Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes.
Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes.
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DOI：
10.1016/j.biopsych.2022.03.021
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发表时间：
2022-10-01
影响因子：
10.6
通讯作者：
中科院分区：
文献类型：
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确定基于神经生物学的抑郁症和精神病的跨诊断类别可能会阐明异质性，并为预测性建模提供更好的候选者。我们的目标是根据结构性神经成像数据确定新近发病的抑郁症(Rod)和新近发病的精神病(ROP)患者的聚集性。我们假设，这些跨诊断簇将识别结果较差的患者，并允许比传统诊断结构更准确地预测症状缓解。Hydra(通过判别分析实现的异质性)从多站点Pronia研究的发现样本中挑选了577名参与者进行了全脑体积测量培训，以确定神经生物学驱动的簇，然后在Pronia复制样本(n=404)和三个慢性样本的数据集(卓越生物医学研究中心，n=146；精神临床成像联盟，n=202；慕尼黑，n=470)中进行外部验证。最佳的分群方案是两个经诊断的群(群1：N=153，67ROP，86 ROD；群2：N=149，88 ROP，61 ROD；调整的Rand指数=0.618)。这两组患者既包括ROP患者，也包括Rod患者。一组有广泛的灰质体积缺陷以及更多的阳性、阴性和功能缺陷(受损组)，另一组显示出更保留的神经解剖学特征和更核心的抑郁症状(保留组)。集群解决方案在预测9个月症状缓解方面进行了内部和外部验证和临床实用评估，表现优于传统的诊断结构。我们确定了两个跨诊断神经解剖学信息簇，它们在临床和生物学上是截然不同的，挑战了新近发病的精神健康障碍的当前诊断界限。这些结果可能有助于通过诊断了解不良预后患者的病因，并促进分层治疗的发展。
Identifying neurobiologically based transdiagnostic categories of depression and psychosis may elucidate heterogeneity and provide better candidates for predictive modeling. We aimed to identify clusters across patients with recent-onset depression (ROD) and recent-onset psychosis (ROP) based on structural neuroimaging data. We hypothesized that these transdiagnostic clusters would identify patients with poor outcome and allow more accurate prediction of symptomatic remission than traditional diagnostic structures. HYDRA (Heterogeneity through Discriminant Analysis) was trained on whole-brain volumetric measures from 577 participants from the discovery sample of the multisite PRONIA study to identify neurobiologically driven clusters, which were then externally validated in the PRONIA replication sample (n = 404) and three datasets of chronic samples (Centre for Biomedical Research Excellence, n = 146; Mind Clinical Imaging Consortium, n = 202; Munich, n = 470). The optimal clustering solution was two transdiagnostic clusters (cluster 1: n = 153, 67 ROP, 86 ROD; cluster 2: n = 149, 88 ROP, 61 ROD; adjusted Rand index = 0.618). The two clusters contained both patients with ROP and patients with ROD. One cluster had widespread gray matter volume deficits and more positive, negative, and functional deficits (impaired cluster), and one cluster revealed a more preserved neuroanatomical signature and more core depressive symptomatology (preserved cluster). The clustering solution was internally and externally validated and assessed for clinical utility in predicting 9-month symptomatic remission, outperforming traditional diagnostic structures. We identified two transdiagnostic neuroanatomically informed clusters that are clinically and biologically distinct, challenging current diagnostic boundaries in recent-onset mental health disorders. These results may aid understanding of the etiology of poor outcome patients transdiagnostically and improve development of stratified treatments.
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影响因子：
73.3
作者：
First, Michael B.;Rebello, Tahilia J.;Reed, Geoffrey M.
通讯作者：
Reed, Geoffrey M.
DOI：
10.1038/npp.2009.32
发表时间：
2009-08
期刊：
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
影响因子：
--
作者：
通讯作者：
--
影响因子：
14.5
作者：
Chand, Ganesh B.;Dwyer, Dominic B.;Davatzikos, Christos
通讯作者：
Davatzikos, Christos
影响因子：
5.3
作者：
Brand SJ;Moller M;Harvey BH
通讯作者：
Harvey BH
影响因子：
11
作者：
Kapur, S.;Phillips, A. G.;Insel, T. R.
通讯作者：
Insel, T. R.