A new UK study suggests computer analysis of brain scans could help predict the severity of psychosis and allow doctors to make more accurate decisions about how best to treat patients.
Paola Dazzan, Ph.D., and Janaina Mourao-Miranda, Ph.D., reported using computer algorithms to analyze magnetic resonance imaging (MRI) scans and assess a mental health patient’s outcome.
The use of computer technology to quantify the risk of further episodes of disease is common in areas of medicine such as cardiovascular medicine and oncology, but no accurate tests were available to psychiatrists. Historically, brain imagining by MRIs to detect the subtle and difficult changes in the brain associated with psychosis have been of limited benefit for clinical practice.
“This is the first step towards being able to use brain imaging to provide tangible benefit to patients affected by psychosis,” said Dazzan.
Psychosis refers to an abnormal condition of the mind and is a term often used for more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur.
The most common forms are part of mental health conditions such as schizophrenia and bipolar disorder, but symptoms of psychosis can also occur in conditions such as Parkinson’s disease and alcohol or drug abuse.
Many patients recover from psychosis with minimal symptoms, but for others, the psychosis can be persistent and can affect their ability to function and lead a normal life.
Currently, physicians are generally unable to predict a person’s risk of future episodes of psychosis. Uncertainty over the course of the illness compromises patient counseling and development of a treatment plan.
Dazzan and colleagues worked with a cohort of 100 patients, taking MRI brain scans when they presented to clinical services with a first psychotic episode.
In addition, the researchers scanned the brains of a control group of 91 healthy individuals. The patients were followed up around six years later and classified as having developed a continuous, episodic or intermediate illness course, depending on whether their symptoms remitted or not during this time.
From this larger sample, the researchers then analyzed scans from 28 subjects with a continuous course of illness, the same number from patients with an episodic course and again, the same number from healthy controls.
The scans were then used to develop pattern recognition software to distinguish between the different severities of the illness. The algorithm, applied to the scans collected at the first episode of psychosis, was able to differentiate between patients who then went on to develop continuous psychosis and those who went on to develop a more benign, episodic psychosis in seven out of 10 cases.
“Although we have some way to go to improve the accuracy of these tests and validate the results on independent large samples, we have shown that in principle it should be possible to use brain scans to identify at the first episode of illness both patients who are likely to go on to have a continuous psychotic illness and those who will develop a less severe form of the illness,” said Mourao-Miranda.
“This suggests that even by the time that they have their first episode of psychosis, significant changes have already occurred to their brains.”
According to Dazzan, “This could in future offer a fast and reliable way of predicting the outcome for an individual patient allowing us to optimize treatments for those most in need, while avoiding long-term exposure to antipsychotic medications in those with very mild forms.
“Structural MRI scans can be obtained in as little as 10 minutes and so this technique could be incorporated into routine clinical investigations. The information this provides could help inform the treatment options available to each patient and help us better manage their illness.”
The study findings are found in the journal Psychological Medicine.
Source: Wellcome Trust