title: Distinguishing prodromal from first-episode psychosis using neuroanatomical single-subject pattern recognition.
abstract: BACKGROUND
  The at-risk mental state for psychosis (ARMS) and the first episode of psychosis have been associated with structural brain abnormalities that could aid in the individualized early recognition of psychosis. However, it is unknown whether the development of these brain alterations predates the clinical deterioration of at-risk individuals, or alternatively, whether it parallels the transition to psychosis at the single-subject level.
  
  
  METHODS
  We evaluated the performance of an magnetic resonance imaging (MRI)-based classification system in classifying disease stages from at-risk individuals with subsequent transition to psychosis (ARMS-T) and patients with first-episode psychosis (FE). Pairwise and multigroup biomarkers were constructed using the structural MRI data of 22 healthy controls (HC), 16 ARMS-T and 23 FE subjects. The performance of these biomarkers was measured in unseen test cases using repeated nested cross-validation.
  
  
  RESULTS
  The classification accuracies in the HC vs FE, HC vs ARMS-T, and ARMS-T vs FE analyses were 86.7%, 80.7%, and 80.0%, respectively. The neuroanatomical decision functions underlying these discriminative results particularly involved the frontotemporal, cingulate, cerebellar, and subcortical brain structures.
  
  
  CONCLUSIONS
  Our findings suggest that structural brain alterations accumulate at the onset of psychosis and occur even before transition to psychosis allowing for the single-subject differentiation of the prodromal and first-episode stages of the disease. Pattern regression techniques facilitate an accurate prediction of these structural brain dynamics at the early stage of psychosis, potentially allowing for the early recognition of individuals at risk of developing psychosis.
authors.affiliation: Department of Psychiatry, University of Basel, Basel, Switzerland. sborgwardt@uhbs.ch
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koutsouleris
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Aston
authors.forename: Erich
authors.initials: E
authors.lastname: Studerus
authors.forename: Renata
authors.initials: R
authors.lastname: Smieskova
authors.forename: Anita
authors.initials: A
authors.lastname: Riecher-Rössler
authors.forename: Eva M
authors.initials: EM
authors.lastname: Meisenzahl
mesh_terms: D000328:Adult; D001185:Artificial Intelligence; D015415:Biomarkers; D054022:Cerebrum / Q000033:anatomy & histology / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000145:classification / Q000473:pathology*; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers