Micro- and Macrostructural White Matter Integrity in Never-Treated and Currently Unmedicated Patients With Schizophrenia and Effects of Short-Term Antipsychotic Treatment
Micro- and Macrostructural White Matter Integrity in Never-Treated and Currently Unmedicated Patients With Schizophrenia and Effects of Short-Term Antipsychotic Treatment
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DOI：
10.1016/j.bpsc.2019.01.002
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发表时间：
2019-05-01
影响因子：
5.9
通讯作者：
Lahti, Adrienne Carol
中科院分区：
文献类型：
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作者：
Kraguljac, Nina Vanessa;Anthony, Thomas;Lahti, Adrienne Carol
背景：精神分裂症与进行性白质改变有关，但尚不清楚抗精神病药物是否与此有关。我们的目的是表征短期利培酮治疗对白质扩散指数的影响。方法：在这项前瞻性病例对照神经影像学研究中，我们招募了42名精神分裂症患者（30名从未接受治疗，12名目前未接受治疗）和42名匹配的健康对照受试者。患者接受为期6周的利培酮试验。通过弥散张量成像，我们评估了与对照组相比，未服药患者的微结构（分数各向异性、平均扩散率和径向扩散率）和宏观结构（径向纤维萎缩）白质完整性缺陷，以及抗精神病药物治疗前后患者白质完整性的变化（终点时利哌酮的平均剂量为3.73 +/- 1.72 mg）。结果：与对照组相比，患者左侧内侧颞叶白质（聚类范围：123体素；蒙特利尔神经学研究所峰坐标：x = -51, y = -44, z = -7; α < 0.05）的分数各向异性降低，延伸至扣带海马部分的梭状回/舌回白质（聚类范围：185体素；峰坐标：x = -27, y = -49, z = 2; α < .04）的平均弥散性增加。径向扩散率和宏观组织未见异常。治疗6周后，体素和全脑白质分析均未发现弥散指标有显著变化。结论：我们证明了在未接受药物治疗的早期精神分裂症患者中，在没有宏观结构损伤的情况下，微结构白质完整性异常。在我们的数据中，我们发现短期利培酮治疗后白质没有明显改变。
BACKGROUND: Schizophrenia is associated with progressive white matter changes, but it is unclear whether antipsychotic medications contribute to these. Our objective was to characterize effects of short-term treatment with risperidone on white matter diffusion indices.METHODS: We recruited 42 patients with schizophrenia (30 never treated and 12 currently untreated) and 42 matched healthy control subjects in this prospective case-control neuroimaging study. Patients received a 6-week trial of risperidone. Using diffusion tensor imaging, we assessed microstructural (fractional anisotropy, mean diffusivity, and radial diffusivity) and macrostructural (radial fiber trophy) white matter integrity deficits in unmedicated patients compared with control subjects and change in white matter integrity in patients before and after antipsychotic treatment (mean risperidone dose at end point was 3.73 +/- 1.72 mg).RESULTS: At baseline, fractional anisotropy was decreased in the left medial temporal white matter (cluster extent: 123 voxels; Montreal Neurological Institute peak coordinates: x = -51, y = -44, z = -7; alpha < .05), and mean diffusivity was increased in the fusiform/lingual gyrus white matter extending to the hippocampal part of the cingulum (cluster extent: 185 voxels; peak coordinates: x = -27, y = -49, z = 2; alpha < .04) in patients compared with control subjects. Radial diffusivity and macrostructure were not abnormal. None of the diffusion indices showed a significant change after 6 weeks of treatment with both voxelwise and whole-brain white matter analyses.CONCLUSIONS: We demonstrate microstructural white matter integrity abnormalities in the absence of macrostructural impairment in unmedicated patients with primarily early-stage schizophrenia. In our data, we found no significant white matter changes after short-term treatment with risperidone.