Compliance with medication but not structural MRI measures predict functional outcome in first-episode schizophrenia patients.

Compliance with medication but not structural MRI measures predict functional outcome in first-episode schizophrenia patients Dear Editors, In longitudinal studies in schizophrenia a variety of clinical variables were consistently associated with symp-tomatological and functional outcome including gender, age and mode of illness-onset, duration of untreated psychosis, compliance with and response to medication (Häfner and an der Heiden, 2003). Besides these clinical variables, structural imaging abnormalities are related to outcome with ventricular enlargement and gray matter (GM) decrease being the most unequivocal MRI abnormalities (Wright et al., 2000). Longitudinal MRI studies in first-episode patients reported an association of prefrontal and temporal GM (Mathalon et al., 2001) or frontal white matter (WM) decline (Ho et al., 2003) and levels of symptoms on follow-up as well as a correlation of temporal lobe (Milev et al., 2003) and global GM volume (Cahn et al., 2002) with outcome. We therefore hypothesized that GM pathomorphology assessed during the first-episode via MRI already points to specific functional outcome characteristics as do the mentioned clinical variables. Twenty-three middle-class Caucasians (11 females, 12 males; age 24.1 ± 5.4 years, education 12.0 ± 1.5 years) during their first treatment for schizophrenia were consecutively included in the study. There were no concomittant disorders, history of severe substance abuse or relevant past exposure to antipsychotic medication. Follow-up assessments were performed 13.8 ± 1.2 months after hospital discharge. IRB approval and informed consent were obtained. Diagnoses were established with SCID for DSM-IV, psychopathological symptoms with the PANSS, information on mode of onset and duration of untreated illness with the Strauss-Carpenter-Scale (SCS). Ratings were repeated on follow-up and supplemented by GAF, compliance with medication was assessed via interview. MR-imaging was performed with a 1.5-T scanner (Siemens Magnetom Vision). Scans were analyzed using BRAINS software which is based on Tailarach atlas spaces and differentiates blood, CSF, GM, and WM. Comparison of patients' and controls' MRI as well as methodological details have been reported elsewhere (Bachmann et al., 2004; Bottmer et al., 2005). A regression analysis for outcome GAF was performed with SPSS where age, gender, symptoms on remission, compliance with medication, SCS items on duration of illness (duration of any psychosis-related symptoms in months, also see Hoff et al., 2000), family history of psychiatric illness, extent of work, and number of social contacts during the year prior to assessment were entered as well as both GM and WM measures of right and left frontal, temporal, …