Available online 29 January 2024, 111790

Brain changes in schizophrenia are likely to progress through the course of illness

Younger age of onset and higher cumulative doses of antipsychotics may contribute to putative progressive structural brain changes in schizophrenia

Apart from age of onset, other characteristics of illness during the first episode of psychosis may not contribute to longitudinal gray matter changes seen in midlife

Exposure to antipsychotics as well as certain first-episode illness characteristics have been associated with greater gray matter (GM) deficits in the early phase of schizophrenia. Whether the first-episode illness characteristics affect the long-term progression of the structural brain changes remain unexplored. We therefore assessed the role of first-episode illness characteristics and life-time antipsychotic use in relation to long-term structural brain GM changes in schizophrenia. Individuals with schizophrenia (SZ, n=29) and non-psychotic controls (n=61) from the Northern Finland Birth Cohort 1966 underwent structural MRI at the ages of 34 (baseline) and 43 (follow-up) years. At follow-up, the average duration of illness was 19.8 years. Voxel-based morphometry was used to assess the effects of predictors on longitudinal GM changes in schizophrenia-relevant brain areas. Younger age of onset (AoO), higher cumulative antipsychotic dose and severity of symptoms were associated with greater GM deficits in the SZ group at follow-up. None of the first-episode illness characteristics were associated with longitudinal GM changes during 9-year follow-up period. We conclude that a younger AoO and high life-time antipsychotic use may contribute to progression of structural brain changes in schizophrenia. Apart from AoO, other first-episode illness characteristics may not contribute to longitudinal GM changes in midlife.

schizophrenia

brain

antipsychotics

symptoms

illness characteristics

age of onset

DUP

© 2024 The Authors. Published by Elsevier B.V.