Columbia University Medical Center
NewYork-Presbyterian Hospital The University Hospital of Columbia and Cornell
October 19, 2008

A multi-center study using time-lapsed analysis of magnetic resonance imaging (MRI) to measure changes in the brains of schizophrenic patients assigned to two different drug treatments reveals differences in the loss of cortical gray matter in patients recovering from their first episode of psychosis. These results suggest that treatment can ameliorate the effects of schizophrenia on brain structure and may help psychiatrists make more targeted treatment choices. These results were reported in the October 8, 2008 on-line version of Cerebral Cortex. <br>

After measuring gray matter volume by creating time lapse maps of patients with schizophrenia assigned to two different drug treatments, the researchers observed that patients who were treated with haloperidol had a larger decrease in gray matter. The decrease in gray matter was less in patients treated with olanzapine. These results suggest that olanzapine may be a better choice for first-onset of psychosis; however, it cannot be determined from this neuroimaging study whether the treatment is causing less neurotoxicity or a neuroprotective effect. <br>

In this study, researchers used four-dimensional models of disease progression created from four repeated high-resolution brain MRI scans of 36 first-episode schizophrenia patients. The patients were randomized to treatment either with haloperidol, a first generation antipsychotic drug, or to treatment with olanzapine, known as a second generation drug. They were imaged at intervals of three, six and twelve months. <br>

“These maps of gray matter loss show us that different treatments may prevent some volume loss and thereby mitigate disease progression,” said Jeffrey Lieberman, M.D., chairman of the Department of Psychiatry at Columbia University Medical Center and director of the New York State Psychiatric Institute. “This line of research will be crucial for informing psychiatrists and patients and their family members as they make initial treatment decisions at the onset of a first psychotic episode. Our ultimate objective and hope is that we can preserve gray matter possibly by reducing the duration of psychotic episodes and preventing their recurrence thereby preventing long-term morbidity associated with schizophrenia.” <br>

MRI brain imaging is an important technology which can enhance the care of patients in psychiatry. Scientists hope to use this technique to inform drug development and investigate ways to possibly delay illness progression for those who are severely mentally ill. <br>

In addition, both first generation and second generation antipsychotics have serious side effects, so decisions about which drugs to begin with at first psychosis and for treatment thereafter and in the case of relapse, need to be made with discussion of the risks of side effects and gray matter loss versus the benefit of treatment and halting psychosis. Previous research has shown that each psychotic episode in itself is associated with gray matter loss and subsequent cognitive deficits. <br>

This research was a collaborative effort involving the study’s first author Paul M. Thompson at the Laboratory of Neuro Imaging in the Department of Neurology at UCLA School of Medicine, and others from the Department of Radiology at Duke University School of Medicine in North Carolina, the Department of Psychiatry at the University of North Carolina School of Medicine, Lilly Research Laboratories in Indianapolis, Indiana, McLean Hospital/Harvard Medical School in Belmont, Mass., in addition to Dr. Lieberman at Columbia. <br>

Images Available: Computer video images showing the differences in gray matter loss depending on treatment type after timed intervals are available by request. <br>

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 Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding of and current treatment for psychiatric disorders including depression, suicide, schizophrenia, bipolar and anxiety disorders, and childhood psychiatric disorders. Located at the New York State Psychiatric Institute on the Columbia University Medical Center/ NewYork-Presbyterian Hospital campus in the Washington Heights community of Upper Manhattan, the department enjoys a collaborative relationship with physicians in various disciplines at Columbia University’s College of Physician and Surgeons. Visit http://columbiapsychiatry.org/. <br>

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future health care leaders at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia’s College of Physicians & Surgeons was the first in the country to grant the M.D. degree. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. Visit www.cumc.columbia.edu.

 

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