The effects of antipsychotics on brain structure: what have we learnt from structural imaging of schizophrenia? A commentary on ‘Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings’ by Navari & Dazzan ()

• Published in: Psychological medicine Vol. 39; no. 11; pp. 1781 - 1782
• Main Authors: Borgwardt, S. J., Smieskova, R., Fusar-Poli, P., Bendfeldt, K., Riecher-Rössler, A.
• Format: Journal Article
• Language: English
• Published: Cambridge Cambridge University Press 01.11.2009
• Subjects: Anatomy & physiology; Antipsychotic drugs; Antipsychotics; Brain; Brain structure; Cortex; Drug therapy; Genetic engineering; Imaging; Medical imaging; Psychotropic drugs; Schizophrenia
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291709006060

We read with great interest the article by Navari & Dazzan (2009) recently published in Psychological Medicine. These authors found that antipsychotic treatment may contribute to brain structural changes observed in psychosis and that antipsychotics act regionally rather than globally on the brain, with specific effects on different brain structures. In an own systematic review on the effects of antipsychotics on the brain (Smieskova et al. in press) we summarized findings from structural imaging studies of schizophrenia. We focused on studies investigating schizophrenia patients using neuroimaging techniques according to antipsychotic medication and studies considering the differences in medication either in various antipsychotic medications or over the time or in various groups of patients. Overall, we found that patients with schizophrenia receiving treatment with antipsychotics had reduced grey matter (GM) volume, particularly in frontal and temporal lobes. Medication with typical antipsychotics also leads to increased volume of the basal ganglia, while atypical antipsychotics reversed the effect after switching. Studies with typical antipsychotics have reported increased GM volume in cingulate cortex, in contrast to atypical antipsychotics with the excess more often seen in thalamus volume. Adapted from the source document.