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Baseline Frontoparietal Task-Related BOLD Activity as a Predictor of Improvement in Clinical Symptoms at 1-Year Follow-Up in Recent-Onset Psychosis
American Journal of Psychiatry ( IF 17.7 ) Pub Date : 2019-07-01 , DOI: 10.1176/appi.ajp.2019.18101126
Jason Smucny 1 , Tyler A. Lesh 1 , Cameron S. Carter 1
Affiliation  

Objective:

The early course of illness in psychotic disorders is highly variable, and predictive biomarkers of treatment response have been lacking. Trial and error remains the basis for care in early psychosis, and poor outcomes are common. Early prediction of nonimprovement in response to treatment could help identify those who would benefit from alternative and/or supplemental interventions. The goal of this study was to evaluate the ability of functional MRI (fMRI) measures of cognitive control–related brain circuitry collected at baseline to predict symptomatic response in patients after 1 year.

Methods:

Patients with recent-onset (<2 years) psychotic disorders (N=82) in early psychosis specialty care were classified as improvers (>20% improvement in total score on the Brief Psychiatric Rating Scale [BPRS] at 1-year follow-up compared with baseline) or as nonimprovers. Behavioral (d′ context) and fMRI (proactive control–associated activation in a priori frontoparietal regions of interest) measures of cognitive control were then evaluated on their ability to predict BPRS improvement using linear and logistic regression.

Results:

Cognitive control–associated measures significantly predicted BPRS improvement and improver status, with 70% positive predictive value, 60% negative predictive value, and 66% accuracy. Only the fMRI-based measure (and not the behavioral measure) significantly predicted status.

Conclusions:

These results suggest that frontoparietal activation during cognitive control performance at baseline significantly predicts subsequent symptomatic improvement during early psychosis specialty care. Potential implications for fMRI-based personalized patient treatment are discussed.



中文翻译:

基线额腹前任务相关的大胆活动,作为近期发作的精神病患者一年随访中临床症状改善的预测指标

客观的:

精神病性疾病的早期病程变化很大,并且缺乏治疗反应的预测性生物标志物。反复试验仍然是早期精神病患者护理的基础,而且预后很差。对治疗无改善的早期预测可以帮助确定那些将从替代和/或补充干预中受益的人。这项研究的目的是评估基线时收集的与认知控制相关的脑回路的功能性MRI(fMRI)量度,以预测1年后患者的症状反应的能力。

方法:

早期精神病专科护理中新近发作(<2年)的精神病患者(N = 82)被归为改善者(在1年随访中,简易精神病学评分表[BPRS]的总得分提高了20%以上)与基线相比)或作为非改进者。然后,通过线性和逻辑回归评估认知控制的行为(d'情境)和功能核磁共振成像(功能性先天性额叶前额叶区域中的主动控制相关激活)的预测措施,以评估其预测BPRS改善的能力。

结果:

认知控制相关的措施可显着预测BPRS的改善和改善者的状态,阳性预测值为70%,阴性预测值为60%,准确度为66%。只有基于功能磁共振成像的量度(而非行为量度)可以显着预测状态。

结论:

这些结果表明,基线认知控制期间的额前额叶激活明显预测了早期精神病专科护理期间的症状改善。讨论了基于fMRI的个性化患者治疗的潜在含义。

更新日期:2019-10-01
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