MRI May Provide Biomarker in Antipsychotic Drug Treatment

Magnetic resonance imaging may predict patient response to antipsychotic drug treatment, according to a study published in The American Journal of Psychiatry.

Researchers from The Feinstein Institute for Medical Research in Manhasset, NY, sought to determine if intrinsic striatal connectivity patterns provided prognostic information, potentially serving as a potential biomarker of treatment response to antipsychotic drugs.

The researchers developed a prognostic index among a cohort of patients who had been newly diagnosed with schizophrenia (the discovery cohort). This index was then tested in newly hospitalized chronic patients with acute psychosis (independent cohort).[[{"type":"media","view_mode":"media_crop","fid":"42207","attributes":{"alt":"Deepak Sarpal, MD","class":"media-image media-image-right","id":"media_crop_8759068121807","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4546","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Deepak Sarpal, MD","typeof":"foaf:Image"}}]]

The patients in the discovery cohort underwent resting-state fMRI when they began randomized controlled treatment with a second-generation antipsychotic. “Whole-brain functional connectivity maps were generated for each subject from striatal seed regions,” the authors wrote. “A stringent measure of clinical response was calculated that required sustained improvement over two consecutive study visits.”

The striatal connectivity was created, comprising functional connections of the striatum that predicted treatment response. The researchers then tested this striatal connectivity index on the independent cohort.

The results showed that 91 regions that were functionally connected with the striatum provided significant prognostic information. “Connectivity in these regions was used to create a baseline striatal connectivity index that predicted response to antipsychotic treatment with high sensitivity and specificity in both the discovery and generalizability cohorts,” the authors wrote.

"This study is the first to report a predictive fMRI-derived measure validated in an independent study group of patients treated with antipsychotics," lead author Deepak Sarpal, MD, said in a release. "The results we found from this study open the door for contemporary 'precision medicine' approaches to psychiatry, and more specifically, the use of fMRI scans as important players in the treatment of psychiatric disorders."