A longitudinal study of hippocampal volume in first episode psychosis and chronic schizophrenia

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Abstract

Brain abnormalities have been identified in patients with schizophrenia, but what is unclear is whether these changes are progressive over the course of the disorder. In this longitudinal study, hippocampal and temporal lobe volumes were measured at two time points in 30 patients with first episode psychosis (mean follow-up interval=1.9 years, range 0.54–4.18 years) and 12 with chronic schizophrenia (mean follow-up interval=2.3 years, range 1.03–4.12 years) and compared to 26 comparison subjects (mean follow-up interval 2.2 years, range 0.86–4.18 years). Hippocampal, temporal lobe, whole-brain and intracranial volumes (ICV) were estimated from high-resolution magnetic resonance images. Only whole-brain volume showed significant loss over the follow-up interval in both patient groups. The rate of this volume loss was not different in the first episode group compared to the chronic group. There were no changes in either hippocampal or temporal lobe volumes. The negative findings for the hippocampus and temporal lobes may mean that the abnormalities in these regions are stable features of schizophrenia. Alternatively, the period before the onset of frank psychotic symptoms may be the point of greatest risk for progressive change.

Section snippets

Participants

Thirty first-episode inpatients (19 male, 11 female; mean age 21.8±3.6 years) were recruited from the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne Australia (McGorry et al., 1996). Study inclusion criteria were: (1) age at onset 16–30 years, (2) currently psychotic as reflected by the presence of at least one of; (a) delusions, (b) hallucinations, (c) disorder of thinking/speech, other than simple accelerations or retardation, (d) disorganised, bizarre or markedly

Results

There was no significant group difference in gender, handedness, premorbid IQ or time between scans, but there was a significant difference in age (F(2,65)=15.2, p<0.001). Post-hoc Games-Howell analyses indicated that the patients with chronic schizophrenia were significantly older than the other two groups. The two patient groups were not significantly different in their mean age at illness onset.

Table 1 shows the mean baseline intracranial, hippocampal and whole-brain volumes. There was no

Discussion

This study has not found any evidence for progressive loss of either hippocampal or temporal lobe volume in patients with chronic schizophrenia or first episode psychosis. However, we have been able to identify changes in whole-brain volume over the follow-up interval in both patient groups. Given the lack of change in the temporal lobes, these changes may be explained by volume reductions in other brain regions.

There are a number of studies that have investigated the possible progression of

Acknowledgements

The authors would like to thank Tabasum Hussein for assistance with the intracranial volume measurements. Dr Wood is currently supported as a National Health and Medical Research Council Research Officer and Dr Stuart as a NARSAD Young Investigator. This research was supported by the Mental Health Research Institute, the National Health and Medical Research Council (Nos: 970598 and 981112), the Australian Communications and Computing Institute, the Jack Brockhoff Foundation, the Ian Potter

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