After a first psychotic episode, patients who were treated with an atypical antipsychotic medication had less change in brain volume compared with patients treated with a conventional antipsychotic medication, according to an article in the April issue of Archives of General Psychiatry.
Structural brain abnormalities, such as reductions in gray matter volume, have been consistently described in patients with schizophrenia, according to background information in the article. The current study was designed to test whether patients treated with an atypical antipsychotic medication (olanzapine) would have less reduction in gray matter volume than patients treated with a conventional antipsychotic medication (haloperidol), and whether these changes are associated with changes in disturbed thinking and general mental functioning.
Jeffrey A. Lieberman, M.D., of the University of North Carolina Medical School, Chapel Hill, at the time of the study, and colleagues studied 161 patients who were randomly assigned treatment with either haloperidol or olanzapine at the time of a first psychotic episode (baseline). Patients underwent neurocognitive testing and magnetic resonance imaging (MRI) assessments at baseline, and then at 12, 24, 52 and 104 weeks of treatment in a five-year longitudinal study conducted at 14 academic medical centers. A matched sample of 58 healthy volunteers underwent MRI and were compared on brain volume measures.
"The principle new finding of this study is the significant difference in the course and magnitude of these changes between patients treated with haloperidol, a conventional antipsychotic, and olanzapine, an atypical antipsychotic," the authors report. "Specifically, olanzapine was associated with less such change in brain volume during and in the aftermath of the first psychotic episode. These differences in volume change were highlighted by the comparison with healthy volunteers, which showed no significant reductions in gray matter volume and a trajectory similar to that of the olanzapine group."