ASSOCIATION BETWEEN REGIONAL BRAIN VOLUMES AND CLOZAPINE RESPONSE IN SCHIZOPHRENIA

Background: Clozapine has shown considerable therapeutic promise in th e treatment of schizophrenia however, the clinical risk; and initial h igh treatment costs associated with its administration motivate the se arch to identify patients who Will best respond. Neuroimaging studies have suggested that prefrontal sulcal prominence may be a predictor of nonresponsiveness, Methods: We used magnetic resonance imaging (MRI) to test whether volumes in any cortical regions of the brain were asso ciated with symptom improvement with clozapine treatment. The 21 schiz ophrenic men, studied were clinically evaluated during treatment with typical neuroleptics (baseline) and after a mean of 6.2 months treatme nt with clozapine (final dose 300-900, median = 562 mg/ day). At least a 20% improvement on total Brief Psychiatric Rating Scale (BPRS) was seen in 47.6% of the schizophrenics. Clinical improvement was regresse d on baseline differences in clinical severity, and the residual score s were related to MRI values, Results: Patients with larger anterior s uperior temporal lobe cerebrospinal fluid volumes (primarily sylvian f issure ) showed greater improvement on total BPRS and witdrawal/retard ation symptoms. Conclusions: Even schizophrenics with significant brai n dysmorphology can have a positive clinical response to clozapine. (C ) 1998 Society of Biological Psychiatry.