Paola Dazzan

What can brain scans tell about outcomes in psychosis?

Difficulties in the prediction of outcome after the onset of psychosis are linked to the high clinical and biological heterogeneity of this disorder. Epidemiological cohort studies of first episode psychosis have mostly been limited to prevalence samples with schizophrenia only, which tend to have an over-representation of patients with poorer outcomes and an under-representation of those who do not remain in treatment. Also, attempts to characterise neurobiological predictors of outcome have been confounded by the lack of standardised treatment protocols in the samples investigated, and by the paucity of strong biological markers.

What these studies have shown however is that there are brain structural alterations in psychosis, subtle and diffuse, and evident in both affective and non-affective psychoses, and possibly more so in a subgroup of patients with particularly poor outcome. To achieve a more detailed definition of the neurobiological subtypes associated with poorer (or better) clinical outcomes, that are useful at individual level, data from large epidemiological, multi-centre MRI studies, using integrated clinical trial approaches should be used.

This presentation will discuss evidence from large multicentre epidemiological and neuroimaging studies, conducted in multiple datasets of patients evaluated at their first episode of psychosis, and followed up clinically from 1 month to 10 years.

Data from these studies suggest that while multiple, integrated approaches can help define subtypes of psychosis, there are a number of challenges, of which biological heterogeneity is one, that should be addressed to improve our ability to identify clinically meaningful and useful neurobiological subtypes of psychosis.