Gyrification unfolds psychosis treatment response
By Eleanor McDermid, Senior medwireNews Reporter
20 August 2013
JAMA Psychiatry 2013; Advance online publication

medwireNews: A study assessing cortical folding, or gyrification, offers a way to predict which patients with first-episode psychosis will respond to treatment with antipsychotics.

Using “unbiased” whole-brain measurements, Lena Palaniyappan (University of Nottingham, UK) and team found that patients who failed to respond within 12 weeks of starting treatment had significant reductions in cortical folding (hypogyria) across multiple regions, relative to healthy controls.

“The potential of neuroimaging studies to provide measures of translational importance in predicting treatment response and reducing the duration of psychotic episodes has become paramount,” the researchers write in JAMA Psychiatry.

They say: “Our study provides crucial evidence of neuroimaging markers that can be used early in psychosis to predict prognosis in clinical settings. Identifying putative poor responders at the outset could assist in stratified treatment plans at an individual level and with appropriate resource allocation at the service level.”

Forty of 80 patients in the study achieved clinical remission within 12 weeks of starting antipsychotic treatment. These patients had significant hypogyria of the left lingual gyrus when compared with 46 mentally healthy controls, but no other differences.

Patients who did not respond to treatment also had hypogyria in the left lingual gyrus, as well as in many other regions, including the bilateral middle frontal gyrus and the right superior/inferior temporal cortex, angular gyrus, and medial occipital cortex. They also had significant hypogyria in multiple regions relative to responders.

Nonresponders had similar widespread hypogyria regardless of whether they had an affective or nonaffective diagnosis. By contrast, responders with nonaffective psychosis had significantly reduced gyrification across several areas relative to those with affective psychosis. This is “in line with the notion of greater neurodevelopmental deficits in schizophrenia than affective psychosis,” note the researchers.

Palaniyappan et al observe that gyrification is likely closely associated with brain connectivity, implying more neurodevelopmental abnormalities in psychosis patients who do not respond to treatment. “Relevant to this notion is the observation that neurological soft signs, often considered to be an index of neurodevelopmental disturbances in schizophrenia, are related to both reduced gyrification and poor response to antipsychotics in psychosis,” they add.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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