This article is more than 5 years old. Information may no longer be current.

Intrinsic striatal connectivity patterns may predict treatment response in individuals with acute psychosis

Individual differences in striatal functional connectivity predicted response to antipsychotic treatment among individuals with acute psychotic illness, according to study findings in the American Journal of Psychiatry.

“Antipsychotic drugs are the mainstay of treatment for psychosis, yet they are associated with substantial heterogeneity in their therapeutic efficacy. Nonresponse to standard antipsychotic agents contributes to poor functional outcomes and a large economic impact on health care systems, including up to a tenfold increase in total health resource utilization. Treatment algorithms for these illnesses are devoid of prognostic measures, and clinicians often resort to trial and error when faced with the potential inefficacy of their treatment choices,” Deepak K. Sarpal, MD, of the North Shore-LIJ Health System in Glen Oaks, New York, and colleagues wrote.

Researchers used resting-state functional MRI to develop a prognostic index among a discovery cohort of 41 individuals with first-episode schizophrenia and then tested the index among an independent generalizability cohort of 40 individuals newly hospitalized with chronic acute psychosis.

The discovery cohort underwent resting-state MRI scanning at initiation of randomized controlled treatment with a second-generation antipsychotic. Whole-brain functional connectivity maps were derived from striatal seed regions for each participant. Clinical response, which required sustained improvement over two consecutive study visits, was measured and then entered into a survival analysis where Cox regression was applied to functional connectivity data.

Overall, 91 regions functionally connected to the striatum provided significant prognostic information, according to researchers.

Connectivity in these regions was used to create a baseline striatal connectivity index that predicted response to antipsychotic treatment. The striatal connectivity index predicted treatment response with high sensitivity and specificity in both the discovery and generalizability cohorts.

“In this study, we provide evidence for a potential baseline resting-state [functional] MRI biomarker that predicts response to treatment with antipsychotic drugs in patients with psychotic disorders,” Sarpal and colleagues wrote. “We describe a potential prognostic biomarker of response to antipsychotic medication in patients entering treatment for psychosis. With further development, the striatal connectivity index may have clinical utility, and with subsequent integration with clinical algorithms available to prescribers, it has the potential to decrease the overall suffering of patients and their families, and to decrease the strain on our health care systems.” – by Amanda Oldt

Disclosure: Sarpal reports receiving research support from Janssen Pharmaceutical. Please see the full study for a list of all authors’ relevant financial disclosures.