 |
|
Prediction of Functional Outcome 18 Months After a First Psychotic Episode
A Proton Magnetic Resonance Spectroscopy Study
Stephen J. Wood, PhD;
Gregor E. Berger, MD;
Martin Lambert, MD;
Phillipe Conus, MD;
Dennis Velakoulis, FRANZCP;
Geoffrey W. Stuart, PhD;
Patricia Desmond, MD;
Patrick D. McGorry, PhD;
Christos Pantelis, MD
Arch Gen Psychiatry. 2006;63:969-976.
Context Recent magnetic resonance imaging studies have attempted to relate volumetric brain measurements in early schizophrenia to clinical and functional outcome some years later. These studies have generally been negative, perhaps because gray and white matter volumes inaccurately assess the underlying dysfunction that might be predictive of outcome.
Objective To investigate the predictive value of frontal and temporal spectroscopy measures for outcome in patients with first-episode psychoses.
Design Left prefrontal cortex and left mediotemporal lobe voxels were assessed using proton magnetic resonance spectroscopy to provide the ratio of N-acetylaspartate (NAA) and choline-containing compounds to creatine and phosphocreatine (Cr) (NAA/Cr ratio). These data were used to predict outcome at 18 months after admission, as assessed by a systematic medical record audit.
Setting Early psychosis clinic.
Participants Forty-six patients with first-episode psychosis.
Main Outcome Measures We used regression models that included age at imaging and duration of untreated psychosis to predict outcome scores on the Global Assessment of Functioning Scale, Clinical Global Impression scales, and Social and Occupational Functional Assessment Scale, as well as the number of admissions during the treatment period. We then further considered the contributions of premorbid function and baseline level of negative symptoms.
Results The only spectroscopic predictor of outcome was the NAA/Cr ratio in the prefrontal cortex. Low scores on this variable were related to poorer outcome on all measures. In addition, the frontal NAA/Cr ratio explained 17% to 30% of the variance in outcome.
Conclusions Prefrontal neuronal dysfunction is an inconsistent feature of early psychosis; rather, it is an early marker of poor prognosis across the first years of illness. The extent to which this can be used to guide treatment and whether it predicts outcome some years after first presentation are questions for further research.
Author Affiliations: Melbourne Neuropsychiatry Centre, University of Melbourne (Drs Wood, Velakoulis, Stuart, and Pantelis); Brain Research Institute (Dr Wood); ORYGEN Research Centre (incorporating the Early Psychosis Prevention and Intervention Centre) (Drs Berger, Lambert, Conus, and McGorry); and Department of Radiology, Royal Melbourne Hospital (Dr Desmond), Melbourne, Australia.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Neuroimaging and other neurobiological indices in schizophrenia: relationship to measurement of functional outcome
Waddington
Br. J. Psychiatry 2007;191:s52-s57.
ABSTRACT
| FULL TEXT
|
