Magnetic Resonance Imaging Predictors of Treatment Response in First-Episode Schizophrenia

White Matter Changes Associated with Antipsychotic Treatment in First-Episode Psychosis

“…These abnormalities were associated with impaired processing speed. Moreover, we reported previously that compared with patients with schizophrenia, who did not respond to antipsychotic treatment, those who did respond had more pronounced abnormalities in the occipital regions (Szeszko et al, 2012). Thus, we hypothesize that occipital FA changes may be a potentially important consideration in identifying treatment targets in schizophrenia.…”

The neurobiology of transition to psychosis

“…30 Grey matter increase in patients with psychosis has now been reported in both crosssectional studies of treated [31][32][33] and neuroleptic-naive patients 34,35 and in longitudinal studies [36][37][38][39][40][41] in which patients were treated with antipsychotics. Dukart and colleagues report that a medium to large effect size of increase in grey matter tissue can occur even before the onset of psychosis in individuals with ARMS.…”

“…[92][93][94] Consistent with this notion, using 7 T magnetization transfer imaging in conjunction with 3 T diffusion tensor imaging, we reported significant reduction in myelin affecting both white matter and cortical grey matter in the occipitotemporal cortex in a medicated group of patients with schizophrenia. 95 Interestingly, Dukart and colleagues and others who observed increased grey matter in individuals with psychosis 30,31,32 report increased grey matter in overlapping occipitotemporal regions.…”

“…A more directly relevant observation is the association between higher occipital grey matter tissue and a favourable treatment response in individuals with psychosis. 31 In a cross-sectional sample of 93 antipsychotic-treated patients at various clinical stages of schizophrenia, we previously reported that the brain regions showing pronounced grey matter deficits in medicated early-stage patients had notably reduced deviation from controls in medicated laterstage samples, thus having the effect of "closing the gap." 30 We also noted a higher than expected covariance between regions with reduced thickness and regions with increased thickness, suggesting that the processes leading to grey matter loss in some regions and grey matter increase in the others are intricately linked in schizophrenia.…”

Overdiagnosis in the Era of Neuropsychiatric Imaging

“…For example, response to therapy for depression has been associated with baseline resting state network activity (75) and regional white matter integrity (72). Response to antipsychotic therapy has been associated with decreased white matter integrity and volume reduction in several regions (76)(77)(78)(79)(80)(81)(82). Response to cognitive behavioral therapy in PTSD has been associated with anterior cingulate activity and volume, as well as amygdala activity (83,84).…”