) and medication (i.e. FGA and SGA) subgroups. Patients in each group were also compared to age- and sex-matched healthy controls (n = 28). A whole-brain cortical thickness interaction analysis of medication and diagnosis was then performed. Correlations between cortical thickness with antipsychotic dose and psychotic symptoms were examined. The effects of medication and diagnosis did not interact, suggesting independent effects. Compared with controls, diagnostic differences were found in frontal, parietal and temporal regions. Decreased thickness in FGA-treated versus SGA-treated groups was found in a large frontoparietal region (p < 0.001, corrected). Comparisons with healthy controls revealed decreased cortical thickness in the FGA group whereas the SGA group showed increases in addition to decreases. In FGA-treated patients cortical thinning was associated with higher negative symptoms whereas increased cortical thickness in the SGA-treated group was associated with lower positive symptoms. Our results suggest that FGA and SGA treatments have divergent effects on cortical thickness during the first episode of psychosis that are independent from changes due to illness.
Highlights
The choice of antipsychotic medication to treat a first episode of psychosis may affect medication adherence (Kahn et al 2008), symptom remission (Boter et al 2009) and patient outcomes (Menezes et al 2006)
Differences were found for dosage, with the second-generation antipsychotics (SGAs) group exhibiting a higher mean chlorpromazine equivalents (CPZ-Eq) The control group was matched for age and sex but had higher pre-morbid intelligence when compared to patients (Table 1)
Given the aim of the study to investigate differences between firstgeneration antipsychotics (FGAs) and SGA treatment, we focused on dose–response analysis of the clusters derived from the medication subgroup comparison
Summary
The choice of antipsychotic medication to treat a first episode of psychosis may affect medication adherence (Kahn et al 2008), symptom remission (Boter et al 2009) and patient outcomes (Menezes et al 2006). Chronic administration of both drug classes results in the same reductions of grey matter volume primarily of the frontal cortices in rats (Vernon et al 2011, 2014) and macaques (DorphPetersen et al 2005) These results are not replicated in human neuroimaging studies, which report differential effects in the first 6 to 12 months of treatment (Dazzan et al 2005; Garver et al 2005; Lieberman et al 2005; Girgis et al 2006; Thompson et al 2009; van Haren et al 2011).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
