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Third-generation neuroimaging in early schizophrenia: Translating research evidence into clinical utility

  • Stefan Borgwardt (a1) and Paolo Fusar-Poli (a2)
Summary

Psychiatric imaging needs to move away from simple investigations of the neurobiology underlying the early phases of schizophrenia to translate imaging findings in the clinical field, targeting clinical outcomes including transition, remission and response to preventive interventions.

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Copyright
Corresponding author
Stefan J. Borgwardt, Department of Psychiatry, University of Basel, c/o University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Email: sborgwardt@uhbs.ch
Footnotes
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See pp. 300–307

Declaration of interest

S.B. has received honoraria for lectures and consultancy fees from Lilly.

Footnotes
References
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5 Bora, E, Fornito, A, Radua, J, Walterfang, M, Seal, M, Wood, SJ, et al. Neuroanatomical abnormalities in schizophrenia: a multimodal voxelwise meta-analysis and meta-regression analysis. Schizophr Res 2011; 127: 4657.
6 Lahti, AC, Weiler, MA, Holcomb, HH, Tamminga, CA, Cropsey, KL. Modulation of limbic circuitry predicts treatment response to antipsychotic medication: a functional imaging study in schizophrenia. Neuropsychopharmacology 2009; 34: 2675–90.
7 Snitz, BE, Macdonald, A 3rd, Cohen, JD, Cho, RY, Becker, T, Carter, CS. Lateral and medial hypofrontality in first-episode schizophrenia: functional activity in a medication-naive state and effects of short-term atypical antipsychotic treatment. Am J Psychiatry 2005; 162: 2322–9.
8 Smieskova, R, Fusar-Poli, P, Allen, P, Bendfeldt, K, Stieglitz, RD, Drewe, J, et al. The effects of antipsychotics on the brain: what have we learnt from structural imaging of schizophrenia? A systematic review. Curr Pharm Des 2009; 15: 2535–49.
9 Fusar-Poli, P, Radua, J, McGuire, P, Borgwardt, S. Neuroanatomical maps of psychosis onset: voxel-wise meta-analysis of antipsychotic-naive VBM studies. Schizophr Bull 2011; Nov 10 (Epub ahead of print).
10 Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, M, Barale, F, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high risk. Arch Gen Psychiatry 2012, in press.
11 Fusar-Poli, P, Borgwardt, S, Crescini, A, Deste, G, Kempton, MJ, Lawrie, S, et al. Neuroanatomy of vulnerability to psychosis: a voxel-based meta-analysis. Neurosci Biobehav Rev 2011; 35: 1175–85.
12 Smieskova, R, Fusar-Poli, P, Allen, P, Bendfeldt, K, Stieglitz, R, Drewe, J, et al. Neuroimaging predictors of transition to psychosis – a systematic review and meta-analysis. Neurosci Biobehav Rev 2010; 34: 1207–22.
13 Ettinger, U, Williams, SC, Meisenzahl, EM, Moller, HJ, Kumari, V, Koutsouleris, N. Association between brain structure and psychometric schizotypy in healthy individuals. World J Biol Psychiatry 2011; Oct 24 (Epub ahead of print).
14 Simon, AE, Velthorst, E, Nieman, DH, Linszen, D, Umbricht, D, de Haan, L. Ultra high-risk state for psychosis and non-transition: a systematic review. Schizophr Res 2011; 132: 817.
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20 Ruhrmann, S, Schultze-Lutter, F, Bechdolf, A, Klosterkotter, J. Intervention in at-risk states for developing psychosis. Eur Arch Psychiatry Clin Neurosci 2010; 260 (suppl 2): s904.
21 Fusar-Poli, P, Howes, OD, Allen, P, Broome, M, Valli, I, Asselin, MC, et al. Abnormal frontostriatal interactions in people with prodromal signs of psychosis: a multimodal imaging study. Arch Gen Psychiatry 2010; 67: 683–91.
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26 Fusar-Poli, P, Borgwardt, S, McGuire, P. Vulnerability to Psychosis: From Neurosciences to Psychopathology. Psychology Press, 2011.
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Third-generation neuroimaging in early schizophrenia: Translating research evidence into clinical utility

  • Stefan Borgwardt (a1) and Paolo Fusar-Poli (a2)
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eLetters

Further developing services for treatment of patients with prodromal psychosis

Mark Agius
24 June 2012

Borgwardt and Fusar-Poli make excellent points in their recent articles on neuroimaging in prodromal psychosis[1][2]. We ourselves have recently argued that using neuroimaging findings one could take a staging approach to schizophrenia [3] [4].Using clinical assessment tools such as CAARMS to identify patients at 'Ultra High Risk Mental States' recent studies [5][6] suggest that conversion rates from prodromal to full psychosis are lower than previously thought. There is still a clinical benefit in identifying and treating this small group of patients with 'Ultra High Risk Mental States'.Hence it might now appear logical that patients suspected of developing such states should have access to neuroimaging techniques such as MRI or FMRI. Treatment could then be targeted and offered to only those patients who have increasing gray matter loss on serial neuroimaging, and thus in whom an ongoing disease process has been demonstrated.Such a protocol would require considerable investment in equipment and training and expertise in every mental health trust in the country. Even before such a development can be contemplated, it is necessary to considertwo further issues;

[1] It would need to be decided how frequently and at what interval patients who are suspected of developing a psychotic illness should be subjected to neuroimaging before the decision to treat is made.

[2] A clear protocol for treatment needs to be developed, which implies a consensus on what the appropriate treatment for prodromal psychotic illness actually is.

It is only when a clear consensus is reached on these issues that clinicians will be able to use the neuroimaging techniques advocated by Borgwart and Fusar-Poli to improve clinical practice.

References[1] Borgwardt S, Fusar-Poli P.Third-generation neuroimaging in early schizophrenia: translating research evidence into clinical utility BJP 2012 200:270-272

[2] P. Fusar-Poli ,P. McGuire, S. Borgwardt Mapping prodromal psychosis: A critical review of neuroimaging studies European Psychiatry 2012 27: 181-191

[3] Agius M, Goh C, Ulhaq S, McGorry P.The staging model in schizophrenia, and its clinical implications.Psychiatr Danub. 2010 Jun;22(2):211-20.

[4] Agius M, Butler S, Holt C Does early diagnosis and treatment of schizophrenia lead to improved long-term outcomes? Neuropsychiatry (2011) 1(6), 553-565[5] Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB, Ross ML, Kelly D, Baker K, Amminger GP, Berger G, Thompson AD, Thampi A, McGorry PD. Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis.J Clin Psychiatry. 2011Apr;72(4):430-40.

[6] Morrison AP, Stewart S, Birchwood M, Fowler D, Gumley AI, Jones PB , Bentall RP, Lewis SW, Murray GK, Patterson P, Brunet K, Conroy J, Parker S, Reilly T, Byrne R, Davies LM, Dunn G Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial BMJ 2012;344:e2233

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Conflict of interest: None declared

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