The longer that patients with schizophrenia go without treatment for a psychotic episode, the more their hippocampus atrophies, suggests a study published Feb. 21 in JAMA Psychiatry.

To conduct the study, researchers studied 71 patients between March 5, 2013, and Oct. 8, 2014, who were experiencing their first psychotic episode and were antipsychotic naive. The research team matched those patients with 73 healthy controls, treated the patients with antipsychotics, and performed MRIs on members of both groups at baseline and 8 weeks later. The primary outcome measure was change in left and right hippocampal volume integrity, which is inversely associated with hippocampal atrophy.

Results showed that many patients with psychosis had lower median hippocampal volume integrity. Furthermore, those patients’ left hippocampal volume integrity decreased at a median annualized rate of 4.1%, and their right hippocampal volume integrity decreased at a rate of 3.3%. The duration of untreated psychosis was correlated with both decreases, but this association was only significant with left hippocampal volume integrity.

This relationship is “consistent with a persistent, possibly deleterious, effect of untreated psychosis on brain structure,” wrote Donald C. Goff, MD , of the psychiatry department at New York University, and his associates. “Larger longitudinal studies of longer duration are needed to examine the association between [duration of untreated psychosis], hippocampal volume, and clinical outcomes.”

Dr. Goff reported receiving research support from the National Institute of Mental Health, the Stanley Medical Research Institute, and Avanir Pharmaceuticals. Another author reported receiving support from numerous entities and honoraria for serving on an advisory board for Allergan. No other disclosures were reported.

Read more at JAMA Psychiatry .


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