A cross-sectional and longitudinal magnetic resonance imaging study of cingulate gyrus gray matter volume abnormalities in first-episode schizophrenia and first-episode affective psychosis

Context: Previous magnetic resonance imaging (MRI) findings have demonstrated psychopathological symptom - related smaller gray matter volumes in various cingulate gyrus subregions in schizophrenia and bipolar disorder. However, it is unclear whether these gray matter abnormalities show a subregional specificity to either disorder and whether they show postonset progression. Objective: To determine whether there are initial and progressive gray matter volume deficits in cingulate gyrus subregions in patients with first-episode schizophrenia (FESZ) and patients with first-episode affective psychosis (FEAFF, mainly manic) and their specificity to FESZ or FEAFF. Design: A naturalistic cross-sectional study at first hospitalization for psychosis and a longitudinal follow-up approximately 11/2 years later. Setting and Participants: Patients were from a private psychiatric hospital. Thirty-nine patients with FESZ and 41 with FEAFF at first hospitalization for psychosis and 40 healthy control subjects (HCs) recruited from the community underwent high-spatial-resolution MRI, with follow-up scans in 17 FESZ patients, 18 FEAFF patients, and 18 HCs. Individual subjects were matched for age, sex, parental socioeconomic status, and handedness. Main Outcome Measures: Cingulate gyrus gray matter volumes in 3 anterior subregions (subgenual, affective, and cognitive) and 1 posterior subregion, and whether there was a paracingulate sulcus. Results: At first hospitalization, patients with FESZ showed significantly smaller left subgenual (P=.03), left (P=.03) and right (P=.005) affective, right cognitive (P=.04), and right posterior (P=.003) cingulate gyrus gray matter subregions compared with HCs. Moreover, at the 11/2-year follow-up, patients with FESZ showed progressive gray matter volume decreases in the subgenual (P=.002), affective (P<.001), cognitive (P<.001), and posterior (P=.02) cingulate subregions compared with HCs. In contrast, patients with FEAFF showed only initial (left, P<.001; right, P=.002) and progressive subgenual subregion abnormalities (P<.001). Finally, patients with FESZ showed a less asymmetric paracingulate pattern than HCs (P=.02). Conclusions: Patients with FEAFF and FESZ showed differences in initial gray matter volumes and in their progression. Initial and progressive changes in patients with FEAFF were confined to the subgenual cingulate, a region strongly associated with affective disorder, whereas patients with FESZ evinced widespread initial and progressively smaller volumes.