Affective and nonaffective FEP patients show brain volume abnormalities
MedWire News: Patients with affective or nonaffective first-episode psychosis (FEP) show grey matter (GM) volume abnormalities compared with mentally healthy individuals, say researchers.
"Several studies have described volumetric brain abnormalities in FEP," write Pilar de Castro-Manglano (University of Navarra Clinic, Pamplona, Spain) and colleagues in the journal Bipolar Disorders.
But they add that "the extent to which these differ in patients with schizophrenia and affective psychoses, or are related to subsequent clinical outcome, is unclear."
The researchers therefore studied 28 adolescent FEP patients, aged an average of 18 years, and 20 age-matched mentally healthy controls.
All of the participants underwent volumetric magnetic resonance imaging (MRI) of the brain, and outcomes among the FEP patients were assessed after 3 years.
At follow up, 18 patients were diagnosed with affective psychosis (FEAP), including 14 patients with bipolar disorder and four with major depression (with psychotic features), and 10 were diagnosed with schizophrenia (FES). The diagnoses were made at follow-up because they are more reliable than those made at first presentation, the researchers explain.
They found that the FEP patient group as a whole had less GM volume in the frontal, parietal, and temporal lobes bilaterally, and in the right insula, cerebellum, and left thalamus compared with controls.
Patients with FEAP had less GM volume than controls in the left superior frontal gyrus and thalamus, the middle frontal gyri bilaterally, the right inferior frontal, postcentral and rectal gyri, and the right rolandic operculum, superior temporal gyrus, and cerebellum.
Patients with FES had less GM volume than controls in a similar set of regions to that seen when all FEP patients were compared with controls, with the addition of reductions in the right hippocampus.
Comparing the FEAP and FES groups directly, the researchers found a trend for the FEAP group to have less GM volume in the cerebellar vermis than the FES group.
Among the FEP patients, poor outcomes after 3 years, defined as continuous hospitalization or complete dependence on others, not being employed or studying, and no evidence of symptom remission, were significantly associated with reduced GM volume in the right hippocampus at baseline.
The researchers conclude: "Both adolescent-onset FEAP and adolescent-onset FES are associated with regional reductions in GM volume.
"There appear to be differences in the findings in these two patient groups, and in the sample as a whole, some of the volumetric abnormalities at baseline are associated with poor subsequent clinical outcome."
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By Mark Cowen