A FOLLOW-UP MAGNETIC-RESONANCE-IMAGING STUDY OF SCHIZOPHRENIA - RELATIONSHIP OF NEUROANATOMICAL CHANGES TO CLINICAL AND NEUROBEHAVIORAL MEASURES

Background: Cross-sectional neuroanatomical studies have reported abno rmalities in schizophrenia that relate to disease variables. Longitudi nal neuroimaging investigations that integrate anatomical, clinical, a nd neurobehavioral measures may help clarify the pathogenesis of schiz ophrenia. Methods: Magnetic resonance brain imaging and neurobehaviora l studies were conducted at baseline and after 30.63 +/- 12.92 months (mean +/- SD) in 40 patients with schizophrenia (23 men and 17 women) and 17 healthy controls (13 men and 4 women). The schizophrenia group included 20 first-episode and 20 previously treated subjects. Volumes of whole-brain, cerebrospinal fluid, and frontal and temporal lobes we re measured. The severity of negative and positive symptoms was assess ed, medications were monitored, and neurobehavioral functioning in 8 d omains was evaluated. Results: Both first-episode and previously treat ed patients had smaller brains and frontal and temporal lobes than con trols at intake. Longitudinally, reduction in frontal lobe volume was found only in patients, whereas temporal lobe reduction was also seen in controls. The association between volume reduction and symptom chan ges differed between patient groups, but volume reduction was associat ed with decline in some neurobehavioral functions in both groups. Expl oratory analysis suggested that neuroleptic dose is correlated with ch anges in all 3 domains. Conclusions: The existence of neuroanatomical and neurobehavioral abnormalities in patients with first episode schiz ophrenia indicates that the brain dysfunction occurred before clinical presentation. However, there is also evidence of progression, in whic h anatomical changes may affect some clinical and neurobehavioral feat ures of the illness in some patients.