Brain Scanning Has Potential to Predict Outcome of Psychotic Episodes

The new findings could help physicians make more effective decisions about the best way to treat patients.

Psychosis is a disorder that affects people’s minds, altering the way they think, feel and behave. It can be accompanied by hallucinations and delusions. The most common forms are part of mental health illnesses such as schizophrenia and bipolar disorder, but symptoms of psychosis can also occur in disorders 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 well and lead a normal life. At present, psychiatrists have no distinct method of evaluating an individual’s risk of future episodes and predicting how the disease will progress. This is significant in terms of guiding patients’ and their clinicians’ choices about appropriate treatments.

Now, a study led by Dr. Paola Dazzan and Dr. Janaina Mourao-Miranda from the Institute of Psychiatry, King’s College London (UK) in collaboration with the computer science department at University College London (UK), and published November 9, 2011, in the journal Psychological Medicine reported the successful use of computer algorithms to analyze MRI scans and predict a patient’s outcome.

Algorithms that quantify the risk of additional episodes of disease are common in areas of medicine such as cardiovascular medicine and oncology, but no accurate tests are available to psychiatrists. Researchers have previously used MRI to predict outcome in psychosis, based on the analysis of specific brain regions. However, the changes in the brain tied topsychosis are frequently subtle and difficult to detect, and these approaches have therefore been of limited benefit for clinical practice.

Dr. 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. Moreover, 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 studied scans from 28 individuals with a continuous course of illness, the same number from patients with an episodic course and again, the same number from healthy controls. They used these scans as data to “train” software developed by a group led by Dr. Mourao-Miranda-based on pattern recognition and 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 Dr. Mourao-Miranda, a Wellcome Trust Research career development fellow. The research funded by the Medical Research Council and the Wellcome Trust (both based in London, UK). “This suggests that even by the time that they have their first episode of psychosis, significant changes have already occurred to their brains.”

“This is the first step towards being able to use brain imaging to provide tangible benefit to patients affected by psychosis,” stated Dr. 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.”

Related Links:
Institute of Psychiatry, King’s College London
University College London