Sanna Huhtaniska1,2,3, Erika Jääskeläinen1,2,3,4, Noora Hirvonen5, Jukka Remes6, Graham K Murray7,8, Juha Veijola2,3,4, Matti Isohanni3,4, Jouko Miettunen1,2,3,4. 1. Center for Life Course Health Research, University of Oulu, Oulu, Finland. 2. Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. 3. Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland. 4. Department of Psychiatry, Oulu University Hospital, Oulu, Finland. 5. Information Studies, Faculty of Humanities, University of Oulu, Oulu, Finland. 6. Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland. 7. Department of Psychiatry, University of Cambridge, Cambridge, UK. 8. Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
Abstract
OBJECTIVE: The association between long-term antipsychotic treatment and changes in brain structure in schizophrenia is unclear. Our aim was to conduct a systematic review and a meta-analysis on long-term antipsychotic effects on brain structures in schizophrenia focusing on studies with at least 2 years of follow-up between MRI scans. DESIGN: Studies were systematically collected using 4 databases, and we also contacted authors for unpublished data. We calculated correlations between antipsychotic dose and/or type and brain volumetric changes and used random effect meta-analysis to study correlations by brain area. RESULTS: Thirty-one publications from 16 samples fulfilled our inclusion criteria. In meta-analysis, higher antipsychotic exposure associated statistically significantly with parietal lobe decrease (studies, n = 4; r = -.14, p = .013) and with basal ganglia increase (n = 4; r = .10, p = .044). Most of the reported correlations in the original studies were statistically nonsignificant. There were no clear differences between typical and atypical exposure and brain volume change. The studies were often small and highly heterogeneous in their methods and seldom focused on antipsychotic medication and brain changes as the main subject. CONCLUSIONS: Antipsychotic medication may associate with brain structure changes. More long-term follow-up studies taking into account illness severity measures are needed to make definitive conclusions.
OBJECTIVE: The association between long-term antipsychotic treatment and changes in brain structure in schizophrenia is unclear. Our aim was to conduct a systematic review and a meta-analysis on long-term antipsychotic effects on brain structures in schizophrenia focusing on studies with at least 2 years of follow-up between MRI scans. DESIGN: Studies were systematically collected using 4 databases, and we also contacted authors for unpublished data. We calculated correlations between antipsychotic dose and/or type and brain volumetric changes and used random effect meta-analysis to study correlations by brain area. RESULTS: Thirty-one publications from 16 samples fulfilled our inclusion criteria. In meta-analysis, higher antipsychotic exposure associated statistically significantly with parietal lobe decrease (studies, n = 4; r = -.14, p = .013) and with basal ganglia increase (n = 4; r = .10, p = .044). Most of the reported correlations in the original studies were statistically nonsignificant. There were no clear differences between typical and atypical exposure and brain volume change. The studies were often small and highly heterogeneous in their methods and seldom focused on antipsychotic medication and brain changes as the main subject. CONCLUSIONS: Antipsychotic medication may associate with brain structure changes. More long-term follow-up studies taking into account illness severity measures are needed to make definitive conclusions.
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