Thalamic, hippocampal, amygdalar and brainstem long-term changes in schizophrenia co-localised with normative neurotransmitter distributions

The study examined long-term brain volume changes in 357 patients with schizophrenia spectrum disorder and 196 healthy controls over 20 years. Using magnetic resonance imaging, volumes of specific brain structures including the thalamus, hippocampus, amygdala, and brainstem were measured. Patients showed diverse changes across these regions, with the hippocampus demonstrating prominent early volume reduction associated with antipsychotic medication doses. Amygdalar volume reduction was more widespread and strongly correlated with positive symptom severity. The occurrence of these changes overlapped with maps of dopamine, GABA, glutamate, serotonin, and acetylcholine distribution in the brain. The results suggest that structural changes in schizophrenia are organized according to distinct neurochemical profiles.