Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK.
Psychol Med. 2009 Nov;39(11):1763-77. doi: 10.1017/S0033291709005315. Epub 2009 Apr 2.
The potential effects of antipsychotic drugs on brain structure represent a key factor in understanding neuroanatomical changes in psychosis. This review addresses two issues: (1) do antipsychotic medications induce changes in total or regional human brain volumes and (2) do such effects depend on antipsychotic type?
A systematic review of studies reporting structural brain magnetic resonance imaging (MRI) measures: (1) directly in association with antipsychotic use; and (2) in patients receiving lifetime treatment with antipsychotics in comparison with drug-naive patients or healthy controls. We searched Medline and EMBASE databases using the medical subject heading terms: 'antipsychotics' AND 'brain' AND (MRI NOT functional). The search included studies published up to 31 January 2007. Wherever possible, we reported the effect size of the difference observed.
Thirty-three studies met our inclusion criteria. The results suggest that antipsychotics act regionally rather than globally on the brain. These volumetric changes are of a greater magnitude in association with typical than with atypical antipsychotic use. Indeed, there is evidence of a specific effect of antipsychotic type on the basal ganglia, with typicals specifically increasing the volume of these structures. Differential effects of antipsychotic type may also be present on the thalamus and the cortex, but data on these and other brain areas are more equivocal.
Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.
抗精神病药物对大脑结构的潜在影响是理解精神病患者神经解剖学变化的关键因素。本综述主要探讨两个问题：（1）抗精神病药物是否会引起人脑总体积或区域性体积的变化；（2）这种影响是否取决于抗精神病药物的类型？
系统检索了直接与抗精神病药物使用相关的结构磁共振成像（MRI）测量研究，以及（1）在接受抗精神病药物终生治疗的患者中，与未用药患者或健康对照者进行比较的研究。我们使用医学主题词“抗精神病药物”和“大脑”以及（非功能 MRI）在 Medline 和 EMBASE 数据库中进行检索。检索时间截至 2007 年 1 月 31 日。只要可能，我们就报告了观察到的差异的效应大小。
33 项研究符合纳入标准。结果表明，抗精神病药物对大脑的作用是区域性的，而不是全身性的。与使用典型抗精神病药物相比，使用非典型抗精神病药物时，这些体积变化的幅度更大。事实上，有证据表明抗精神病药物的类型对基底节有特定的影响，典型药物会特异性地增加这些结构的体积。抗精神病药物类型也可能对丘脑和皮质有不同的影响，但关于这些和其他脑区的数据则更不确定。
抗精神病药物治疗可能导致精神病患者观察到的大脑结构变化。未来的研究应考虑到这些潜在的影响，并使用足够的样本量，以改善对这些疾病的神经影像学发现的解释。
