***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Our previous work has identified that unmedicated volunteers with schizophrenia have regional cerebral blood flow ( rCBF ) activation patterns inappropriately related to the cognitive dem and of a task in anterior cingulate cortex ( ACC ) . Using positron emission tomography ( PET ) with 15O water , we compared task-induced rCBF patterns induced by haloperidol or clozapine in individuals with schizophrenia . We hypothesized that clozapine , given its superior clinical action , would tend to normalize the abnormal task-activated response in ACC more than haloperidol . Schizophrenia volunteers ( SVs ) ( n=6 ) and normal volunteers ( NVs ) ( n=12 ) were trained to perform a tone discrimination task with 70–80 % accuracy . They were then scanned during three task conditions : ( 1 ) Rest , ( 2 ) sensory motor control ( SMC ) task , and ( 3 ) decision task ( DEC ) . SVs were initially scanned after withdrawal of all psychotropic medication and again after treatment with therapeutic doses of haloperidol ( n=5 ) and /or clozapine ( n=5 ) . rCBF values , sample d in the grown maxima of the task-activated ACC cluster , were analyzed between groups and task conditions . Task performance was similar across the unmedicated ,  haloperidol- and clozapine-medicated  SV groups . There was a reduction in accuracy in the haloperidol SV group compared to the NVs . Group and task conditions affected rCBF in the ACC . Clozapine , but not haloperidol , reversed the abnormal ACC rCBF pattern in unmedicated SV to normal . The clozapine-treated SV group showed a rCBF pattern similar to the NV group in that ACC activation was not observed during the control task but occurred during the decision condition . The pattern seen in the haloperidol-treated SV group was similar to the unmedicated SV group in that ACC activation was seen during the control task and no further activation was seen during the DEC . We report that clozapine , but not haloperidol , normalizes anterior cingulate rCBF patterns in schizophrenia during a cognitive task . Based on these preliminary data , we propose that this pattern may account for the superior therapeutic effect of clozapine and represents a surrogate marker of this action Subjects at their first psychotic episode show an enlarged volume of the pituitary gl and , but whether this is due to hypothalamic – pituitary – adrenal ( HPA ) axis hyperactivity , or to stimulation of the prolactin-secreting cells by antipsychotic treatment , is unclear . We measured pituitary volume , using 1.5-mm , coronal , 1.5 T , high-resolution MRI images , in 78 patients at the first psychotic episode and 78 age- and gender-matched healthy controls . In all , 18 patients were antipsychotic-free ( 12 of these were antipsychotic-naïve ) , 26 were receiving atypical antipsychotics , and 33 were receiving typical antipsychotics .  As hypothesized , patients had a larger pituitary volume than controls ( + 22 % , p<0.001 ) . When divided by antipsychotic treatment , and compared to controls , the pituitary volume was 15 % larger in antipsychotic-free patients ( p=0.028 ) , 17 % larger in patients receiving atypicals ( p=0.01 ) , and 30 % larger in patients receiving typicals ( p<0.001 ) . Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together ( + 11 % , p=0.08 ) . When divided by diagnosis , and compared to controls , the pituitary volume was 24 % larger in patients with schizophrenia/schizophreniform disorder ( n=40 , p<0.001 ) , 19 % larger in depressed patients ( n=13 , p=0.022 ) , 16 % larger in bipolar patients ( n=16 , p=0.037 ) , and 12 % larger in those with other psychoses ( n=9 , p=0.2 ) . In conclusion , the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presence of antipsychotic treatment , and this could be due to activation of the HPA axis . Typical antipsychotics exert an additional enlarging effect on pituitary volume , likely to be related to activation of prolactin-secreting cells . This activation of the hormonal stress response could participate to the important metabolic abnormalities observed in patients with psychosis Using time-lapse maps , we visualized the dynamics of schizophrenia progression , revealing spreading cortical changes that depend on the type of antipsychotic treatment . Dynamic , 4-dimensional models of disease progression were created from 4 repeated high-resolution brain magnetic resonance imaging scans of 36 first-episode schizophrenia patients ( 30 men/6 women ; mean age : 24.2 + /- 5.1 SD years ) r and omized to haloperidol ( HAL ) ( n = 15 ) or olanzapine ( OLZ ) treatment ( n = 21 ) , imaged at baseline , 3 , 6 , and 12 months ( 144 scans ) . Based on surface-based cortical models and point-by-point measures of gray matter volume , we generated time-lapse maps for each treatment . Disease trajectories differed for atypical versus typical neuroleptic drugs . A rapidly advancing parietal-to-frontal deficit trajectory , in HAL-treated patients , mirrored normal cortical maturation but greatly intensified . The disease trajectory advanced even after symptom normalization , involving the frontal cortex within 12 months with typical drug treatment . Areas with fastest tissue loss shifted anteriorly in the first year of psychosis . This trajectory was not seen with OLZ . Whether this association reflects either reduced neurotoxicity or neuroprotection can not be addressed with neuroimaging ; changes may relate to glial rather than neural components . These maps revise current models of schizophrenia progression ; due to power limitations , the findings require confirmation in a sample large enough to model group x time interactions BACKGROUND Pathomorphologic brain changes occurring as early as first-episode schizophrenia have been extensively described . Longitudinal studies have demonstrated that these changes may be progressive and associated with clinical outcome . This raises the possibility that antipsychotics might alter such pathomorphologic progression in early-stage schizophrenia . OBJECTIVE To test a priori hypotheses that olanzapine-treated patients have less change over time in whole brain gray matter volumes and lateral ventricle volumes than haloperidol-treated patients and that gray matter and lateral ventricle volume changes are associated with changes in psychopathology and neurocognition . DESIGN Longitudinal , r and omized , controlled , multisite , double-blind study . Patients treated and followed up for up to 104 weeks .  Neurocognitive and magnetic resonance imaging ( MRI ) assessment  s performed at weeks 0 ( baseline ) , 12 , 24 , 52 , and 104 . Mixed-models analyses with time-dependent covariates evaluated treatment effects on MRI end points and explored relationships between MRI , psychopathologic , and neurocognitive outcomes . SETTING Fourteen academic medical centers ( United States , 11 ; Canada , 1 ; Netherl and s , 1 ; Engl and , 1 ) . PARTICIPANTS Patients with first-episode psychosis ( DSM-IV ) and healthy volunteers . INTERVENTIONS R and om allocation to a conventional antipsychotic , haloperidol ( 2 - 20 mg/d ) , or an atypical antipsychotic , olanzapine ( 5 - 20 mg/d ) . MAIN OUTCOME MEASURES Brain volume changes assessed by MRI . RESULTS Of 263 r and omized patients , 161 had baseline and at least 1 postbaseline MRI evaluation .  Haloperidol-treated patients exhibited significant decreases in gray matter volume , whereas olanzapine-treated patients did not . A matched sample of healthy volunteers ( n = 58 ) examined contemporaneously showed no change in gray matter volume . CONCLUSIONS Patients with first-episode psychosis exhibited a significant between-treatment difference in MRI volume changes .  Haloperidol was associated with significant reductions in gray matter volume , whereas olanzapine was not . Post hoc analyses suggested that treatment effects on brain volume and psychopathology of schizophrenia may be associated . The differential treatment effects on brain morphology could be due to haloperidol-associated toxicity or greater therapeutic effects of olanzapine BACKGROUND Recent anatomical brain magnetic resonance imaging ( MRI ) studies show a striking postpsychotic progressive loss of cortical gray matter ( GM ) in patients with childhood-onset schizophrenia ( COS ) , which appears greater than that seen for adult patients . However , the diagnostic specificity and the relationship of these changes to drug treatment and cognitive functioning remain unclear . We performed a comparative prospect i ve brain MRI study in patients with COS and pediatric patients with transient psychosis with behavior problems ( psychosis not otherwise specified ) provisionally considered multidimensionally impaired ( MDI ) . We hypothesized that cortical GM loss would occur in patients with COS but not in adolescents with atypical psychoses . METHODS Anatomical brain MRI was performed at baseline and follow-up in 19 patients in the MDI group ( mean [ SD ] age of 13.3 [ 3.1 ] years ) ; in 23 patients with COS matched for age , sex , IQ score , and drug treatment ( mean [ SD ] age of 13.9 [ 2.5 ] years ) ; and 38 healthy control subjects matched for age and sex ( mean [ SD ] age of 13.3 [ 3.1 ] years ) . The mean ( SD ) follow-up was 2.5 ( 0.8 ) years . Volumes of the cerebrum and total and regional GM were obtained by using automated analysis , and percent change in volume across time was calculated . One-way analyses of variance with post hoc Tukey Honestly Significantly Different comparisons were performed to examine group differences in the percent change in GM across follow-up . RESULTS The COS group had significantly greater total , frontal , temporal , and parietal GM loss than did the MDI or healthy control groups ; analysis of variance post hoc P values ranged from.03 to.001 . The MDI and control groups did not differ significantly from each other . CONCLUSIONS The cortical GM volume loss in COS appears diagnostically specific ; it was not seen in children and adolescents with atypical psychosis . Because both patient groups had similar early developmental patterns , cognitive functioning , medications , and hospitalizations , this progressive loss appears to be intrinsic to COS . An ongoing neurodevelopmental process and /or brain response specific to the illness could account for these changes OBJECTIVE A follow-up study of patients with schizophrenia was conducted to examine change in striatal volumes and extrapyramidal symptoms after a change in medication . METHOD Thirty-seven patients with schizophrenia and 23 healthy volunteers were examined . Patients at baseline receiving typical antipsychotics ( N=10 ) or risperidone but exhibiting limited response ( N=13 ) were switched to treatment with  olanzapine . Patients receiving risperidone and exhibiting a good response ( N=14 ) continued treatment with risperidone . Cau date , putamen , and pallidal volumes were assessed with magnetic resonance imaging . The Extrapyramidal Symptoms Rating Scale was used to assess clinical signs and symptoms . RESULTS At baseline , basal ganglia volumes in patients treated with typical antipsychotics were greater than in healthy subjects ( putamen : 7.0 % larger ; globus pallidus : 20.7 % larger ) . After the switch to olanzapine , putamen and globus pallidus volumes decreased ( 9.8 % and 10.7 % , respectively ) and did not differ from those of healthy subjects at the follow-up evaluation . Akathisia was also reduced . In the patients receiving risperidone at baseline , basal ganglia volumes did not differ between those exhibiting good and poor response , and no significant volume changes were observed in subjects with poor risperidone response after the switch to olanzapine treatment . CONCLUSIONS Olanzapine reversed putamen and globus pallidus enlargement induced by typical antipsychotics but did not alter volumes in patients previously treated with risperidone . Changes in striatal volumes related to typical and atypical antipsychotics may represent an interactive effect between individual medications and unique patient characteristics Typical antipsychotics have been reported to enlarge the cau date nucleus in schizophrenic patients . The atypical antipsychotic , clozapine , is associated with a decrease in cau date size in patients previously treated with typical antipsychotics . The present study investigates whether a change in cau date volume after switching from treatment with typical antipsychotics to treatment with clozapine is related to improvement in symptoms or tardive dyskinesia ( TD ) .  Twenty-six schizophrenic patients participated in this open study . Cau date nucleus volume and TD were assessed before discontinuing typical antipsychotics and after 24 weeks of treatment with clozapine . After discontinuing typical antipsychotics , symptoms were assessed in a 3 days drug-free period and subsequently once a month . Treatment with clozapine result ed in a decrease in cau date volume , improvement in symptoms and amelioration of TD . However , no difference in cau date volume changes was found between responders and non-responders to clozapine and no correlations were found between cau date volume changes and reduction of T 
    Output:
    
In patients with schizophrenia treated with antipsychotics  , reduced gray matter volume was described , particularly in the frontal and temporal lobes .
Structural neuroimaging studies indicate that treatment with typical as well as atypical antipsychotics may affect regional gray matter ( GM ) volume .
In particular , typical antipsychotics led to increased gray matter volume of the basal ganglia , while atypical antipsychotics reversed this effect after switching .
Atypical antipsychotics , however , seem to have no effect on basal ganglia structure