White-matter hyperintensities have been associated with both schizophrenia and mood disorders, particularly bipolar disorder, but results are inconsistent across studies

To examine whether white-matter hyperintensities are a vulnerability marker for psychosis or are specifically associated with bipolar disorder

T2-weighted magnetic resonance imaging data were acquired in 129 individuals with first-episode psychosis (either affective or non-affective psychoses) and 102 controls who were randomly selected from the same geographical areas. Visual white-matter hyperintensity ratings were used for group and subgroup comparisons

There were no statistically significant between-group differences in white-matter hyperintensity frequency or severity scores. No significant correlations were found between white-matter hyperintensity scores and duration of illness, duration of untreated psychosis, or severity of psychotic, manic or depressive symptoms

White-matter hyperintensities are not associated with vulnerability to psychosis in general, or specifically with affective psychoses. Further, first-episode psychosis investigations using more quantitative methods are warranted to confirm these findings

In low-and middle-income countries people with schizophrenia are reported to experience better outcomes than those in high-income countries

To examine structural brain differences in people with first-episode psychosis and controls in Brazil

Magnetic resonance imaging using voxel-based morphometry was performed on 122 people with first-episode psychosis and 94 controls

There were significant decreases in grey matter in the left superior temporal and inferior prefrontal cortices, insula bilaterally and the right hippocampal region in first-episode psychosis (P<0.05, corrected for multiple comparisons). The subgroup of people with schizophrenia (n=62) exhibited a similar pattern of decrease in grey matter relative to controls

Structural abnormalities reported in psychosis in high-income countries are also present in first-episode psychosis in Brazil