Altered Cortical Gyrification as a Marker of Treatment Resistance in Patients with First-Episode P
Poster No:
501
Submission Type:
Abstract Submission
Authors:
Moonyoung Jang1, Jun Soo Kwon2, Minah Kim1
Institutions:
1Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Seoul, 2Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Seoul
First Author:
Co-Author(s):
Jun Soo Kwon
Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences
Seoul, Seoul
Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences
Seoul, Seoul
Introduction:
Predicting resistance to drug treatment in the early stages of schizophrenia can improve patient outcomes and ultimately enable more personalized therapies, potentially leading to healthcare cost savings. Currently, there is no biomarker that accurately predicts the prognosis of first-episode psychosis patients. Alterations in gyrification represent abnormal neurodevelopmental processes and have the potential to identify treatment resistance at the onset of the illness. However, only a few studies have explored the gyrification patterns of first-episode psychosis, and none of them suggested alterations in gyrification as a predictive marker of treatment resistance. This study aims to investigate cortical gyrification as a viable biomarker candidate for predicting resistance to drug treatment in the first-episode of schizophrenia.
Methods:
A cohort of 101 individuals diagnosed with first-episode psychosis and an equivalent number of age- and sex-matched healthy controls underwent T1-weighted magnetic resonance imaging scans immediately after their initial contact. Patients received treatment in a naturalistic clinical setting, and treatment resistance was assessed at the last follow-up. Treatment resistance was defined as either taking clozapine or exhibiting moderate to severe symptoms despite of taking more than two types of antipsychotics in sufficient amounts and duration at their last follow-up point, based on Treatment Response and Resistance in Psychosis Working Group Consensus criteria. Cortical gyrification was calculated using the local gyrification index in a vertex-wise manner across the entire cortical surface, employing Freesurfer pipeline. Local gyrification indices were compared across treatment-resistant patients, non-treatment-resistant patients, and healthy controls.
Results:
Patients with first-episode psychosis exhibited hypogyria compared to healthy controls in three clusters: (1) precuneus, cuneus, and lingual gyrus, (2) precentral and postcentral gyrus, and (3) insula. Patients classified as treatment-resistant showed significant reduction in cortical gyrification compared to healthy controls in a cluster including precuneus, cuneus, and lingual gyri. Meanwhile, patients not categorized as treatment-resistant exhibited significantly reduced cortical gyrification compared to healthy controls in a cluster including precentral and postcentral areas (all clusters significant at P < 0.05).
Conclusions:
The present study revealed that the treatment-resistant group exhibited hypogyria in the parieto-occipital region, consistent with previous findings in patients with first-episode psychosis who showed poor response to initial antipsychotic treatments and in asymptomatic individuals at a genetic high risk for schizophrenia. Conversely, patients not classified as treatment-resistant exhibited hypogyria in the fronto-parietal region, aligning with previous findings in first-episode psychosis patients. The observed disparities in gyrification patterns between the two groups suggest the presence of discrete neurodevelopmental anomalies underlying these distinct groups. These findings indicate that cortical gyrification may serve as a promising biomarker for early prediction of treatment resistance in conventional antipsychotic interventions within the context of psychotic disorders.
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 1
Neuroanatomy, Physiology, Metabolism and Neurotransmission:
Cortical Anatomy and Brain Mapping
Novel Imaging Acquisition Methods:
Anatomical MRI 2
Keywords:
Cortex
MRI
Psychiatric
Psychiatric Disorders
Schizophrenia
STRUCTURAL MRI
1|2Indicates the priority used for review
Provide references using author date format
Das, T., et al. (2018), 'Disorganized Gyrification Network Properties During the Transition to Psychosis', JAMA Psychiatry, 75 (6), 613-22.
Fond, G., et al. (2015), 'The promise of biological markers for treatment response in first-episode psychosis: a systematic review', Schizophr Bull, 41 (3), 559-73.
Howes, O. D., et al. (2017), 'Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology', Am J Psychiatry, 174 (3), 216-29.
Palaniyappan, L., et al. (2013), 'Cortical folding defects as markers of poor treatment response in first-episode psychosis', JAMA Psychiatry, 70 (10), 1031-40.
Park, I., et al. (2021), 'Reduced cortical gyrification in the posteromedial cortex in unaffected relatives of schizophrenia patients with high genetic loading', NPJ Schizophr, 7 (1), 17.
Sasabayashi, D., et al. (2020), 'Increased brain gyrification in the schizophrenia spectrum', Psychiatry Clin Neurosci, 74 (1), 70-76.
Schaer, M., et al. (2008), 'A surface-based approach to quantify local cortical gyrification', IEEE Trans Med Imaging, 27 (2), 161-70.