Psychosis includes symptoms such as hallucinations (hearing voices) or delusions (unshakeable beliefs based on the person’s altered perception of reality). Psychosis is present in conditions such as schizophrenia and, less often, in bipolar disorder.
About half of people having their first episode of a psychosis do not respond very well to the first medication prescribed, leading to a greater risk for future episodes and worse outcomes.
Figuring out which individuals may not respond to drugs could lead to better medication, and may eventually allow doctors to prescribe personalized treatment plans.
For the study, researchers used structural Magnetic Resonance Imaging (MRI) to scan the brains of 126 individuals — 80 presenting with their first episode of psychosis, and 46 healthy controls. Patients had an MRI scan right after their first psychotic episode, and another assessment 12 weeks later, to establish whether symptoms had improved following the first treatment with antipsychotic drugs.
Of particular interest to the researchers was the “cortical gyrification” — the extent of folding of the cerebral cortex and a marker of how it has developed.
They found that patients who did not respond to treatment already had a significant reduction in gyrification across multiple brain regions, compared to patients who did respond and to healthy individuals.
This reduced gyrification was especially pronounced in brain regions considered important in psychosis, such as the temporal and frontal lobes. Interestingly, those who responded to treatment were virtually indistinguishable from the healthy controls.
“There have been few advances in developing novel anti-psychotic drugs over the past 50 years and we still face the same problems with a sub-group of people who do not respond to the drugs we currently use,” Dazan said.
“We could envisage using a marker like this one to identify people who are least likely to respond to existing medications and focus our efforts on developing new medication specifically adapted to this group.
“In the longer term, if we were able to identify poor responders at the outset, we may be able to formulate personalized treatment plans for that individual patient.”
Source: King’s College London