Voxel-based morphometry comparison between first episodes of psychosis with and without evolution to schizophrenia

Abstract First episodes (FE) of psychosis may evolve or not to schizophrenia in ensuing years, but there is a lack of reliable predictors of which patients will have to face such an unfavorable outcome. Given the replicated structural alterations of the brain in schizophrenia, it seems advisable to assess whether the alterations of this kind that can be detected at the time of an initial psychotic episode are different depending on the outcome of the patients. To this end, here we applied voxel-based morphometry to assess whether the degree of cerebral abnormalities differ between 30 FE patients who evolved to schizophrenia in the ensuing 2 years and another 14 FE patients who could not be diagnosed as such during that period. Forty-one controls were also included in the study. We found that the FE patients who evolved to schizophrenia had a significantly lower GM value than the controls bilaterally in the left dorsolateral prefrontal (BA 9) and in left anterior cingulate (BA 33) regions while the FE patients who did not develop schizophrenia showed a distinct, right-sided pattern of deviation (visual cortex, superior temporal gyrus and inferior frontal). The direct comparison between FE patients who evolved or not evolved to schizophrenia did not reveal significant differences. Taken together, our results support the notion that brain abnormalities may be different in psychotic FE patients depending on their evolution in the medium term.