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

Abstract

Introduction Treatment response at an early stage of schizophrenia is of considerable value with regard to future management of the disorder; however, there are currently no biomarkers that can inform physicians about the likelihood of response. Objects We aim to develop and validate regional brain activity derived from functional magnetic resonance imaging (fMRI) as a potential signature to predict early treatment response in schizophrenia. Methods Amplitude of low‐frequency fluctuation (ALFF) was measured at the start of the first/single episode resulting in hospitalization. Inpatients were included in a principal dataset ( n = 79) and a replication dataset ( n = 44). Two groups of healthy controls ( n = 87; n = 106) were also recruited for each dataset. The clinical response was assessed at discharge from the hospital. The predictive capacity of normalized ALFF in patients by healthy controls, ALFF ratio , was evaluated based on diagnostic tests and clinical correlates. Results In the principal dataset, responders exhibited increased baseline ALFF in the left postcentral gyrus/inferior parietal lobule relative to non‐responders. ALFF ratio of responders before treatment was significantly higher than that of non‐responders ( p < 0.001). The area under the receiver operating characteristic curve was 0.746 for baseline ALFF ratio to distinguish responders from non‐responders, and the sensitivity, specificity, and accuracy were 72.7%, 68.6%, and 70.9%, respectively. Similar results were found in the independent replication dataset. Conclusions Baseline regional activity of the brain seems to be predictive of early response to treatment for schizophrenia. This study shows that psycho‐neuroimaging holds promise for influencing the clinical treatment and management of schizophrenia.

Baseline structural and functional magnetic resonance imaging predicts early treatment response in schizophrenia with radiomics strategy

“…Given such a background, we aimed to investigate the psycho-radiomic application using structural morphology and functional connectivity to predict the response to the overall treatment of schizophrenia at the end of the first or a single hospitalization. The mean length of the stay in the hospital is around 2-3 weeks for patients in our previous study (Cui et al, 2019a). This period is of clinical importance because patients usually demonstrate whether they respond to an initial antipsychotic medication or not in the first 2 weeks.…”

“…The classification accuracy was 79% (sensitivity = 75%; specificity = 83%) when predicting the negative symptom improvement using working memory‐related functional connectivity (Nejad et al., 2013). Regional activity (e.g., the normalized amplitude of low‐frequency fluctuation) presented a fair prediction performance (70.9% accuracy, 72.7% sensitivity, and 68.8% specificity) for early treatment response (Cui et al., 2019a). Extending these results, radiomics that saves raw data and discovers their contribution may provide an opportunity to determine which features of structural and functional MRI mostly influence the predictive capacity.…”

“…Treatment response before discharging was assessed using the percentage change of symptoms based on PANSS. Responders were defined as a 30% reduction in PANSS total scores that was traditionally used, and 30 was subtracted from the baseline score because the theoretical minimum is 30 for the total score (Cui et al., 2019a; Obermeier et al., 2010; Yu et al., 2018). Table 1 provides further details of the two patient populations.…”

“…Currently, an obvious clinical obstacle for schizophrenia is a lack of personalized treatment. Driven by the need for better management of schizophrenia and advances in neuroimaging (Fox, 2018), a quest for the accurate prediction of early treatment response using neuroimaging‐derived features has been noted (Cui et al., 2019a; Doucet et al., 2020).…”

Association Between Connectivity of Hippocampal Sub-Regions and Auditory Verbal Hallucinations in Schizophrenia

“…High-resolution structural imaging and resting-state functional data were acquired on a Siemens 3.0 T scanner for dataset 1 and a GE 3.0 T scanner for dataset 2 using protocols published previously (Cui et al, 2019). More details are shown in Supplementary Table 1.…”