Structural brain changes associated with antipsychotic treatment in schizophrenia as revealed by voxel-based morphometric MRI: an activation likelihood estimation meta-analysis

Author(s)

Torres, Ulysses S. ^{[1, 2, 3]} ; Portela-Oliveira, Eduardo ^[4] ; Borgwardt, Stefan ^{[5, 6]} ; Busatto, Geraldo F. ^{[1, 2, 3]}

Affiliation

^[1] Univ Sao Paulo, Sch Med, Inst Radiol INRAD, Postgrad Program Radiol, BR-05403010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Inst Psychiat, Lab Neuroimaging Psychiat LIM 21, Ctr Med Nucl, BR-05403010 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Ctr Interdisciplinary Res Appl Neurosci NAPNA, BR-05403010 Sao Paulo - Brazil

^[4] Hosp Base, Sao Jose do Rio Preto Med Sch, Dept Radiol, Sao Paulo - Brazil

^[5] Univ Basel, Dept Psychiat, Basel - Switzerland

^[6] Kings Coll London, Inst Psychiat, Dept Psychosis Studies, London WC2R 2LS - England

• Document type: Journal article
• Source: BMC Psychiatry; v. 13, DEC 20 2013.
• Web of Science Citations: 34

Abstract

Background: The results of multiple studies on the association between antipsychotic use and structural brain changes in schizophrenia have been assessed only in qualitative literature reviews to date. We aimed to perform a meta-analysis of voxel-based morphometry (VBM) studies on this association to quantitatively synthesize the findings of these studies. Methods: A systematic computerized literature search was carried out through MEDLINE/PubMed, EMBASE, ISI Web of Science, SCOPUS and PsycINFO databases aiming to identify all VBM studies addressing this question and meeting predetermined inclusion criteria. All studies reporting coordinates representing foci of structural brain changes associated with antipsychotic use were meta-analyzed by using the activation likelihood estimation technique, currently the most sophisticated and best-validated tool for voxel-wise meta-analysis of neuroimaging studies. Results: Ten studies (five cross-sectional and five longitudinal) met the inclusion criteria and comprised a total of 548 individuals (298 patients on antipsychotic drugs and 250 controls). Depending on the methodologies of the selected studies, the control groups included healthy subjects, drug-free patients, or the same patients evaluated repeatedly in longitudinal comparisons (i.e., serving as their own controls). A total of 102 foci associated with structural alterations were retrieved. The meta-analysis revealed seven clusters of areas with consistent structural brain changes in patients on antipsychotics compared to controls. The seven clusters included four areas of relative volumetric decrease in the left lateral temporal cortex {[}Brodmann area (BA) 20], left inferior frontal gyrus (BA 44), superior frontal gyrus extending to the left middle frontal gyrus (BA 6), and right rectal gyrus (BA 11), and three areas of relative volumetric increase in the left dorsal anterior cingulate cortex (BA 24), left ventral anterior cingulate cortex (BA 24) and right putamen. Conclusions: Our results identify the specific brain regions where possible associations between antipsychotic drug usage and structural brain changes in schizophrenia patients are more consistently reported. Additional longitudinal VBM studies including larger and more homogeneous samples of schizophrenia patients may be needed to further disentangle such alterations from those possibly linked to the intrinsic pathological progressive process in schizophrenia. (AU)

• FAPESP's process: 11/18631-1 - Study of brain structural alterations in patients with chronic and first-episode Schizophrenia through magnetic resonance imaging with voxel-based morphometry
• Grantee: Ulysses dos Santos Torres
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)