BRAIN MORPHOLOGY IN FIRST-EPISODE SCHIZOPHRENIA

Objective: Neuroimaging studies have provided robust evidence that sch izophrenia is associated with structural brain abnormalities. However, the underlying pathophysiology of these changes is still unknown. By evaluating brain morphology early in the course of illness, confoundin g effects of treatment and duration of illness are minimized. The goal of this study was to evaluate brain structure in patients early in th e course of schizophrenia who had received no or minimal neuroleptics. Method: Magnetic resonance imaging was used to evaluate 12 male avid 12 female patients experiencing their first episode of schizophrenia ( mean duration of psychotic episode=14 weeks) and 12 male and 12 female normal volunteers equivalent in age, height, and parents' socioeconom ic status. A totally automated method was used to analyze scans, yield ing volumes of brain tissue and CSF, divided into lobes. Results: The patient group had significantly more total CSF than the comparison sub jects. This was accounted for by higher levels of intersulcal CSF as w ell as ventricular CSF. There were no differences in total volume of b rain tissue between the two groups, but patients had a significant reg ionally specific decrement in frontal lobe tissue compared with the no rmal subjects. Conclusions: These findings indicate that structural br ain abnormalities are present very early in schizophrenia and may not be due to factors such as treatment or chronicity of illness. Rather, since the abnormalities are present near the onset of the illness, a n eurodevelopmental mechanism may be suggested.