Association of brain structural change with the heterogeneous course of schizophrenia from early childhood through five years subsequent to a first hospitalization

Fifty first-episode patients with schizophrenia were followed for 5 years s ubsequent to their first hospitalization. The course of illness was charted prospectively and premorbid childhood histories were obtained retrospectiv ely at the initial evaluation, and MRI scans were obtained initially and at each follow-up. Fifteen different life-time patterns of illness course eme rged, although none were specifically associated with structural brain chan ge. A deterioration in premorbid scores was positively correlated with larg er ventricular volume at the first hospitalization, and the larger the vent ricles, the less the subsequent change in ventricular size thereafter. An a nalysis to see whether initial hemispheric and ventricular size could predi ct different course types only revealed that patients with an acute onset a nd complete recovery had significantly smaller ventricles than all others. No differences emerged for initial hemispheric size. Thirty-four percent of patients individually showed some association of brain ventricular size an d 28% hemisphere volume reductions with fluctuation in psychotic symptoms. Paradoxically, most showed larger ventricles and smaller hemispheres to be associated with clinical improvement, rather than the predicted reverse. Th ese latter data question the notion that the structural brain changes seen over time in some patients are related to poor outcome, although small vent ricular size in those patients with acute onset may be predictive of recove ry. Thus, brain structural change is occurring early in the course of illne ss and may be a consequence of the process leading to resolution. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.