electronic international standard serial number (EISSN)
Context Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses. Objective To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up. Design Prospective, multicenter, naturalistic, 2-year follow-up study. Main Outcome Measures The GM and cerebrospinal fluid (CSF) volumes in the total brain and frontal, parietal, and temporal lobes. Results Compared with controls, patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up (left:−3.3 vs−0.6 cm3, P = .004; right:−3.7 vs−0.8 cm3, P = .005) and left frontal CSF volume increase (left: 6.7 vs 2.4 cm3, P = .006). In addition to frontal volume, changes for total GM (−37.1 vs−14.5 cm3, P = .001) and left parietal GM (−4.3 vs−2.2 cm3, P = .04) were significantly different in schizophrenic patients compared with controls. No significant differences emerged for patients with bipolar disease. Greater left frontal GM volume loss was related to more weeks of hospitalization, whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia. Conclusions Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls. Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder. These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis.