Patients with schizophrenia have detectable alterations to their brain structure at early stages of the disease, which are unlikely to be caused by medication or long-standing symptoms, say neurologists. Dr Dominic Fannon and colleagues (Institute of Psychiatry, Denmark Hill, London) performed magnetic resonance imaging scans on 37 patients who had recently experienced their first schizophrenic episode and 25 controls. Compared with the control group, the patients with schizophrenia had a significant reduction in the volume of some areas of the brain but an increase in the volume of others. In addition, whole brain volume was reduced in the patients with schizophrenia. 'The detection of dispersed structural deficits in subjects with these clinical characteristics confirms the view that such findings cannot be attributed to the effects of medication or disease chronicity,' Dr Fannon and colleagues say. Of the 37 patients, 13 had never received antipsychotic treatment at the time of scanning and the remainder had been treated for a mean duration of 4.6 weeks. The mean duration of their symptoms was 31.3 weeks. The patients with schizophrenia had reductions in cortical grey matter, temporal lobe grey matter and overall brain volume but their lateral and third ventricles were enlarged, the authors say (American Journal of Psychiatry 2000;157:1829).