Brain Volume Varies Depending on Symptom Severity and Treatment Response in Schizophrenia

Schizophrenia is a complex psychiatric disorder with varying treatment responses. This study hypothesizes that treatment-resistant schizophrenia patients exhibit distinct structural brain abnormalities compared to treatment-responsive patients and healthy controls. Identifying these differences may provide insight into the neurobiological basis of treatment resistance and guide personalized interventions. A cross-sectional study was conducted with 24 schizophrenia patients and 24 healthy controls. Schizophrenia patients were categorized into treatment responders (≥30% clinical improvement) and treatment-resistant (<30% improvement) based on clinical assessments, including standardized scales and expert evaluation. Among the scales, Positive and Negative Syndrome Scale (PANSS), The Clinical Global Impression Scale (CGI-S), The Global Assessment Scale (GAS), The Brief Psychiatric Rating Scale (BPRS) were used. Brain volumetric data were acquired using MRI and analyzed through the VolBrain platform, focusing on the frontal, temporal, and parietal lobes, cerebellum, and thalamic nuclei. Treatment-resistant demonstrated significantly reduced brain volumes in the frontal, temporal, and parietal lobes, cerebellum, and thalamic nuclei compared to responders and healthy controls (p<0.05). Additionally, treatment-resistant had higher scores on the PANSS negative symptom scale and the BPRS, indicating more severe clinical symptoms (p<0.05). Responders showed less pronounced volumetric reductions and more favorable clinical profiles. This study reveals that treatment-resistant schizophrenia is associated with marked structural brain abnormalities, particularly in regions critical for cognitive and emotional processing. These findings underscore the potential role of neuroanatomical biomarkers in predicting treatment response and highlight the necessity for targeted therapeutic strategies for treatment-resistant patients.