Subcortical volume reduction and cortical thinning 3 months after switching to clozapine in treatment resistant schizophrenia

The neurobiological effects of clozapine are under characterised. We examined the effects clozapine treatment on subcortical volume and cortical thickness and investigated whether macrostructural changes were linked to alterations in glutamate or N-acetylaspartate (NAA). Data were acquired in 24 patients with treatment-resistant schizophrenia before and 12 weeks after switching to clozapine. During clozapine treatment we observed reductions in caudate and putamen volume, lateral ventricle enlargement (P < 0.001), and reductions in thickness of the left inferior temporal cortex, left caudal middle frontal cortex, and the right temporal pole. Reductions in right caudate volume were associated with local reductions in NAA (P = 0.002). None of the morphometric changes were associated with changes in glutamate levels. These results indicate that clozapine treatment is associated with subcortical volume loss and cortical thinning and that at least some of these effects are linked to changes in neuronal or metabolic integrity.

Automated summary

The neurobiological effects of clozapine treatment on subcortical volume and cortical thickness were investigated. The results showed reductions in the volumes of caudate and putamen, enlargement of the lateral ventricles, and reductions in the thickness of specific cortical regions. The reduction in right caudate volume was associated with local reductions in NAA. No association was found between these morphometric changes and glutamate levels.