Understanding the effects of antipsychotic medication on the brains of young people

A new study led by Professor Alex Fornito that examines young people who have just developed psychosis has moved one step closer to understanding how treatment with antipsychotic medications affects the brain.

Each year, approximately 1 in 200 Australians will experience a psychotic illness, many of them young adults between the ages of 16-25 years. Antipsychotic medication is generally the first line of treatment following a first episode of psychosis (FEP), but understanding precisely how these treatments impact the brain has proven challenging.

In a world-first study led by Professor Alex Fornito, researchers from the Turner Institute, in collaboration with the ORYGEN Centre of Excellence in Youth Mental Health and The University of Melbourne, are beginning to tease apart the physiological effects of medication and illness on the brain by comparing brain scans of medicated and unmedicated patients following FEP.

As part of the Magnetic Resonance Imaging (MRI) study, which was recently published in the journal Neuropsychopharmacology, sixty-two FEP patients with no history of antipsychotic medication use received either anti-psychotic or a placebo over a period of six months. This is the first study to give patients a placebo, which was made possible by close clinical monitoring and specialised care. In addition, all patients received intensive psychosocial therapy as part of their treatment.

According to the paper’s lead author, PhD candidate Sidhant Chopra, psychosis is often associated with a reduced volume of the pallidum, a subcortical structure of the brain involved in the regulation of voluntary movement and motivation. Through this research, the team has demonstrated antipsychotic medications prevent volume loss in this part of the brain and that this effect is related symptom improvement within the first three months of illness.

“We know that an increase in pallidum volume is correlated with a decrease in psychotic symptoms. In comparing the brains of medicated patients against patients receiving the placebo, we found over time that there was an increase in volume in the pallidum of patients receiving medication.

“In being able to differentiate between the effects of the medication and the effects of the illness, our research supports the use of antipsychotic medication as an effective first-line of treatment in the early stages of psychosis, especially when accompanied by psychosocial therapy,” Sidhant said.

“The underlying causes of psychosis are typically very complex, but our objective is to find ways to improve the quality of care for patients in Australia by developing better treatment options. Our next steps will be to move beyond brain volume, and use different types of MRI scans to map different pathways within the brain. With more accurate mapping we hope to identify opportunities for more targeted treatments, with fewer side effects.”

Read the paper