Duration of Untreated Psychosis Correlates With Brain Connectivity and Morphology in Medication-Naïve Patients With First-Episode Psychosis.
Duration of Untreated Psychosis Correlates With Brain Connectivity and Morphology in Medication-Naïve Patients With First-Episode Psychosis.
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DOI：
10.1016/j.bpsc.2019.10.014
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发表时间：
2020-02
期刊：
影响因子：
--
通讯作者：
Lahti AC
中科院分区：
文献类型：
--
作者：
Maximo JO;Nelson EA;Armstrong WP;Kraguljac NV;Lahti AC
在美国，未治疗精神病（DUP）的平均持续时间为21个月，目前尚不清楚DUP对antipsychotic-naïve首发精神病（FEP）患者脑功能的影响时间。我们的目的是确定DUP对静息状态功能和结构MRI测量的功能连通性和脑形态的影响。Medication-naïve FEP患者来自不同的临床环境。在考虑排除标准、损耗和数据质量后，最终分析纳入55例患者（35M/20F，平均年龄24.18岁）。FEP患者接受了为期16周的利培酮试验，利培酮是一种常用的抗精神病药物。治疗反应通过BPRS精神病量表在基线至16周之间的变化来计算。静息状态功能连通性MRI和脑形态学（表面积和皮质厚度）进行评估。较长的DUP与较差的治疗反应和功能连接减少有关-更具体地说，在默认，突出和执行网络中。此外，较长的DUP与显著性和执行网络表面积的减少以及默认模式和显著性网络皮质厚度的增加有关。当加入默认模式网络的功能连通性作为中介时，DUP与治疗反应之间的关系不再显著。我们的数据表明，以功能连接和表面积减少以及皮质厚度增加的形式出现的几种神经生物学改变支撑了延长DUP的影响。
In the United States, the average duration of untreated psychosis (DUP) is 21 months and it remains unknown how longer DUP may affect brain functioning in antipsychotic-naïve patients with first episode psychosis (FEP). Our objective was to determine the effects of DUP on functional connectivity and brain morphology measured with resting state functional and structural MRI. Medication-naïve FEP patients were referred from various clinical settings. After accounting for exclusion criteria, attrition, and data quality, final analyses included 55 patients (35M/20F; mean age of 24.18 years). FEP patients were subjected to a 16-week trial of risperidone, a commonly used antipsychotic drug. Treatment response was calculated as change in the BPRS psychosis subscale between baseline and 16 weeks. Resting state functional connectivity MRI and brain morphology (surface area and cortical thickness) were assessed. Longer DUP was associated with worse treatment response and reduced functional connectivity – more specifically in default, salience, and executive networks. Moreover, longer DUP was associated with reduced surface area in salience and executive networks and with increased cortical thickness in default mode and salience networks. When the functional connectivity of the default mode network was added as a mediator, the relationship between DUP and treatment response was no longer significant. Our data suggest that several neurobiological alterations in the form of reduced functional connectivity and surface area and increased cortical thickness underpin the effect of prolonged DUP.
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