Jørgensen Kjetil N, Nesvåg Ragnar, Gunleiksrud Sindre, Raballo Andrea, Jönsson Erik G, Agartz Ingrid
Department of Psychiatric Research, Diakonhjemmet Hospital, P.O. Box 85, 0319, Vinderen, Oslo, Norway.
NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Eur Arch Psychiatry Clin Neurosci. 2016 Aug;266(5):451-60. doi: 10.1007/s00406-015-0650-9. Epub 2015 Nov 7.
Antipsychotic medication may influence brain structure, but to what extent effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) differ is still not clear. Here we aimed to disentangle the effects of FGA and SGA on variation in volumes of subcortical structures in patients with long-term treated schizophrenia. Magnetic resonance images were obtained from 95 patients with schizophrenia and 106 healthy control subjects. Among the patients, 40 received only FGA and 42 received only SGA. FreeSurfer 5.3.0 was used to obtain volumes of 27 subcortical structures as well as total brain volume and estimated intracranial volume. Findings of reduced total brain volume, enlarged ventricular volume and reduced hippocampal volume bilaterally among patients were replicated, largely independent of medication class. In the basal ganglia, FGA users had larger putamen bilaterally and right caudate volume compared to healthy controls, and the right putamen was significantly larger than among SGA users. FGA and SGA users had similar and larger globus pallidus volumes compared to healthy controls. Post hoc analyses revealed that the difference between FGA and SGA could be attributed to smaller volumes in the clozapine users specifically. We therefore conclude that basal ganglia volume enlargements are not specific to FGA.
抗精神病药物可能会影响脑结构，但第一代抗精神病药物（FGAs）和第二代抗精神病药物（SGAs）的影响在何种程度上存在差异仍不清楚。在此，我们旨在厘清FGA和SGA对长期接受治疗的精神分裂症患者皮质下结构体积变化的影响。我们从95名精神分裂症患者和106名健康对照者那里获取了磁共振图像。在这些患者中，40名仅接受FGA治疗，42名仅接受SGA治疗。使用FreeSurfer 5.3.0获取27个皮质下结构的体积以及全脑体积和估计的颅内体积。患者全脑体积减小、双侧脑室体积增大和海马体积减小的结果得到了重复验证，且在很大程度上与药物类别无关。在基底神经节中，与健康对照者相比，使用FGA的患者双侧壳核和右侧尾状核体积更大，且右侧壳核明显大于使用SGA的患者。与健康对照者相比，使用FGA和SGA的患者苍白球体积相似且更大。事后分析显示，FGA和SGA之间的差异可能具体归因于使用氯氮平的患者体积较小。因此，我们得出结论，基底神经节体积增大并非FGA所特有。
