Study ties use of drugs to control schizophrenia to brain tissue loss

Researchers at the University of Iowa using imaging studies to probe the brains schizophrenics have made what they consider a troubling discovery: the drugs often prescribed for people with the neuropsychiatric disorder appear to increase the brain loss they have seen in people with schizophrenia.

Nancy Andreasen and her colleagues at Iowa’s Carver College of Medicine say they published the results of their brain-imaging studies in the American Journal of Psychiatry knowing the information could prove disturbing to people who take the antipsychotic drugs and the doctors who prescribe them.

Andreasen and her collaborators based their findings on MRI studies conducted on schizophrenia patients. The patients began undergoing the MRIs after their first schizophrenic episode and had them repeated at regular intervals for as long as 15 years.

What Andreasen and her colleagues found while combing through the data was that at the first occurrence of symptoms schizophrenics have less brain tissue than healthy people. This suggested to them that something must going to in the brains of schizophrenics before the disorder begins to affect them.

“There are several studies, mine included, that show people with schizophrenia have smaller-than-average cranial size,” said Andreasen, the Andrew H. Woods Chair of Psychiatry at Carver. “Since cranial development is completed within the first few years of life, there may be some aspect of earliest development – perhaps things such as pregnancy complications or exposure to viruses – that on average, affected people with schizophrenia.”

Another finding is that the majority of the brain tissue loss seen in people with schizophrenia happens within two years after the first episode and then hits a plateau. This information may help doctors time treatments meant to prevent brain tissue loss and other negative schizophrenia impacts.

What the researchers learned when they began to look at the effect of antipsychotic drugs on brain tissue proved “very upsetting,” Andreasen said. In general, they found, the larger the dose of these medicine at person with schizophrenia is receiving the great the amount of brain tissue loss.

This, however, is not the first time antipsychotic drugs have been found to have potentially negative side effects. Doctors have known for years that these medications can be associated with conditions such as discomfort and muscle and movement disorders, breast enlargement in men and sexual dysfunction.

Nevertheless, the Iowa researchers spent roughly two years reviewing the data on brain tissue loss and antipsychotic drugs “more or less hoping we had made a mistake,” Andreasen said.

“But in the end, it was a solid finding that wasn’t going to go away, so we decided to go ahead and publish it. The impact is painful because psychiatrists, patients, and family members don’t know how to interpret this finding. ‘Should we stop using antipsychotic medication? Should we be using less?’ ”

Although they remain the subject of controversy surrounding their effectiveness and possible negative side effects, antipsychotic drugs are generally credited with helping people with schizophrenia and other neuropsychiatric problems such as bipolar disorder avoid long-term institutionalization.

Because of her findings Anreasen is suggesting antipsychotic drugs should be used with “great care.”

The Iowa study was funded in part by Janssen Scientific Affairs LLC, the medical education department of Janssen Pharmaceuticals, which makes antipsychotic drugs such as Risperdal, Latuda and Invega.

The U.S. National Institutes of Health and the nonprofit Brain & Behavior Research Foundation, in Great Neck, N.Y., provided additional funding.

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