Molecular, physiological and functional features underlying antipsychotic medication use related cortical thinning

Abstract Use of antipsychotic medication is related to thinning of the cerebral cortex, but the underlying mechanisms of this effect remain largely unknown. Here, we investigated potential mechanisms across multiple levels of description, from molecular and physiological factors to whole-brain functional patterns. We first analyzed a single site discovery sample of patients (N=131) with early psychosis for whom antipsychotic related cortical thinning was estimated based on lifetime exposure to antipsychotics. Findings were replicated using data from a large (N≥2168) ENIGMA meta-analysis. We discovered that antipsychotic related cortical thinning is associated with a number of neurotransmitter systems, most notably the serotonin system, physiological measures, and functional networks and neural oscillatory power distributions typical for regions subserving higher cognition. At the functional level, antipsychotic related cortical thinning affects regions involved in executive function and motivation, but not perception. These results show how molecular, physiological, and large-scale functional patterns underlie antipsychotic related cortical thinning.