Brain volume declines with antipsychotic use
THE largest and longest study linking the use of antipsychotics to the loss of brain volume has Australian experts divided over the impact of early treatment initiation.
The Iowa Longitudinal Study found the use of antipsychotics was correlated with smaller brain volume after controlling for illness severity, duration of follow-up and substance misuse.
The prospective study, which followed 211 patients with schizophrenia for a median seven years, found higher doses of antipsychotics were associated with smaller brain volume on MRI.
Professor Louise Newman, developmental psychiatrist at Monash University, said the study should flag the need for caution when initiating antipsychotics.
“It suggests very careful consideration of antipsychotic use before we have clearly established symptoms [in individuals],” she said.
The publication of the Iowa study coincides with a British Journal of Psychiatry editorial by Dr Joanna Moncrieff, co-chair of the UK’s Critical Psychiatry Network. She cites mounting evidence that antipsychotics are linked to brain volume reduction, suggesting early use in young people is not justified.
But Professor Patrick McGorry, executive director of Australia’s Orygen Youth Health, said there was no consensus on the clinical significance of brain volume changes. “It would be very destructive to say that just because the brain issue is not clear, young people shouldn’t get any help,” he said.
Professor David Le Couteur, president of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists, said the relevant clinical outcome was long-term cognitive effects.
“[Let’s] see whether these changes in brain volume, which are just a surrogate marker, in fact pan out to have an impact clinically,” he said.
Arch Gen Psychiatry 2011; 68:128-37; B J Psychiatry 2011; 198:85-87
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