Ho, 2011 Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia.

[Altostrata]

Nancy Andreasen was a co-author. Robert Whitaker's article on this study http://www.psychologytoday.com/blog/mad-in-america/201102/andreasen-drops-bombshell-antipsychotics-shrink-the-brain

 

Arch Gen Psychiatry. 2011 Feb;68(2):128-37.

Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia.

Ho BC, Andreasen NC, Ziebell S, Pierson R, Magnotta V.

 

Source

 

Departments of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.

 

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/21300943 Full text at http://archpsyc.jamanetwork.com/article.aspx?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.

 

 

Archives of General Psychiatry Editorial | February 2011

Antipsychotic Medications and Brain VolumeDo We Have Cause for Concern?

David A. Lewis, MD

 

Full text at http://archpsyc.jamanetwork.com/article.aspx?articleid=211017

 

....the findings of Ho and colleagues, in concert with those of the aforementioned animal studies and prior reports in humans,8 raise the important question of the clinical significance of the observed brain volume changes. Do the reductions in brain volume associated with antipsychotic medications impair function or are they related to the therapeutic benefits of these medications? Many individuals with schizophrenia discontinue taking typical and antipsychotic medications because of limited efficacy and poorly tolerated adverse effects.9 The observation by Ho and colleagues that the amount of antipsychotic treatment predicted the degree of brain volume reduction leaves open the possibility that the patients who benefitted the most continued to receive antipsychotic treatment and subsequently had the greatest brain volume changes. The idea that strategic reductions in brain volume can be functionally beneficial is supported by the improvements in cognitive capacity that accompany cortical gray matter volume reductions during adolescence.10 Alternatively, as suggested by Ho and colleagues, perhaps antipsychotic medications improve symptoms and contribute to progressive brain tissue reductions through different actions on separate brain circuits.

 

A classic maxim in clinical medicine is to treat the patient, not the laboratory test—or in this case, the MRI. Thus, the findings of Ho and colleagues should not be construed as an indication for discontinuing the use of antipsychotic medications as a treatment for schizophrenia. But they do highlight the need to closely monitor the benefits and adverse effects of these medications in individual patients, to prescribe the minimal amount needed to achieve the therapeutic goal, to consider the addition of nonpharmacological approaches that may improve outcomes,11 and to continue the pursuit of new antipsychotic medications with different mechanisms of action and more favorable benefit to harm ratios.

[alexjuice]

Good Lord... There's so many things I could comment about here... So let's get started:

 

Nancy Andreasen was a co-author.

Departments of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.

 

I saw Andreasen's interview in the NYT some time back. Her attitude was deplorable. I'm sure others have seen it. For me, someone who took schizophrenic doses on antipsychotics for years, it was disheartening. To paraphrase, she said "It's a shame, really. We're so surprised because we thought it was going to turn out to be an effect of the disease. We were shocked to discover the data strongly blame the drugs. But we love our drugs, so we're going to keep prescribing them because the brain atrophy is preferable to the alternative."

 

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.

 

How so? You prescribe them and advocate for them whatever the findings??

 

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.

I've regularly said I'd rather have used crack cocaine and alcohol than psychiatric drugs -- I used both. I think the street drugs are safer (assuming one survives the using of them which I did). Of course, street drugs are bad news. I never displayed any indication as a youth I was heading for street drug abuse. My high school friends, whom I lost contact with when I became agoraphobic in response to intense Drugging, were shocked to discover I'd become an alcohol abuser. I could never drink with them and, through high school and early college, tried to avoid drinking and disliked it greatly.

 

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.

 

Seriously?? A subtle influence on the loss of cortical mass? Some things are not subtle. Like brain atrophy. 9/11 - A subtle reminder that not everybody loves the USA!

 

A classic maxim in clinical medicine is to treat the patient, not the laboratory test—or in this case, the MRI.

 

Among my favorite things as an observer of humanity is noticing the so-called maxims which people oft-quote in discussing their behavior yet actually pay no heed to when behaving. The defining feature of modern conventional medicine -- psychiatry can not, with respect to psychiatrists, be called medecine -- is the preeminence of the lab values in most treatment scenarios. Treating the patient is not time or resource efficient.

 

Oh well. And the band played on.

 

Alex

[Altostrata]

There is some self-serving rhetoric in these papers.