Global fractional anisotropy predicts transition to psychosis after 12 months in individuals at ultra-high risk for psychosis
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Objective: Psychosis spectrum disorders are associated with cerebral changes, but the prognostic value and clinical utility of these findings are unclear. Here, we applied a multivariate statistical model to examine the predictive accuracy of global white matter fractional anisotropy (FA) for transition to psychosis in individuals at ultra-high risk for psychosis (UHR). Methods: 110 UHR individuals underwent 3 Tesla diffusion-weighted imaging and clinical assessments at baseline, and after 6 and 12 months. Using logistic regression, we examined the reliability of global FA at baseline as a predictor for psychosis transition after 12 months. We tested the predictive accuracy, sensitivity and specificity of global FA in a multivariate prediction model accounting for potential confounders to FA (head motion in scanner, age, gender, antipsychotic medication, parental socioeconomic status and activity level). In secondary analyses, we tested FA as a predictor of clinical symptoms and functional level using multivariate linear regression. Results: Ten UHR individuals had transitioned to psychosis after 12 months (9%). The model reliably predicted transition at 12 months (χ2 = 17.595, p = 0.040), accounted for 15–33% of the variance in transition outcome with a sensitivity of 0.70, a specificity of 0.88 and AUC of 0.87. Global FA predicted level of UHR symptoms (R2 = 0.055, F = 6.084, p = 0.016) and functional level (R2 = 0.040, F = 4.57, p = 0.036) at 6 months, but not at 12 months. Conclusion: Global FA provided prognostic information on clinical outcome and symptom course of UHR individuals. Our findings suggest that the application of prediction models including neuroimaging data can inform clinical management on risk for psychosis transition.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Acta Psychiatrica Scandinavica |
| Vol/bind | 144 |
| Udgave nummer | 5 |
| Sider (fra-til) | 448-463 |
| ISSN | 0001-690X |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
The authors would like to thank all participants for their valued contribution to the project. The study has been funded through The Danish Council for Independent Research (DFF‐4004‐00314); TrygFonden (ID 108119); the Mental Health Services in the Capital Region of Denmark; the Research Fund of the Capital Region of Denmark; the Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS (R155‐2013‐16337) and Lundbeck Foundation grant for BHE (R316‐2019‐191). CP was supported by a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (1105825), an NHMRC L3 Investigator Grant (1196508), and by a grant from the Lundbeck Foundation (ID: R246‐2016‐3237).
Funding Information:
BHE is part of the Advisory Board of Eli Lilly Denmark A/S, Janssen‐Cilag, Lundbeck Pharma A/S and Takeda Pharmaceutical Company Ltd; and has received lecture fees from Bristol‐Myers Squibb, Otsuka Pharma Scandinavia AB, Eli Lilly Company, Boehringer Ingelheim and Lundbeck Pharma A/S. In the last 3 years, CP has received honoraria for talks at educational meetings and has served on an advisory board for Lundbeck, Australia Pty Ltd. BYG is the leader of a Lundbeck Foundation Centre of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), which is partially financed by an independent grant from the Lundbeck Foundation based on international review and partially financed by the Mental Health Services in the Capital Region of Denmark, the University of Copenhagen and other foundations. All grants are the property of the Mental Health Services in the Capital Region of Denmark and administrated by them. She has no other conflicts to disclose.
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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