TY - JOUR

T1 - Association of Structural Magnetic Resonance Imaging Measures with Psychosis Onset in Individuals at Clinical High Risk for Developing Psychosis

T2 - An ENIGMA Working Group Mega-analysis

AU - Jalbrzikowski, Maria

AU - Hayes, Rebecca A.

AU - Wood, Stephen J.

AU - Nordholm, Dorte

AU - Zhou, Juan H.

AU - Fusar-Poli, Paolo

AU - Uhlhaas, Peter J.

AU - Takahashi, Tsutomu

AU - Sugranyes, Gisela

AU - Kwak, Yoo Bin

AU - Mathalon, Daniel H.

AU - Katagiri, Naoyuki

AU - Hooker, Christine I.

AU - Smigielski, Lukasz

AU - Colibazzi, Tiziano

AU - Via, Esther

AU - Tang, Jinsong

AU - Koike, Shinsuke

AU - Rasser, Paul E.

AU - Michel, Chantal

AU - Lebedeva, Irina

AU - Hegelstad, Wenche Ten Velden

AU - De La Fuente-Sandoval, Camilo

AU - Waltz, James A.

AU - Mizrahi, Romina

AU - Corcoran, Cheryl M.

AU - Resch, Franz

AU - Tamnes, Christian K.

AU - Haas, Shalaila S.

AU - Lemmers-Jansen, Imke L.J.

AU - Agartz, Ingrid

AU - Allen, Paul

AU - Amminger, G. Paul

AU - Andreassen, Ole A.

AU - Atkinson, Kimberley

AU - Bachman, Peter

AU - Baeza, Inmaculada

AU - Baldwin, Helen

AU - Bartholomeusz, Cali F.

AU - Borgwardt, Stefan

AU - Catalano, Sabrina

AU - Chee, Michael W.L.

AU - Chen, Xiaogang

AU - Cho, Kang Ik K.

AU - Cooper, Rebecca E.

AU - Cropley, Vanessa L.

AU - Dolz, Montserrat

AU - Ebdrup, Bjørn H.

AU - Glenthøj, Birte Y.

AU - Nordentoft, Merete

AU - ENIGMA Clinical High Risk for Psychosis Working Group

N1 - Publisher Copyright: © 2021 American Medical Association. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Importance: The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk. Objective: To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between participants at CHR who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-). Design, Setting, and Participants: In this case-control study, baseline T1-weighted magnetic resonance imaging (MRI) data were pooled from 31 international sites participating in the ENIGMA Clinical High Risk for Psychosis Working Group. CHR status was assessed using the Comprehensive Assessment of At-Risk Mental States or Structured Interview for Prodromal Syndromes. MRI scans were processed using harmonized protocols and analyzed within a mega-analysis and meta-analysis framework from January to October 2020. Main Outcomes and Measures: Measures of regional cortical thickness (CT), surface area, and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR group vs control group) and conversion status (CHR-PS+ group vs CHR-PS- group vs control group). Results: Of the 3169 included participants, 1428 (45.1%) were female, and the mean (SD; range) age was 21.1 (4.9; 9.5-39.9) years. This study included 1792 individuals at CHR and 1377 healthy controls. Using longitudinal clinical information, 253 in the CHR-PS+ group, 1234 in the CHR-PS- group, and 305 at CHR without follow-up data were identified. Compared with healthy controls, individuals at CHR exhibited widespread lower CT measures (mean [range] Cohen d = -0.13 [-0.17 to -0.09]), but not surface area or subcortical volume. Lower CT measures in the fusiform, superior temporal, and paracentral regions were associated with psychosis conversion (mean Cohen d = -0.22; 95% CI, -0.35 to 0.10). Among healthy controls, compared with those in the CHR-PS+ group, age showed a stronger negative association with left fusiform CT measures (F = 9.8; P <.001; q <.001) and left paracentral CT measures (F = 5.9; P =.005; q =.02). Effect sizes representing lower CT associated with psychosis conversion resembled patterns of CT differences observed in ENIGMA studies of schizophrenia (ρ = 0.35; 95% CI, 0.12 to 0.55; P =.004) and individuals with 22q11.2 microdeletion syndrome and a psychotic disorder diagnosis (ρ = 0.43; 95% CI, 0.20 to 0.61; P =.001). Conclusions and Relevance: This study provides evidence for widespread subtle, lower CT measures in individuals at CHR. The pattern of CT measure differences in those in the CHR-PS+ group was similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread disruptions in CT coupled with abnormal age associations in those at CHR may point to disruptions in postnatal brain developmental processes..

AB - Importance: The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk. Objective: To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between participants at CHR who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-). Design, Setting, and Participants: In this case-control study, baseline T1-weighted magnetic resonance imaging (MRI) data were pooled from 31 international sites participating in the ENIGMA Clinical High Risk for Psychosis Working Group. CHR status was assessed using the Comprehensive Assessment of At-Risk Mental States or Structured Interview for Prodromal Syndromes. MRI scans were processed using harmonized protocols and analyzed within a mega-analysis and meta-analysis framework from January to October 2020. Main Outcomes and Measures: Measures of regional cortical thickness (CT), surface area, and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR group vs control group) and conversion status (CHR-PS+ group vs CHR-PS- group vs control group). Results: Of the 3169 included participants, 1428 (45.1%) were female, and the mean (SD; range) age was 21.1 (4.9; 9.5-39.9) years. This study included 1792 individuals at CHR and 1377 healthy controls. Using longitudinal clinical information, 253 in the CHR-PS+ group, 1234 in the CHR-PS- group, and 305 at CHR without follow-up data were identified. Compared with healthy controls, individuals at CHR exhibited widespread lower CT measures (mean [range] Cohen d = -0.13 [-0.17 to -0.09]), but not surface area or subcortical volume. Lower CT measures in the fusiform, superior temporal, and paracentral regions were associated with psychosis conversion (mean Cohen d = -0.22; 95% CI, -0.35 to 0.10). Among healthy controls, compared with those in the CHR-PS+ group, age showed a stronger negative association with left fusiform CT measures (F = 9.8; P <.001; q <.001) and left paracentral CT measures (F = 5.9; P =.005; q =.02). Effect sizes representing lower CT associated with psychosis conversion resembled patterns of CT differences observed in ENIGMA studies of schizophrenia (ρ = 0.35; 95% CI, 0.12 to 0.55; P =.004) and individuals with 22q11.2 microdeletion syndrome and a psychotic disorder diagnosis (ρ = 0.43; 95% CI, 0.20 to 0.61; P =.001). Conclusions and Relevance: This study provides evidence for widespread subtle, lower CT measures in individuals at CHR. The pattern of CT measure differences in those in the CHR-PS+ group was similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread disruptions in CT coupled with abnormal age associations in those at CHR may point to disruptions in postnatal brain developmental processes..

U2 - 10.1001/jamapsychiatry.2021.0638

DO - 10.1001/jamapsychiatry.2021.0638

M3 - Journal article

C2 - 33950164

AN - SCOPUS:85105956496

VL - 78

SP - 753

EP - 766

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 7

ER -