Using structural magnetic resonance imaging (MRI), researchers found that the folding patterns in the brain could act as “markers,” or biological predictors, of whether a person experiencing his or her first psychotic episode will respond to medication. Psychosis involves symptoms such as hallucinations, hearing voices or delusions (unshakeable beliefs based on the person’s altered perception of reality, which may not correspond to the way others see the world). Psychotic episodes are present in conditions such as schizophrenia and bipolar disorder and many patients do not respond to the initial treatment, putting them at serious risk of further psychotic episodes and deteriorating mental health.
Three-time NARSAD Grantee, Paola Dazzan, M.Sc., Ph.D., of King's College London, is senior author of the paper describing the findings, published on August 14th in JAMA Psychiatry. “Our study provides crucial evidence of a neuroimaging marker that, if validated, could be used early in psychosis to help identify those people less likely to respond to medications,” she says.
The study involved 126 individuals, 80 of whom were experiencing their first episode of psychosis (FEP) and 46 of whom were healthy “controls.” Participants were given MRI scans shortly after their FEP and again 12 weeks later to determine whether symptoms had improved with antipsychotic medication treatment. The researchers examined “cortical gyrification” - the extent of folding in the cerebral cortex, the outermost sheet of brain tissue that plays a key role in memory, language and consciousness. Individuals who did not respond to the medication showed a significant reduction in gyrification across multiple brain regions, particularly in areas considered important in psychosis, such as the temporal and frontal lobes. Gyrification in those who responded to treatment was virtually indistinguishable from the healthy controls.
Dr. Dazzan explains the importance of the findings: “We could envisage using a marker like this one to identify people who are least likely to respond to existing medications and focus our efforts on developing new medications specifically adapted to this group. In the longer term, if we were able to identify poor responders at the outset, we may be able to formulate personalized treatment plans for that individual patient.”
Read the press release from King's College London