MRI Predicts Remission at 1 Year in First-Episode Schizophrenia in Females with Larger Striato-Thalamic Volumes

Abstract

Background/Aims: The Remission in Schizophrenia Working Group has defined remission as ‘a low-mild symptom intensity level, maintained for a minimum of 6 months, where such symptoms do not affect an individual's behaviour' [Andreasen et al.: Am J Psychiatry 2005;162:441-449]. Since brain morphology relates to symptomatology, treatment and illness progression, MRI may assist in predicting remission. Methods: Thirty-nine patients newly diagnosed with DSM-IV schizophrenia underwent MRI brain scan prior to antipsychotic exposure. The Global Assessment of Functioning (GAF) score was entered into a voxel-based analysis to evaluate its relationship with cerebral grey matter volume from the baseline MRI. We entered age, total intracranial volume and intake GAF score as co-variates. Males and females were analysed separately because gender is a potent determinant of outcome. Results: Males had lower GAF scores than females, both at intake and at 1 year. Males comprised only 40% (12 out of 39) of the early remission group. For females only, early remission was strongly and positively correlated with bilateral lentiform and striatal volumes. For males, there was no such relationship. Conclusion: Larger striato-thalamic volume correlated with early remission in females only. These baseline MRI findings were unlikely to be confounded by antipsychotic treatment and chronicity. These brain morphological markers show gender dimorphism and may assist in the prediction of early remission in newly diagnosed schizophrenia.

Prediction of early response to overall treatment for schizophrenia: A functional magnetic resonance imaging study

“…Finally, we systematically reviewed clinical studies within the past five years to predict the outcome of patients with schizophrenia and/or other psychotic disorders (Supporting information Table S4) using MRI, widely including high‐resolution T1‐weighted imaging (Altamura et al, ; Dusi et al, ; Francis et al, ; Fung et al, ; Hutcheson et al, ; Molina et al, ; Morch‐Johnsen et al, ; Palaniyappan et al, ; Premkumar et al, ), BOLD‐fMRI (Hadley et al, ; Kraguljac, White, Hadley, Visscher et al, ; Kraguljac, White, Hadley, Hadley et al, ; Li, Jing et al, ; Nejad et al, ; Sarpal et al, ), diffusion tensor imaging (Crossley et al, ; Reis Marques et al, ), and arterial spin labeling (Stegmayer et al, ). In spite of relatively low predictive capacity (72.7%‐82.1% sensitivity and 62.5%‐68.6% specificity) compared with tests previously discovered (80% sensitivity and 75% specificity) (Sarpal et al, ), we propose this novel tool for early prediction as an alternative approach to contribute to the current potential markers.…”

“…Initially, a relatively high level of regional activity might reflect its sensitivity to treatment in patients with schizophrenia. Furthermore, according to the structural and functional neuroimaging results, in a volumetric MRI study (Huang et al, 2015), a group of schizophrenia patients exhibit reduced gray matter volume in contrast to healthy (Altamura et al, 2017;Dusi et al, 2017;Francis et al, 2018;Fung et al, 2014;Hutcheson et al, 2014;Molina et al, 2014;Morch-Johnsen et al, 2015;Palaniyappan et al, 2013;Premkumar et al, 2015), BOLD-fMRI (Hadley et al, 2014;Kraguljac, White, Hadley, Visscher et al, 2016;Li, Jing et al, 2017;Nejad et al, 2013;Sarpal et al, 2016), diffusion tensor imaging (Crossley et al, 2017;Reis Marques et al, 2014), and arterial spin labeling (Stegmayer et al, 2017). In spite of relatively low predictive capacity (72.7%-82.1% sensitivity and 62.5%-68.6% specificity) compared with tests previously discovered (80% sensitivity and 75% specificity) (Sarpal et al, 2016), we propose this novel tool for early prediction as an alternative approach to contribute to the current potential markers.…”

“…Dazzan et al concluded that alterations of gray and white matter identified on structural neuroimaging, predominantly distributed in the medial temporal and prefrontal cortices, are potential neuroanatomical markers for the prediction of poor symptomatic and functional outcome (Dazzan et al, 2015). There have also been studies that identified correlations between structural features and antipsychotic treatment response from the perspectives of both volume and morphology, involving asymmetry and hypogyria (Altamura et al, 2017;Dusi et al, 2017;Francis et al, 2018;Fung et al, 2014;Hutcheson, Clark, Bolding, White, & Lahti, 2014;Molina, Taboada, Aragues, Hernandez, & Sanz-Fuentenebro, 2014;Morch-Johnsen et al, 2015;Palaniyappan et al, 2013;Premkumar et al, 2015). However, functional brain imaging-based prognostic markers require further investigation before being used clinically for individualized psychosis treatment decisions (Keefe & Kahn, 2017).…”

Overdiagnosis in the Era of Neuropsychiatric Imaging

“…For example, response to therapy for depression has been associated with baseline resting state network activity (75) and regional white matter integrity (72). Response to antipsychotic therapy has been associated with decreased white matter integrity and volume reduction in several regions (76)(77)(78)(79)(80)(81)(82). Response to cognitive behavioral therapy in PTSD has been associated with anterior cingulate activity and volume, as well as amygdala activity (83,84).…”

Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response

“…Biomarkers based on data derived from brain imaging have recently shown considerable promise in estimating individual clinical outcome. 3 , 4 Magnetic resonance imaging (MRI) studies have found neuroanatomical differences such as structural morphology, 5 volume, 6 , 7 ventricle size, 8 and cortical thickness, 9 , 10 as well as differences in functional connectivity 11–13 to be associated with likelihood of AP response.…”