Researchers at the University of Seville have examined changes in the cerebral cortex among people experiencing psychosis. Their study, led by Claudio Alemán Morillo and Rafael Romero García from the Neuroimaging and Brain Networks Laboratory, highlights that psychosis does not progress in a uniform way for all individuals. The evolution of the disorder is influenced by a combination of brain development, symptoms, cognitive abilities, and treatment approaches.
"Psychosis is a set of symptoms—such as hallucinations and delusions—that are common in schizophrenia and involve a loss of contact with reality. From their first manifestation, known as the first psychotic episode, these symptoms can appear and evolve in very different ways between individuals, thus making schizophrenia a particularly complex disorder," according to the authors.
The research found that at the time of the initial psychotic episode, patients showed reduced cortical volume. This reduction was especially noticeable in areas with high concentrations of serotonin and dopamine receptors. These neurotransmitters play important roles both in the biology of psychosis and as targets for antipsychotic drugs. The findings also suggest that not only neurons but also other brain cells involved in inflammation and immune responses may be significant factors in the disease process.
Treatment appears to slow down further brain deterioration over time. Structural differences between patients and healthy controls decrease during clinical intervention. However, those who need higher doses of antipsychotic medication tend to maintain more pronounced differences in cortical volume over time. The study notes this does not mean that higher medication causes greater volume loss; rather, individuals with more severe symptoms often require stronger treatments.
Additionally, cognitive impairments were observed early on among patients with psychosis. Many experienced improvements in symptoms and cognitive function throughout follow-up care—indicating some recovery may occur alongside clinical stabilization. Yet this improvement was less evident among those receiving higher-dose medications.
The study included magnetic resonance imaging data from 357 patients diagnosed with schizophrenia compared to 195 control subjects. A notable aspect is its ten-year duration, which enabled researchers to track long-term changes in brain structure alongside shifts in clinical symptoms and cognitive performance such as attention or memory challenges.
For the first time, researchers used percentile-based analysis to assess whether specific brain regions had atypical volumes—similar to how pediatricians use percentiles for tracking growth deviations like weight or height—in order to detect abnormalities more precisely.
