Cortical folding defects as markers of poor treatment response in first-episode psychosis.
OBJECTIVE
At present, no reliable predictors exist to distinguish future responders from nonresponders to treatment during the first episode of psychosis. Among potential neuroimaging predictors of treatment response, gyrification represents an important marker of the integrity of normal cortical development that may characterize, already at illness onset, a subgroup of patients with particularly poor outcome.


OBJECTIVE
To determine whether patients with first-episode psychosis who do not respond to 12 weeks of antipsychotic treatment already have significant gyrification defects at illness onset.


METHODS
Case-control study with 12 weeks' longitudinal follow-up to determine treatment response.


METHODS
Secondary psychiatric services in an inner-city area (South London, England).


METHODS
A total of 126 subjects, including 80 patients presenting with first-episode psychosis and 46 healthy controls. Patients were scanned at the outset and received various antipsychotic medications in a naturalistic clinical setting. They were followed up for 12 weeks and classified as responders or nonresponders if they reached criteria for symptom remission, evaluated with the Psychiatric and Personal History Schedule.


METHODS
Patients were exposed to naturalistic antipsychotic treatment for 12 weeks following a magnetic resonance imaging scan.


METHODS
Cortical gyrification was assessed using local gyrification index in a vertexwise fashion across the entire cortical surface with correction for multiple testing using permutation analysis. Differences in local gyrification index were assessed between responders, nonresponders, and healthy controls. The effect of diagnosis (affective vs nonaffective psychosis) on the local gyrification index was also investigated in responders and nonresponders.


RESULTS
Patients with first-episode psychosis showed a significant reduction in gyrification (hypogyria) across multiple brain regions compared with healthy controls. Interestingly, nonresponders showed prominent hypogyria at bilateral insular, left frontal, and right temporal regions when compared with responders (all clusters significant at P < .05). These effects were present for both affective and nonaffective psychoses.


CONCLUSIONS
Gyrification appears to be a useful predictor of antipsychotic treatment response. Early neurodevelopmental aberrations may predict unfavorable prognosis in psychosis, irrespective of the existing diagnostic boundaries.
Translational Neuroimaging, Division of Psychiatry, Institute of Mental Health, University of Nottingham and Nottinghamshire Healthcare National Health Service Trust, Nottingham, England.
Lena
L
Palaniyappan
Tiago Reis
TR
Marques
Heather
H
Taylor
Rowena
R
Handley
Valeria
V
Mondelli
Stefania
S
Bonaccorso
Annalisa
A
Giordano
Grant
G
McQueen
Marta
M
DiForti
Andrew
A
Simmons
Anthony S
AS
David
Carmine M
CM
Pariante
Robin M
RM
Murray
Paola
P
Dazzan
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D059906:Neuroimaging; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D017211:Treatment Failure
D014150:Antipsychotic Agents