Duration of untreated illness in schizophrenia is not associated with 5-year brain volume change

Boonstra, Geartsje; Cahn, Wiepke; Schnack, Hugo G.; Pol, Hilleke E. Hulshoff; Minderhoud, Tanca C.; Kahn, René S.; Haren, Neeltje E.M. van

doi:10.1016/j.schres.2011.07.018

Cited by 28 publications

(17 citation statements)

References 74 publications

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“…Some studies have shown a relationship between antipsychotic medication use and longitudinal brain volume change in schizophrenia (Cahn et al 2002;Lieberman et al 2005), although others have failed to clearly demonstrate an influence of antipsychotic medication on brain volume change (Kasai et al 2003;Nakamura et al 2007;Crespo-Facorro et al 2008). Boonstra et al (2011) hypothesized that DUP, DUI or DPP, through their effect on outcome, might be associated with change in brain volume in schizophrenia, although these authors did not observe any significant association when studying the relationship between DUI and brain volume change. The majority of the patients had been taking only atypical antipsychotics during the follow-up but had switched their initially prescribed medication several times during the 3-year follow-up period ).…”

Section: Discussionmentioning

confidence: 95%

“…The majority of the patients had been taking only atypical antipsychotics during the follow-up but had switched their initially prescribed medication several times during the 3-year follow-up period ). It has been suggested that the lack of association between those variables might be confounded by the use of antipsychotic medication (Boonstra et al 2011), given that it might cause either a decrease or an increase in brain volume change over time van Haren et al 2011). Differences in the methodology may also account for inconsistencies between investigations.…”

Section: Discussionmentioning

confidence: 99%

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Three-year longitudinal population-based volumetric MRI study in first-episode schizophrenia spectrum patients

Roiz-Santiáñez

Ayesa-Arriola

Tordesillas‐Gutiérrez

et al. 2013

Psychol. Med.

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Brain volume abnormalities that have been consistently observed at the onset of non-affective psychosis may not inevitably progress, at least over the first years of the illness. Taking together with clinical and cognitive longitudinal data, our findings, showing a lack of brain deterioration in a substantial number of individuals, suggest a less pessimistic and more reassuring perception of the illness.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Three-year longitudinal population-based volumetric MRI study in first-episode schizophrenia spectrum patients

Roiz-Santiáñez

Ayesa-Arriola

Tordesillas‐Gutiérrez

et al. 2013

Psychol. Med.

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show abstract

“…DUP has been found to be correlated with brain tissue volumes in some studies 8,83–86 but not in others. 44,45,87 Moreover, the direction of causality that underlies any association remains to be established because greater deficits in brain tissue volumes in those with greater DUP could reflect a more insidious onset of psychosis in those patients with greater longstanding deficits in brain tissue volumes. 84 Certainly, there has been no evidence to support the idea that longer DUP initiates a process of progressive and continuing brain change.…”

Section: The Search For Progressive Brain Changesmentioning

confidence: 99%

The Myth of Schizophrenia as a Progressive Brain Disease

Zipursky

Reilly

Murray

2012

Schizophrenia Bulletin

286

192

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Schizophrenia has historically been considered to be a deteriorating disease, a view reinforced by recent MRI findings of progressive brain tissue loss over the early years of illness. On the other hand, the notion that recovery from schizophrenia is possible is increasingly embraced by consumer and family groups. This review critically examines the evidence from longitudinal studies of (1) clinical outcomes, (2) MRI brain volumes, and (3) cognitive functioning. First, the evidence shows that although approximately 25% of people with schizophrenia have a poor long-term outcome, few of these show the incremental loss of function that is characteristic of neurodegenerative illnesses. Second, MRI studies demonstrate subtle developmental abnormalities at first onset of psychosis and then further decreases in brain tissue volumes; however, these latter decreases are explicable by the effects of antipsychotic medication, substance abuse, and other secondary factors. Third, while patients do show cognitive deficits compared with controls, cognitive functioning does not appear to deteriorate over time. The majority of people with schizophrenia have the potential to achieve long-term remission and functional recovery. The fact that some experience deterioration in functioning over time may reflect poor access, or adherence, to treatment, the effects of concurrent conditions, and social and financial impoverishment. Mental health professionals need to join with patients and their families in understanding that schizophrenia is not a malignant disease that inevitably deteriorates over time but rather one from which most people can achieve a substantial degree of recovery.

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“…Duration of untreated psychosis at the time of the first entry into treatment was found to be unassociated with 5-year volume changes (Boonstra et al, 2011) While DUP was related to the severity of psychosis at baseline, intervening treatment events (including relapses) accounted for more variance in cortical atrophy over five years than did DUP. In terms of the clinical significance of these brain changes, van Haren et al (2011) demonstrated that the patients with the greatest cortical thinning over the 5-year follow-up period also had the worst five year functional outcomes.…”

Section: The Goal Of This Reviewmentioning

confidence: 99%

Hospitalization and psychosis: Influences on the course of cognition and everyday functioning in people with schizophrenia

Harvey¹,

Loewenstein²,

Czaja³

2013

Neurobiology of Disease

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Long term institutional stay has decreased markedly in people with schizophrenia, although there are still many individuals with a history of long-term institutional stay residing in the community. In addition, although the average duration of acute admissions for schizophrenia is also decreasing, there are indications that psychotic episodes leading to acute admissions are associated with risk for cognitive and functional declines and changes in brain structure. In this paper we review the literature on cognitive changes with aging and institutionalization in schizophrenia, reaching the conclusion that the reasons for chronic institutionalization in the current include largely include severe psychosis and aggressive behavior. Thus, these factors may be the operative factor in the age-related declines in cognition and functioning reported in this population. We also present evidence to suggest that these changes may be similar to those seen in younger patients who experience repeated psychotic episodes leading to hospitalization. Our conclusion is that there is minimal evidence that hospitalization, long or short, leads to cognitive and functional changes, but rather that the reason for these hospitalizations may underlie cognitive and functional declines. Prevention of relapse and discovering treatments to assist patients with resistant symptoms may reduce the risk of cognitive and functional decline across the lifespan in people with schizophrenia.

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Duration of untreated illness in schizophrenia is not associated with 5-year brain volume change

Cited by 28 publications

References 74 publications

Three-year longitudinal population-based volumetric MRI study in first-episode schizophrenia spectrum patients

Three-year longitudinal population-based volumetric MRI study in first-episode schizophrenia spectrum patients

The Myth of Schizophrenia as a Progressive Brain Disease

Hospitalization and psychosis: Influences on the course of cognition and everyday functioning in people with schizophrenia

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