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Brain volume changes in the first year of illness and 5-year outcome of schizophrenia

  • W. Cahn (a1), N. E. M. van Haren (a1), H. E. Hulshoff Pol (a1), H. G. Schnack (a1), E. Caspers (a1), D. A. J. Laponder (a1) and R. S. Kahn (a1)...

Summary

Progressive brain volume changes have been reported in first-episode schizophrenia, but their relationship to the disease process or to other factors remains unclear. We examined such changes in the first year of illness, and related them to 5-year outcome. Progressive brain volume changes, in particular of grey matter, during the first year of illness were found to be significantly associated with clinical and functional outcome 5 years after the first episode. These findings suggest that early dynamic brain volume changes are related to the disease process and predict the longer-term outcome of schizophrenia.

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Copyright

Corresponding author

Dr Wiepke Cahn, Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 GX Utrecht, The Netherlands. Tel: 00 31 30 250 8180; fax: 00 31 30 250 5443; email: wcahn@umcutrecht.nl

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Declaration of interest

None.

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References

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American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Cahn, W., Hulshoff Pol, H. E., Lems, E. B., et al (2002) Brain volume changes in first-episode schizophrenia: a 1-year follow-up study. Archives of General Psychiatry, 59, 10021010.
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Hulshoff Pol, H. E., Schnack, H. G., Bertens, M. G., et al (2002) Volume changes in gray matter in patients with schizophrenia. American Journal of Psychiatry, 159, 244250.
Kay, S. R., Fiszbein, A. & Opler, L. A. (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Lieberman, J. A., Tollefson, G. D., Charles, C. I., et al (2005) Antipsychotic drug effects on brain morphology in first-episode psychosis. Archives of General Psychiatry, 62, 361370.
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van Haren, N. E., Cahn, W., Hulshoff Pol, H. E., et al (2003) Brain volumes as predictor of outcome in recent-onset schizophrenia: a multi-center MRI study. Schizophrenia Research, 64, 4152.
Woods, B. T., Ward, K. E. & Johnson, E. H. (2005) Meta-analysis of the time-course of brain volume reduction in schizophrenia: implications for pathogenesis and early treatment. Schizophrenia Research, 73, 221228.
Wright, I. C., Rabe-Hesketh, S., Woodruff, P. W., et al (2000) Meta-analysis of regional brain volumes in schizophrenia. Psychiatry, 157, 1625.

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Brain volume changes in the first year of illness and 5-year outcome of schizophrenia

  • W. Cahn (a1), N. E. M. van Haren (a1), H. E. Hulshoff Pol (a1), H. G. Schnack (a1), E. Caspers (a1), D. A. J. Laponder (a1) and R. S. Kahn (a1)...

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Brain volume changes in the first year of illness and 5-year outcome of schizophrenia

  • W. Cahn (a1), N. E. M. van Haren (a1), H. E. Hulshoff Pol (a1), H. G. Schnack (a1), E. Caspers (a1), D. A. J. Laponder (a1) and R. S. Kahn (a1)...
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eLetters

This may relate to loss of DHEA...

James M. Howard, Biologist
09 October 2006

It is my hypothesis that schizophrenia results from the effects of low maternal DHEA on fetal brain development. This may result in less than robust brain development. Subsequently for these individuals, the effects of cortisol and testosterone and the natural decline of DHEA whichbegins around age twenty combine to reduce maintenance of their brain structure and function. Hence, schizophrenia often begins following a stressful event, following puberty, and in the late teens to early twenties. Low DHEA has been found in schizophrenia.

This loss of DHEA around age twenty will expose the lack of optimal brain development. This lack of brain development, the current amount of DHEA, and the amount of decline of DHEA will determine the loss of structure and function. Therefore, the early effects of the loss of DHEA should indicate the slope of the decline thereafter.
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Conflict of interest: None Declared

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