Progression of brain volume changes in adolescent-onset psychosis.

Little is known about the changes that take place in the adolescent brain over the first few years following the onset of psychosis. The present longitudinal study builds on an earlier cross-sectional report demonstrating brain abnormalities in adolescent-onset psychosis patients with a recent-onset first episode of psychosis. Magnetic resonance imaging studies were obtained at baseline and 2 years later from 21 adolescents with psychosis and 34 healthy controls matched for age, gender, and years of education. Whole-brain volumes and gray matter (GM) and cerebrospinal fluid (CSF) volumes of the frontal, parietal, temporal, and occipital lobes were measured at baseline and at 2-year follow-up. In the frontal lobe, the rate of GM volume loss was significantly higher in male patients (2.9% and 2.0%, respectively, for left and right) than in controls (1.2% and 0.7%, respectively, for left and right). In the left frontal lobe, male patients showed a significantly higher rate of CSF volume increase than controls (8.6% vs 6.4%). These differences in rates of volume change were observed in male and female patients, although only males showed significant time x diagnosis interactions. This negative finding in females should be interpreted with caution as the study was underpowered to detect change in women due to limited sample size. An exploratory analysis revealed that schizophrenia and nonschizophrenia psychotic disorders showed similar volume change patterns relative to controls. Change in clinical status was not correlated with longitudinal brain changes. Our results support progression of frontal lobe changes in males with adolescent-onset psychosis.

Neurological soft signs in adolescents with first episode psychosis.

The purpose of this study is to determine the decrease of neurological soft signs (NSS) during adolescence and to compare this evolutionary process in two groups of adolescents with first episode psychosis: a) schizophrenia and b) non-schizophrenia patients. The structured neurological evaluation scale (NES) was administered to 24 adolescents with first episode psychosis. The number of NSS, the total and subscales scores were correlated with age in patients and in 39 healthy controls. Adolescents with first-episode psychosis had a higher prevalence of NSS than healthy controls; the schizophrenia patients (N=9) scored higher than non-schizophrenia patients (N=15). The number of NSS, total score and the scores on three of the four NES subscales correlated inversely with age in the healthy control group. No correlation was found for the schizophrenia group. For the non-schizophrenia group, a significant negative correlation was found only in one subscale. The decrease of NSS during adolescence in the healthy population but not in the patient groups with psychosis may be an indicator of a disturbance of brain processes that occurs during development. We did not find a clear pattern of NSS that distinguished schizophrenia from other psychoses.

Structural neuroimaging in adolescents with a first psychotic episode.

OBJECTIVE: The objective of the present study is to replicate findings in first-episode psychosis reporting a smaller volume in brain structures in a population with adolescent onset. METHOD: Magnetic resonance imaging studies were performed on 23 psychotic adolescents (12-18 years old, 17 males, 6 females) consecutively admitted to an adolescent inpatient unit and on 37 normal controls (13-18 years, 23 males, 14 females) matched for age, sex, and years of education. Diagnosis was made at baseline on the basis of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version and confirmed after 12 months of follow-up. Total brain volume and gray matter, white matter, and cerebrospinal fluid (CSF) volumes of the frontal, parietal, temporal, and occipital lobes were measured bilaterally using a segmentation method based on the Talairach grid system. RESULTS: Male patients showed significantly larger volumes than did male controls in overall CSF and left frontal and right parietal sulci CSF. Male patients also showed significantly lower volumes of gray matter in the right and left frontal lobes. No significant volumetric differences were found in females. There were no differences between individuals with a diagnosis of schizophrenia at follow-up and the rest of the patients. CONCLUSIONS: This study suggests that larger CSF and lower gray matter volumes in the frontal lobes may be a nonspecific vulnerability marker for psychosis in male adolescents.