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Symptom remission and brain cortical networks at first clinical presentation of psychosis: the OPTiMiSE study

Research output: Contribution to journalArticle

Original languageEnglish
JournalSchizophrenia Bulletin
Publication statusAccepted/In press - 31 Jul 2020

King's Authors

Abstract

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 individualised treatment of patients with schizophrenia.

We used Magnetic Resonance Imaging (MRI) 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. Final follow-up visit was at 74 weeks.

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 altered organisation of cortical gyrification becomes more defined.

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