Reduced Brain Activity in the Right Putamen as an Early Predictor for Treatment Response in Drug-Naive, First-Episode Schizophrenia.

Renrong Wu,Yangpan Ou,Huabing Li,Wenbin Guo,Jindong Chen,Feng Liu,Xiaoduo Fan,Jingping Zhao

doi:10.3389/fpsyt.2019.00741

Abstract

Antipsychotic medications can have a significant effect on brain function after only several days of treatment. It is unclear whether such an acute effect can serve as an early predictor for treatment response in schizophrenia. Thirty-two patients with drug-naive, first-episode schizophrenia and 32 healthy controls underwent resting-state functional magnetic resonance imaging. Patients were treated with olanzapine and were scanned at baseline and 1 week of treatment. Healthy controls were scanned once at baseline. Symptom severity was assessed within the patient group using the Positive and Negative Syndrome Scale (PANSS) at three time points (baseline, 1 week of treatment, and 8 weeks of treatment). The fractional amplitude of low frequency fluctuation (fALFF) and support vector regression (SVR) methods were used to analyze the data. Compared with the control group, the patient group showed increased levels of fALFF in the bilateral putamen at baseline. After 1week of olanzapine treatment, the patient group showed decreased levels of fALFF in the right putamen relative to those at baseline. The SVR analysis found a significantly positive relationship between the reduction in fALFF after 1 week of treatment and the improvement in positive symptoms after 8 weeks of treatment (r = 0.431, p = 0.014). The present study provides evidence that early reduction and normalization of fALFF in the right putamen may serve as a predictor for treatment response in patients with schizophrenia.

Highlights

IntroductionUp to 30% of patients with schizophrenia respond poorly to current antipsychotic treatment [1]
Antipsychotic medications are the standard treatment for schizophrenia
The present study was the first to explore an early imaging biomarker to predict antipsychotic treatment response in drug-naive, first-episode schizophrenia using a combination of functional magnetic resonance imaging (fMRI) data and pattern classification methods

Summary

Introduction

Up to 30% of patients with schizophrenia respond poorly to current antipsychotic treatment [1]. It is of great clinical value if we can develop a biomarker either before the treatment or during the early treatment course to predict clinical outcome. Antipsychotic treatment modulates intrinsic brain activity in the cortical (i.e., the prefrontal cortex and anterior cingulate cortex) and subcortical regions (i.e., the basal ganglia and amygdala) in patients with schizophrenia, which constitute the thalamocortical network [6, 7, 8, 9]. Lui et al observed a significant relationship between improvement in clinical symptoms and alterations of brain activity in drug-naive, first-episode schizophrenia [13]. Another study suggested that prefrontal lobe dysfunction predicts treatment response in drug-naive, first-episode schizophrenia [14]

Methods

Results

Conclusion