Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia.
Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia.
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DOI：
10.1001/archgenpsychiatry.2010.199
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发表时间：
2011-02
影响因子：
--
通讯作者：
Magnotta, Vincent
中科院分区：
文献类型：
--
作者：
Ho, Beng-Choon;Andreasen, Nancy C.;Ziebell, Steven;Pierson, Ronald;Magnotta, Vincent
精神分裂症患者进行性脑容量变化被认为主要是由疾病引起的。然而，最近的动物研究表明，抗精神病药物，主要用于治疗精神分裂症患者，也可能导致脑组织体积减少。由于抗精神病药物长期用于精神分裂症患者，并且在其他精神疾病中越来越广泛地使用，因此确定它们对人类大脑的长期影响是必要的。评估脑容量变化的4个潜在预测因素（疾病持续时间、抗精神病药物治疗、疾病严重程度和药物滥用）的相对贡献。脑容量变化的预测因子基于多个信息提供者进行前瞻性评估。数据来自爱荷华纵向研究。211名精神分裂症患者在发病后不久就接受了反复的神经成像，总共产生了674张高分辨率磁共振扫描。平均每位患者在7.2年（最长14年）内进行了3次扫描（≥2次，最多5次）。脑容量。在纵向随访中，抗精神病药物治疗反映了1991年至2009年的国家处方实践。随访时间越长，脑组织体积越小，脑脊液体积越大。在控制了其他3个预测因子的影响后，更强的抗精神病药物治疗与广泛性和特异性脑组织减少的指标相关。更多的抗精神病药物治疗与更小的灰质体积相关。在接受更多抗精神病药物治疗的患者中，白质体积的进行性减少最为明显。疾病严重程度与组织体积减少有相对适度的相关性，当调整其他变量的影响时，酒精/非法药物滥用没有显著的相关性。结合动物研究的数据，我们的研究表明抗精神病药物随着时间的推移对脑组织损失有微妙但可测量的影响，这表明对剂量和治疗持续时间以及标签外使用进行仔细的风险-收益审查的重要性。
Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain. To evaluate relative contributions of 4 potential predictors (illness duration, antipsychotic treatment, illness severity, and substance abuse) of brain volume change. Predictors of brain volume changes were assessed prospectively based on multiple informants. Data from the Iowa Longitudinal Study. Two hundred eleven patients with schizophrenia who underwent repeated neuroimaging beginning soon after illness onset, yielding a total of 674 high-resolution magnetic resonance scans. On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years). Brain volumes. During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted. Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.
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