title: Magnetic resonance imaging and the prediction of outcome in first-episode schizophrenia: a review of current evidence and directions for future research.
abstract: Magnetic Resonance Imaging (MRI) measures are promising outcome markers for schizophrenia, since regional frontal and temporal grey matter volumes reductions, and enlargement of the ventricles, have been associated with outcome in this disorder. However, a number of methodological issues have limited the potential clinical utility of these findings. This article reviewed studies that examined brain structure at illness onset as a predictor of outcome, discusses the limitations of the findings, and highlights the challenges that would need to be addressed if structural data are to inform the management of an individual patient.
  
  
  METHODS
  Using a set of a priori criteria, we systematically searched Medline and EMBASE databases for articles evaluating brain structure at the time of the first psychotic episode and assessed response to treatment, symptomatic outcome, or functional outcome at any point in the first 12 months of illness.
  
  
  RESULTS
  The 11 studies identified suggest that alterations in medial temporal and prefrontal cortical areas, and in the networks that connect them with subcortical structures, are promising neuroanatomical markers of poor symptomatic and functional outcomes.
  
  
  CONCLUSIONS
  Neuroimaging data, possibly in combination with other biomarkers of disease, could help stratifying patients with psychoses to generate patient clusters clinically meaningful, and useful to detect true therapeutic effects in clinical trials. Optimization of Treatment and Management of Schizophrenia in Europe (OPTiMiSE), a large multicenter study funded by the FP7 European Commission, could generate these much-needed findings.
authors: Department of Psychosis Studies, Institute of Psychiatry; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; paola.dazzan@kcl.ac.uk.
authors: Paola
authors: P
authors: Dazzan
authors: Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain;
authors: Celso
authors: C
authors: Arango
authors: Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Austria;
authors: Wolfgang
authors: W
authors: Fleischacker
authors: University of Naples SUN, Largo Madonna delle Grazie, Naples, Italy;
authors: Silvana
authors: S
authors: Galderisi
authors: Faculty of Health and Medical Sciences, Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, University of Copenhagen, Copenhagen, Denmark;
authors: Birte
authors: B
authors: Glenthøj
authors: Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany;
authors: Stephan
authors: S
authors: Leucht
authors: Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany;
authors: Andreas
authors: A
authors: Meyer-Lindenberg
authors: Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands;
authors: Rene
authors: R
authors: Kahn
authors: Department of Psychiatry, University of Halle, Halle, Germany.
authors: Dan
authors: D
authors: Rujescu
authors: Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands;
authors: Iris
authors: I
authors: Sommer
authors: Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands;
authors: Inge
authors: I
authors: Winter
authors: Department of Psychosis Studies, Institute of Psychiatry; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors: Philip
authors: P
authors: McGuire
mesh_terms: D001921:Brain / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000473:pathology* / Q000628:therapy*
keywords: MRI; OPTiMiSE; brain structure; psychosis; treatment response