MRI Scans May Predict Response to Antipsychotics

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Functional magnetic resonance imaging (fMRI) scans of the brain may make it possible to predict a patient’s response to antipsychotic medications.

Anil Malhotra, MD, Zucker Hillside Hospital, Glen Oaks, N.Y., and colleagues took fMRIs of 41 first-episode schizophrenia patients to develop a prognostic index in a discovery cohort. The group received a resting-state fMRI after starting randomized treatment with a second-generation anti-psychotic.

The results were compared against FMRIs taken from 40 newly hospitalized chronic patients with acute psychosis. Clinical response was calculated that required sustained improvement over two consecutive study visits. Response was entered into a survival analysis, and Cox regression was applied to the functional connectivity data.

A striatal connectivity index was created, comprising functional connections of the striatum — an area of the brain that tends to be abnormal in those suffering from psychosis — that successfully predicted treatment response, the researchers reported in The American Journal of Psychiatry.

When this index was used to confirm their results in the chronic group, they found that treatment outcome could be predicted in this cohort as well.

“This study is the first to report a predictive fMRI-derived measure validated in an independent study group of patients treated with antipsychotics,” Deepak Sarpal, MD, a study author said in a statement. “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.”

3D Brain Scans Could Improve ADHD Diagnoses
Results open the door for "precision medicine" approach to psychiatry.

Investigators at The Feinstein Institute for Medical Research have discovered that brain scans can be used to predict patients' response to antipsychotic drug treatment. The findings are published online in the latest issue of The American Journal of Psychiatry


Psychotic disorders, such as schizophrenia and bipolar disorder, are characterized by delusions, hallucinations, and disorganized thoughts and behavior. They are estimated to occur in up to three percent of the population and are a leading cause for disability worldwide. Psychotic episodes are currently treated with antipsychotic drugs, but this treatment is given without guidance from lab tests or brain scans, such as functional magnetic resonance imaging or functional MRI (fMRI).

Doctors often use "trial-and-error" when choosing treatment for psychotic disorders, without knowing if patients will respond well. This lack of knowledge places a large burden on not only patients and their families, but also healthcare professionals and healthcare systems.

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