TY - JOUR

T1 - Symptom Remission and Brain Cortical Networks at First Clinical Presentation of Psychosis

T2 - The OPTiMiSE Study

AU - Dazzan, Paola

AU - Lawrence, Andrew J.

AU - Reinders, Antje A.T.S.

AU - Egerton, Alice

AU - van Haren, Neeltje E.M.

AU - Merritt, Kate

AU - Barker, Gareth J.

AU - Perez-Iglesias, Rocio

AU - Sendt, Kyra Verena

AU - Demjaha, Arsime

AU - Nam, Kie W.

AU - Sommer, Iris E.

AU - Pantelis, Christos

AU - Wolfgang Fleischhacker, W.

AU - van Rossum, Inge Winter

AU - Galderisi, Silvana

AU - Mucci, Armida

AU - Drake, Richard

AU - Lewis, Shon

AU - Weiser, Mark

AU - Martinez Diaz-Caneja, Covadonga M.

AU - Janssen, Joost

AU - Diaz-Marsa, Marina

AU - Rodríguez-Jimenez, Roberto

AU - Arango, Celso

AU - Baandrup, Lone

AU - Broberg, Brian

AU - Rostrup, Egill

AU - Ebdrup, Bjørn H.

AU - Glenthøj, Birte

AU - Kahn, Rene S.

AU - McGuire, Philip

AU - OPTiMiSE study group

PY - 2021

Y1 - 2021

N2 - Individuals with psychoses have brain alterations, particularly in frontal and temporal cortices, that may be particularly prominent, already at illness onset, in those more likely to have poorer symptom remission following treatment with the first antipsychotic. The identification of strong neuroanatomical markers of symptom remission could thus facilitate stratification and individualized treatment of patients with schizophrenia. We used magnetic resonance imaging at baseline to examine brain regional and network correlates of subsequent symptomatic remission in 167 medication-naïve or minimally treated patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder entering a three-phase trial, at seven sites. Patients in remission at the end of each phase were randomized to treatment as usual, with or without an adjunctive psycho-social intervention for medication adherence. The final follow-up visit was at 74 weeks. A total of 108 patients (70%) were in remission at Week 4, 85 (55%) at Week 22, and 97 (63%) at Week 74. We found no baseline regional differences in volumes, cortical thickness, surface area, or local gyrification between patients who did or did not achieved remission at any time point. However, patients not in remission at Week 74, at baseline showed reduced structural connectivity across frontal, anterior cingulate, and insular cortices. A similar pattern was evident in patients not in remission at Week 4 and Week 22, although not significantly. Lack of symptom remission in first-episode psychosis is not associated with regional brain alterations at illness onset. Instead, when the illness becomes a stable entity, its association with the altered organization of cortical gyrification becomes more defined.

AB - Individuals with psychoses have brain alterations, particularly in frontal and temporal cortices, that may be particularly prominent, already at illness onset, in those more likely to have poorer symptom remission following treatment with the first antipsychotic. The identification of strong neuroanatomical markers of symptom remission could thus facilitate stratification and individualized treatment of patients with schizophrenia. We used magnetic resonance imaging at baseline to examine brain regional and network correlates of subsequent symptomatic remission in 167 medication-naïve or minimally treated patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder entering a three-phase trial, at seven sites. Patients in remission at the end of each phase were randomized to treatment as usual, with or without an adjunctive psycho-social intervention for medication adherence. The final follow-up visit was at 74 weeks. A total of 108 patients (70%) were in remission at Week 4, 85 (55%) at Week 22, and 97 (63%) at Week 74. We found no baseline regional differences in volumes, cortical thickness, surface area, or local gyrification between patients who did or did not achieved remission at any time point. However, patients not in remission at Week 74, at baseline showed reduced structural connectivity across frontal, anterior cingulate, and insular cortices. A similar pattern was evident in patients not in remission at Week 4 and Week 22, although not significantly. Lack of symptom remission in first-episode psychosis is not associated with regional brain alterations at illness onset. Instead, when the illness becomes a stable entity, its association with the altered organization of cortical gyrification becomes more defined.

KW - cortical thickness

KW - first episode

KW - gyrification

KW - MRI

KW - OPTiMiSE

KW - schizophrenia

KW - trial

U2 - 10.1093/schbul/sbaa115

DO - 10.1093/schbul/sbaa115

M3 - Journal article

C2 - 33057670

AN - SCOPUS:85103226491

VL - 47

SP - 444

EP - 455

JO - Schizophrenia Bulletin

JF - Schizophrenia Bulletin

SN - 0586-7614

IS - 2

ER -