In this posting, I am taking a break from writing about aesthetics to discuss another subject that is quite close to my heart. Although I hear voices only infrequently now (usually when I am in a hypnagogic state, just before sleep) I am still a member of a Hearing Voices network. The local ‘chapter head’ sent the following research synopsis to everyone on her mailing list.
Here is the link to the study online here
http://archpsyc.ama-assn.org/cgi/content/short/68/2/128
“Long-term Antipsychotic Treatment and Brain Volumes
A Longitudinal Study of First-Episode Schizophrenia
Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Ronald Pierson, MS; Vincent Magnotta, PhD
Arch Gen Psychiatry. 2011;68(2):128-137. doi:10.1001/archgenpsychiatry.2010.199
Context Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain.
Objective To evaluate relative contributions of 4 potential predictors (illness duration, antipsychotic treatment, illness severity, and substance abuse) of brain volume change.
Design Predictors of brain volume changes were assessed prospectively based on multiple informants.
Setting Data from the Iowa Longitudinal Study.
Patients Two hundred eleven patients with schizophrenia who underwent repeated neuroimaging beginning soon after illness onset, yielding a total of 674 high-resolution magnetic resonance scans. On average, each patient had 3 scans (2 and as many as 5) over 7.2 years (up to 14 years).
Main Outcome Measure Brain volumes.
Results During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.
Conclusions Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.
Author Affiliations: Departments of Psychiatry (Drs Ho and Andreasen and Messrs Ziebell and Pierson) and Radiology (Dr Magnotta), University of Iowa Carver College of Medicine, Iowa City.”
This article is, for me, deeply worrying. I have been on different sorts of antipsychotics for more than four years now and this study has forced me to consider (again) that I might be stupider now than I was when I was younger. A reduced frontal cortex and augmented ventricles might explain why I perform so poorly at my weekly pub-quiz. And why my last posting, while not being wrong, gives me the impression on re-reading it, of being somewhat dumb.
Anyway, this posting may provide a bridge to the next instalment, in which I shall be considering the animosity between modern neuroscientists and Freudian psychotherapists. And relating this, of course, to literature.