A typical antipsychotic treatment induced gradually expanding white matter alterations in healthy individuals with persistent auditory verbal hallucinations-an artificially controlled pilot study

Int J Neurosci. 2021 Jun;131(6):536-543. doi: 10.1080/00207454.2020.1750387. Epub 2020 Apr 30.

Abstract

Objective: The aim of this study was to explore the effects of atypical antipsychotics (AaPs) on brain white matter (WM) tracts in healthy individuals with auditory verbal hallucinations (Hi-AVHs).

Methods: We analyzed neuroimaging, AVH symptoms, and cognitive assessment data obtained from 39 Hi-AVHs who reported being distressed by persistent AVHs and volunteered to receive AaP treatment. We used tract-based spatial statistics (TBSS) and t tests to explore AaP pharmacotherapy effects on AVH symptoms and brain WM alterations in Hi-AVH subjects.

Results: TBSS and t tests revealed WM alterations after AaP treatment, relative to pretreatment observations. Although AaPs alleviated AVH symptoms, WM alterations in these subjects expanded over 8 months of AaP treatment, encompassing most major WM tracts by the end of the observation period, including the corpus callosum, arcuate fasciculus, cortico-spinal tracts, anterior commissure, and posterior commissure.

Conclusions: The worsening of AaP-associated WM alterations observed in this study suggest that AaPs may not be a good choice for the treatment of Hi-AVHs despite their ability to alleviate AVHs.

Keywords: Atypical antipsychotics; TBSS; auditory verbal hallucinations; white matter.

MeSH terms

  • Adult
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / pharmacology*
  • Corpus Callosum / diagnostic imaging
  • Corpus Callosum / drug effects
  • Corpus Callosum / pathology
  • Diffusion Tensor Imaging
  • Female
  • Hallucinations / diagnostic imaging
  • Hallucinations / drug therapy*
  • Hallucinations / pathology
  • Humans
  • Male
  • Neural Pathways / diagnostic imaging
  • Neural Pathways / drug effects*
  • Neural Pathways / pathology
  • Outcome Assessment, Health Care
  • Pilot Projects
  • Risperidone / administration & dosage
  • Risperidone / adverse effects
  • Risperidone / pharmacology*
  • White Matter / diagnostic imaging
  • White Matter / drug effects*
  • White Matter / pathology
  • Young Adult

Substances

  • Antipsychotic Agents
  • Risperidone