A brain scan may be able to predict how a patient with psychosis will respond to antipsychotic drug treatment, according to a new study by researchers at the Feinstein Institute for Medical Research in New York.
Symptoms of psychotic disorders, such as schizophrenia and bipolar disorder, include delusions, hallucinations, and disorganized thoughts and behavior. Psychotic disorders are estimated to occur in up to three percent of the population and are a leading cause of disability worldwide.
People with psychotic episodes typically are treated with antipsychotic drugs, but this treatment is given without guidance from lab tests or brain scans, such as functional magnetic resonance imaging or functional MRI (fMRI).
While choosing medication for a person with psychosis, doctors therefore must rely on a “trial-and-error” approach, without truly knowing if a patient will respond well to a particular drug. This lack of knowledge places a large burden on not only the patients and their families, but also healthcare professionals and healthcare systems.
For the study, researchers looked at the fMRI brain scans of patients suffering from their first episode of schizophrenia. The scans were taken prior to drug treatment.
The researchers looked for connectivity patterns in a region of the brain known as the striatum, which tends to be atypical in patients suffering from psychotic disorders. They used this information to create an index that was able to predict with strong accuracy if psychotic symptoms were decreased in the study patients.
What’s even more significant is that the researchers applied this index to confirm their results in a separate group of patients with more chronic illness — those who were hospitalized for psychotic symptoms. They found that treatment outcome could be predicted in the replication group as well.
“This study is the first to report a predictive fMRI-derived measure validated in an independent study group of patients treated with antipsychotics,” said Deepak Sarpal, M.D., a lead author of the study.
“The results we found from this study open the door for contemporary ‘precision medicine’ approaches to psychiatry, and more specifically, the use of fMRI scans as important players in the treatment of psychiatric disorders.”
Other researchers involved in the study included Anil Malhotra, M.D., director of psychiatry research at Zucker Hillside Hospital and investigator at the Feinstein Institute, and Todd Lencz, Ph.D., associate investigator at the Zucker Hillside Hospital and the Feinstein Institute.
Their findings are published online in the latest issue of The American Journal of Psychiatry.