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Wang X, Yan C, Yang PY, Xia Z, Cai XL, Wang Y, Kwok SC, Chan RCK. Unveiling the potential of machine learning in schizophrenia diagnosis: A meta-analytic study of task-based neuroimaging data. Psychiatry Clin Neurosci 2024; 78:157-168. [PMID: 38013639 DOI: 10.1111/pcn.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
The emergence of machine learning (ML) techniques has opened up new avenues for identifying biomarkers associated with schizophrenia (SCZ) using task-related fMRI (t-fMRI) designs. To evaluate the effectiveness of this approach, we conducted a comprehensive meta-analysis of 31 t-fMRI studies using a bivariate model. Our findings revealed a high overall sensitivity of 0.83 and specificity of 0.82 for t-fMRI studies. Notably, neuropsychological domains modulated the classification performance, with selective attention demonstrating a significantly higher specificity than working memory (β = 0.98, z = 2.11, P = 0.04). Studies involving older, chronic patients with SCZ reported higher sensitivity (P <0.015) and specificity (P <0.001) than those involving younger, first-episode patients or high-risk individuals for psychosis. Additionally, we found that the severity of negative symptoms was positively associated with the specificity of the classification model (β = 7.19, z = 2.20, P = 0.03). Taken together, these results support the potential of using task-based fMRI data in combination with machine learning techniques to identify biomarkers related to symptom outcomes in SCZ, providing a promising avenue for improving diagnostic accuracy and treatment efficacy. Future attempts to deploy ML classification should consider the factors of algorithm choice, data quality and quantity, as well as issues related to generalization.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Center, Shanghai, China
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Center, Shanghai, China
| | | | - Zheng Xia
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xin-Lu Cai
- Institute of Brain Science and Department of Physiology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Sze Chai Kwok
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Center, Shanghai, China
- Phylo-Cognition Laboratory, Division of Natural and Applied Sciences, Data Science Research Center, Duke Kunshan University, Kunshan, China
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Mamah D. A Review of Potential Neuroimaging Biomarkers of Schizophrenia-Risk. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2023; 8:e230005. [PMID: 37427077 PMCID: PMC10327607 DOI: 10.20900/jpbs.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The risk for developing schizophrenia is increased among first-degree relatives of those with psychotic disorders, but the risk is even higher in those meeting established criteria for clinical high risk (CHR), a clinical construct most often comprising of attenuated psychotic experiences. Conversion to psychosis among CHR youth has been reported to be about 15-35% over three years. Accurately identifying individuals whose psychotic symptoms will worsen would facilitate earlier intervention, but this has been difficult to do using behavior measures alone. Brain-based risk markers have the potential to improve the accuracy of predicting outcomes in CHR youth. This narrative review provides an overview of neuroimaging studies used to investigate psychosis risk, including studies involving structural, functional, and diffusion imaging, functional connectivity, positron emission tomography, arterial spin labeling, magnetic resonance spectroscopy, and multi-modality approaches. We present findings separately in those observed in the CHR state and those associated with psychosis progression or resilience. Finally, we discuss future research directions that could improve clinical care for those at high risk for developing psychotic disorders.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, 63110, USA
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3
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Soldevila-Matías P, Albajes-Eizagirre A, Radua J, García-Martí G, Rubio JM, Tordesillas-Gutierrez D, Fuentes-Durá I, Solanes A, Fortea L, Oliver D, Sanjuán J. Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:101-116. [PMID: 35840277 DOI: 10.1016/j.rpsmen.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/09/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.
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Affiliation(s)
- Pau Soldevila-Matías
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Gracián García-Martí
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Biomedical Engineering Unit/Radiology Department, Quirónsalud Hospital, Spain
| | - José M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; The Feinstein Institute, Northwell Health Hospital, New York, USA
| | - Diana Tordesillas-Gutierrez
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; University Hospital Marqués de Valdecilla (IDIVAL), Department of Psychiatry, School of Medicine, University of Cantabria, Spain; Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Inmaculada Fuentes-Durá
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Julio Sanjuán
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatric, University of Valencia, School of Medicine, Valencia, Spain
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Metzak PD, Addington J, Hassel S, Goldstein BI, MacIntosh BJ, Lebel C, Wang JL, Kennedy SH, MacQueen GM, Bray S. Functional imaging in youth at risk for transdiagnostic serious mental illness: Initial results from the PROCAN study. Early Interv Psychiatry 2021; 15:1276-1291. [PMID: 33295151 DOI: 10.1111/eip.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/29/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In their early stages, serious mental illnesses (SMIs) are often indistinguishable from one another, suggesting that studying alterations in brain activity in a transdiagnostic fashion could help to understand the neurophysiological origins of different SMI. The purpose of this study was to examine brain activity in youth at varying stages of risk for SMI using functional magnetic resonance imaging tasks (fMRI) that engage brain systems believed to be affected. METHODS Two hundred and forty three participants at different stages of risk for SMI were recruited to the Canadian Psychiatric Risk and Outcome (PROCAN) study, however only 179 were scanned. Stages included asymptomatic participants at no elevated risk, asymptomatic participants at elevated risk due to family history, participants with undifferentiated general symptoms of mental illness, and those experiencing attenuated versions of diagnosable psychiatric illnesses. The fMRI tasks included: (1) a monetary incentive delay task; (2) an emotional Go-NoGo and (3) an n-back working memory task. RESULTS Strong main effects with each of the tasks were found in brain regions previously described in the literature. However, there were no significant differences in brain activity between any of the stages of risk for SMI for any of the task contrasts, after accounting for site, sex and age. Furthermore, results indicated no significant differences even when participants were dichotomized as asymptomatic or symptomatic. CONCLUSIONS These results suggest that univariate BOLD responses during typical fMRI tasks are not sensitive markers of SMI risk and that further study, particularly longitudinal designs, will be necessary to understand brain changes underlying the early stages of SMI.
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Affiliation(s)
- Paul D Metzak
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin I Goldstein
- Center for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Lebel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Jian Li Wang
- Work & Mental Health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada.,Arthur Somner Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Signe Bray
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
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Najafpour Z, Fatemi A, Goudarzi Z, Goudarzi R, Shayanfard K, Noorizadeh F. Cost-effectiveness of neuroimaging technologies in management of psychiatric and insomnia disorders: A meta-analysis and prospective cost analysis. J Neuroradiol 2021; 48:348-358. [PMID: 33383065 DOI: 10.1016/j.neurad.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal diagnostic strategy for patients with psychiatric and insomnia disorders has not been established yet. PURPOSE The purpose of this study was to perform cost-effectiveness analysis of six neuroimaging technologies in diagnosis of patients with psychiatric and insomnia disorders. METHODS An economic evaluation study was conducted in three parts, including a systematic review for determining diagnostic accuracy, a descriptive cross-sectional study with Activity-Based Costing (ABC) technique for tracing resource consumption, and a cost-effectiveness analysis using a short-term decision-analytic model. RESULTS In the first phase, 93 diagnostic accuracy studies were included in the systematic review. The accumulated results (meta-analysis) showed that the highest diagnostic accuracy for psychiatric and insomnia disorders was attributed to PET (sensitivity of 90% and specificity of 80%) and MRI (sensitivity of 76% and specificity of 78%) respectively. In the second phase of the study, we calculated the cost of each technology. The results showed that MRI has the lowest cost. Based on the results in the model of cost-effectiveness sMRI ($ 50.08 per accurate diagnosis) and MRI ($ 58.54 per accurate diagnosis) were more cost-effective neuroimaging technologies. CONCLUSION In psychiatric disorders, no single strategy was characterized by both low cost and high accuracy. However, MRI and PET scan had lower cost and higher accuracy for psychiatric disorders, respectively. MRI was the least costly with the highest diagnostic accuracy in insomnia disorders. Based on our model, sMRI in psychiatric disorders and MRI in insomnia disorders were the most cost-effective technologies.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Asieh Fatemi
- Dpartment of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Faculty of Paramedical sciences, Rafsanjan University of Medical Sciences, Iran.
| | - Zahra Goudarzi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
| | | | - Farsad Noorizadeh
- Basir Eye Health Research Center, Exceptional Talents Development Center, Tehran University of Medical Sciences, Tehran, Iran.
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Soldevila-Matías P, Albajes-Eizagirre A, Radua J, García-Martí G, Rubio JM, Tordesillas-Gutierrez D, Fuentes-Durá I, Solanes A, Fortea L, Oliver D, Sanjuán J. Precuneus and insular hypoactivation during cognitive processing in first-episode psychosis: Systematic review and meta-analysis of fMRI studies. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30100-2. [PMID: 32988773 DOI: 10.1016/j.rpsm.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The neural correlates of the cognitive dysfunction in first-episode psychosis (FEP) are still unclear. The present review and meta-analysis provide an update of the location of the abnormalities in the fMRI-measured brain response to cognitive processes in individuals with FEP. METHODS Systematic review and voxel-based meta-analysis of cross-sectional fMRI studies comparing neural responses to cognitive tasks between individuals with FEP and healthy controls (HC) according to PRISMA guidelines. RESULTS Twenty-six studies were included, comprising 598 individuals with FEP and 567 HC. Individual studies reported statistically significant hypoactivation in the dorsolateral prefrontal cortex (6 studies), frontal lobe (8 studies), cingulate (6 studies) and insula (5 studies). The meta-analysis showed statistically significant hypoactivation in the left anterior insula, precuneus and bilateral striatum. CONCLUSIONS While the studies tend to highlight frontal hypoactivation during cognitive tasks in FEP, our meta-analytic results show that the left precuneus and insula primarily display aberrant activation in FEP that may be associated with salience attribution to external stimuli and related to deficits in perception and regulation.
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Affiliation(s)
- Pau Soldevila-Matías
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Anton Albajes-Eizagirre
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Gracián García-Martí
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Biomedical Engineering Unit/Radiology Department, Quirónsalud Hospital, Spain
| | - José M Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA; The Feinstein Institute, Northwell Health Hospital, New York, USA
| | - Diana Tordesillas-Gutierrez
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; University Hospital Marqués de Valdecilla (IDIVAL), Department of Psychiatry, School of Medicine, University of Cantabria, Spain; Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Cantabria, Spain
| | - Inmaculada Fuentes-Durá
- Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Julio Sanjuán
- Research Institute of the Hospital Clínic Universitari of Valencia (INCLIVA), Valencia, Spain; Center for Networking Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatric, University of Valencia, School of Medicine, Valencia, Spain
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Individualized Diagnostic and Prognostic Models for Patients With Psychosis Risk Syndromes: A Meta-analytic View on the State of the Art. Biol Psychiatry 2020; 88:349-360. [PMID: 32305218 DOI: 10.1016/j.biopsych.2020.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The clinical high risk (CHR) paradigm has facilitated research into the underpinnings of help-seeking individuals at risk for developing psychosis, aiming at predicting and possibly preventing transition to the overt disorder. Statistical methods such as machine learning and Cox regression have provided the methodological basis for this research by enabling the construction of diagnostic models (i.e., distinguishing CHR individuals from healthy individuals) and prognostic models (i.e., predicting a future outcome) based on different data modalities, including clinical, neurocognitive, and neurobiological data. However, their translation to clinical practice is still hindered by the high heterogeneity of both CHR populations and methodologies applied. METHODS We systematically reviewed the literature on diagnostic and prognostic models built on Cox regression and machine learning. Furthermore, we conducted a meta-analysis on prediction performances investigating heterogeneity of methodological approaches and data modality. RESULTS A total of 44 articles were included, covering 3707 individuals for prognostic studies and 1052 individuals for diagnostic studies (572 CHR patients and 480 healthy control subjects). CHR patients could be classified against healthy control subjects with 78% sensitivity and 77% specificity. Across prognostic models, sensitivity reached 67% and specificity reached 78%. Machine learning models outperformed those applying Cox regression by 10% sensitivity. There was a publication bias for prognostic studies yet no other moderator effects. CONCLUSIONS Our results may be driven by substantial clinical and methodological heterogeneity currently affecting several aspects of the CHR field and limiting the clinical implementability of the proposed models. We discuss conceptual and methodological harmonization strategies to facilitate more reliable and generalizable models for future clinical practice.
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Multivariate classification of schizophrenia and its familial risk based on load-dependent attentional control brain functional connectivity. Neuropsychopharmacology 2020; 45:613-621. [PMID: 31581175 PMCID: PMC7021788 DOI: 10.1038/s41386-019-0532-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/01/2019] [Accepted: 09/15/2019] [Indexed: 01/01/2023]
Abstract
Patients with schizophrenia (SCZ), as well as their unaffected siblings (SIB), show functional connectivity (FC) alterations during performance of tasks involving attention. As compared with SCZ, these alterations are present in SIB to a lesser extent and are more pronounced during high cognitive demand, thus possibly representing one of the pathways in which familial risk is translated into the SCZ phenotype. Our aim is to measure the separability of SCZ and SIB from healthy controls (HC) using attentional control-dependent FC patterns, and to test to which extent these patterns span a continuum of neurofunctional alterations between HC and SCZ. 65 SCZ with 65 age and gender-matched HC and 39 SIB with 39 matched HC underwent the Variable Attentional Control (VAC) task. Load-dependent connectivity matrices were generated according to correct responses in each VAC load. Classification performances of high, intermediate and low VAC load FC on HC-SCZ and HC-SIB cohorts were tested through machine learning techniques within a repeated nested cross-validation framework. HC-SCZ classification models were applied to the HC-SIB cohort, and vice-versa. A high load-related decreased FC pattern discriminated between HC and SCZ with 66.9% accuracy and with 57.7% accuracy between HC and SIB. A high load-related increased FC network separated SIB from HC (69.6% accuracy), but not SCZ from HC (48.5% accuracy). Our findings revealed signatures of attentional FC abnormalities shared by SCZ and SIB individuals. We also found evidence for potential, SIB-specific FC signature, which may point to compensatory neurofunctional mechanisms in persons at familial risk for schizophrenia.
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Schmidt A, Borgwardt S. Implementing MR Imaging into Clinical Routine Screening in Patients with Psychosis? Neuroimaging Clin N Am 2020; 30:65-72. [DOI: 10.1016/j.nic.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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10
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Tikka DL, Singh AR, Tikka SK. Social cognitive endophenotypes in schizophrenia: A study comparing first episode schizophrenia patients and, individuals at clinical- and familial- 'at-risk' for psychosis. Schizophr Res 2020; 215:157-166. [PMID: 31761472 DOI: 10.1016/j.schres.2019.10.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 10/17/2019] [Accepted: 10/25/2019] [Indexed: 01/19/2023]
Abstract
Impairments in specific domains of social cognition have been suggested as possible endophenotypes for schizophrenia and clinical markers for accurate identification of 'at-risk' (AR) states. Aim of the present study was to find out whether performance on social cognition tasks will distinguish 'clinical at-risk (CAR)' and 'familial at-risk (FAR)' individuals from remitted first episode schizophrenia (FES) patients and healthy controls. Fifty in each of these four groups were included for analysis. Schizophrenia psychopathology in FES group was assessed using the Positive and Negative Syndrome Scale (PANSS). Theory of mind (ToM; first and second order (SOT and FOT), and faux pas composite (FPC)), attributional bias (AB) and social perception (SP) were assessed using the Social Cognition Rating Tool in Indian Setting (SOCRATIS). Facial emotion recognition task was used to assess emotional-expression recognition (ER). Significant differences in ToM, SP and ER between the four groups were found, even after controlling for performance on various neurocognitive tasks. ToM and SP were identified to follow an endophenotype pattern. While, both ToM and SP classified FES from healthy with large accuracy rates, SP, specifically, distinguished at-risk from disease groups. None of the social cognitive domains accurately classified familial at-risk from clinical at-risk groups. We conclude that social cognitive measures may be used as reliable endophenotype markers for schizophrenia and its sub-domains may be used for valid identification of AR individuals.
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Affiliation(s)
- Deyashini Lahiri Tikka
- Department of Clinical Psychology, Ranchi Institute of Neuro Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, 834006, India
| | - Amool Ranjan Singh
- Department of Clinical Psychology, Ranchi Institute of Neuro Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand, 834006, India
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences, Tatibandh, Raipur, Chhattisgarh, 492099, India.
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Ellis JK, Walker EF, Goldsmith DR. Selective Review of Neuroimaging Findings in Youth at Clinical High Risk for Psychosis: On the Path to Biomarkers for Conversion. Front Psychiatry 2020; 11:567534. [PMID: 33173516 PMCID: PMC7538833 DOI: 10.3389/fpsyt.2020.567534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
First episode psychosis (FEP), and subsequent diagnosis of schizophrenia or schizoaffective disorder, predominantly occurs during late adolescence, is accompanied by a significant decline in function and represents a traumatic experience for patients and families alike. Prior to first episode psychosis, most patients experience a prodromal period of 1-2 years, during which symptoms first appear and then progress. During that time period, subjects are referred to as being at Clinical High Risk (CHR), as a prodromal period can only be designated in hindsight in those who convert. The clinical high-risk period represents a critical window during which interventions may be targeted to slow or prevent conversion to psychosis. However, only one third of subjects at clinical high risk will convert to psychosis and receive a formal diagnosis of a primary psychotic disorder. Therefore, in order for targeted interventions to be developed and applied, predicting who among this population will convert is of critical importance. To date, a variety of neuroimaging modalities have identified numerous differences between CHR subjects and healthy controls. However, complicating attempts at predicting conversion are increasingly recognized co-morbidities, such as major depressive disorder, in a significant number of CHR subjects. The result of this is that phenotypes discovered between CHR subjects and healthy controls are likely non-specific to psychosis and generalized for major mental illness. In this paper, we selectively review evidence for neuroimaging phenotypes in CHR subjects who later converted to psychosis. We then evaluate the recent landscape of machine learning as it relates to neuroimaging phenotypes in predicting conversion to psychosis.
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Affiliation(s)
- Justin K Ellis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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12
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Lei D, Pinaya WHL, Young J, van Amelsvoort T, Marcelis M, Donohoe G, Mothersill DO, Corvin A, Vieira S, Huang X, Lui S, Scarpazza C, Arango C, Bullmore E, Gong Q, McGuire P, Mechelli A. Integrating machining learning and multimodal neuroimaging to detect schizophrenia at the level of the individual. Hum Brain Mapp 2019; 41:1119-1135. [PMID: 31737978 PMCID: PMC7268084 DOI: 10.1002/hbm.24863] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023] Open
Abstract
Schizophrenia is a severe psychiatric disorder associated with both structural and functional brain abnormalities. In the past few years, there has been growing interest in the application of machine learning techniques to neuroimaging data for the diagnostic and prognostic assessment of this disorder. However, the vast majority of studies published so far have used either structural or functional neuroimaging data, without accounting for the multimodal nature of the disorder. Structural MRI and resting‐state functional MRI data were acquired from a total of 295 patients with schizophrenia and 452 healthy controls at five research centers. We extracted features from the data including gray matter volume, white matter volume, amplitude of low‐frequency fluctuation, regional homogeneity and two connectome‐wide based metrics: structural covariance matrices and functional connectivity matrices. A support vector machine classifier was trained on each dataset separately to distinguish the subjects at individual level using each of the single feature as well as their combination, and 10‐fold cross‐validation was used to assess the performance of the model. Functional data allow higher accuracy of classification than structural data (mean 82.75% vs. 75.84%). Within each modality, the combination of images and matrices improves performance, resulting in mean accuracies of 81.63% for structural data and 87.59% for functional data. The use of all combined structural and functional measures allows the highest accuracy of classification (90.83%). We conclude that combining multimodal measures within a single model is a promising direction for developing biologically informed diagnostic tools in schizophrenia.
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Affiliation(s)
- Du Lei
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Walter H L Pinaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Jonathan Young
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Mental Health Care Institute Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Gary Donohoe
- School of Psychology & Center for neuroimaging and Cognitive Genomics, NUI Galway University, Galway, Ireland
| | - David O Mothersill
- School of Psychology & Center for neuroimaging and Cognitive Genomics, NUI Galway University, Galway, Ireland
| | - Aiden Corvin
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sandra Vieira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Cristina Scarpazza
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.,Department of General Psychology, University of Padua, Padua, Italy
| | - Celso Arango
- Child and Adolescent Department of Psychiatry, Hospital General Universitario Gregorio Marañon, School of Medicine, Universidad Complutense Madrid, IiSGM, CIBERSAM, Madrid, Spain
| | - Ed Bullmore
- Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
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13
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Abstract
BACKGROUND This paper aims to synthesise the literature on machine learning (ML) and big data applications for mental health, highlighting current research and applications in practice. METHODS We employed a scoping review methodology to rapidly map the field of ML in mental health. Eight health and information technology research databases were searched for papers covering this domain. Articles were assessed by two reviewers, and data were extracted on the article's mental health application, ML technique, data type, and study results. Articles were then synthesised via narrative review. RESULTS Three hundred papers focusing on the application of ML to mental health were identified. Four main application domains emerged in the literature, including: (i) detection and diagnosis; (ii) prognosis, treatment and support; (iii) public health, and; (iv) research and clinical administration. The most common mental health conditions addressed included depression, schizophrenia, and Alzheimer's disease. ML techniques used included support vector machines, decision trees, neural networks, latent Dirichlet allocation, and clustering. CONCLUSIONS Overall, the application of ML to mental health has demonstrated a range of benefits across the areas of diagnosis, treatment and support, research, and clinical administration. With the majority of studies identified focusing on the detection and diagnosis of mental health conditions, it is evident that there is significant room for the application of ML to other areas of psychology and mental health. The challenges of using ML techniques are discussed, as well as opportunities to improve and advance the field.
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Affiliation(s)
- Adrian B R Shatte
- Federation University, School of Science, Engineering & Information Technology,Melbourne,Australia
| | - Delyse M Hutchinson
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health,Geelong,Australia
| | - Samantha J Teague
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health,Geelong,Australia
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14
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Diaconescu AO, Hauke DJ, Borgwardt S. Models of persecutory delusions: a mechanistic insight into the early stages of psychosis. Mol Psychiatry 2019; 24:1258-1267. [PMID: 31076646 PMCID: PMC6756090 DOI: 10.1038/s41380-019-0427-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/27/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022]
Abstract
Identifying robust markers for predicting the onset of psychosis has been a key challenge for early detection research. Persecutory delusions are core symptoms of psychosis, and social cognition is particularly impaired in first-episode psychosis patients and individuals at risk for developing psychosis. Here, we propose new avenues for translation provided by hierarchical Bayesian models of behaviour and neuroimaging data applied in the context of social learning to target persecutory delusions. As it comprises a mechanistic model embedded in neurophysiology, the findings of this approach may shed light onto inference and neurobiological causes of transition to psychosis.
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Affiliation(s)
- Andreea Oliviana Diaconescu
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland. .,Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland.
| | - Daniel Jonas Hauke
- 0000 0004 1937 0642grid.6612.3Department of Psychiatry (UPK), University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- 0000 0004 1937 0642grid.6612.3Department of Psychiatry (UPK), University of Basel, Basel, Switzerland ,0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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15
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Bonoldi I, Allen P, Madeira L, Tognin S, Bossong MG, Azis M, Samson C, Quinn B, Calem M, Valmaggia L, Modinos G, Stone J, Perez J, Howes O, Politi P, Kempton MJ, Fusar-Poli P, McGuire P. Basic Self-Disturbances Related to Reduced Anterior Cingulate Volume in Subjects at Ultra-High Risk for Psychosis. Front Psychiatry 2019; 10:254. [PMID: 31133887 PMCID: PMC6526781 DOI: 10.3389/fpsyt.2019.00254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Alterations of the "pre-reflective" sense of first-person perspective (e.g., of the "basic self") are characteristic features of schizophrenic spectrum disorders and are significantly present in the prodromal phase of psychosis and in subjects at ultra-high risk for psychosis (UHR). Studies in healthy controls suggest that neurobiological substrate of the basic self involves cortical midline structures, such as the anterior and posterior cingulate cortices. Neuroimaging studies have identified neuroanatomical cortical midline structure abnormalities in schizophrenic spectrum disorders. Objectives: i) To compare basic self-disturbances levels in UHR subjects and controls and ii) to assess the relationship between basic self-disturbances and alterations in cortical midline structures volume in UHR subjects. Methods: Thirty-one UHR subjects (27 antipsychotic-naïve) and 16 healthy controls were assessed using the 57-item semistructured Examination of Anomalous Self-Experiences (EASE) interview. All subjects were scanned using magnetic resonance imaging (MRI) at 3 T, and gray matter volume was measured in a priori defined regions of interest (ROIs) in the cortical midline structures. Results: EASE scores were much higher in UHR subjects than controls (p < 0.001). The UHR group had smaller anterior cingulate volume than controls (p = 0.037). There were no structural brain imaging alterations between UHR individuals with or without self-disturbances. Within the UHR sample, the subgroup with higher EASE scores had smaller anterior cingulate volumes than UHR subjects with lower EASE scores and controls (p = 0.018). In the total sample, anterior cingulate volume was inversely correlated with the EASE score (R = 0.52, p < 0.016). Conclusions: Basic self-disturbances in UHR subjects appear to be related to reductions in anterior cingulate volume.
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Affiliation(s)
- Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychology, University of Roehampton, London, United Kingdom.,Department of Psychiatry, Icahn Medical School, Mt Sinai Hospital, New York, NY, United States
| | - Luis Madeira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Matthijs G Bossong
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mathilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,The West London Early Intervention service, Imperial College London, London, United Kingdom
| | - Carly Samson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
| | - Beverly Quinn
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Maria Calem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gemma Modinos
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - James Stone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,The West London Early Intervention service, Imperial College London, London, United Kingdom
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,MRC Clinical Sciences Centre (CSC), London, United Kingdom.,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paolo Fusar-Poli
- OASIS service, SLaM NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS service, SLaM NHS Foundation Trust, London, United Kingdom
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16
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Hirjak D, Meyer-Lindenberg A, Kubera KM, Thomann PA, Wolf RC. Motor dysfunction as research domain in the period preceding manifest schizophrenia: A systematic review. Neurosci Biobehav Rev 2018; 87:87-105. [DOI: 10.1016/j.neubiorev.2018.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 12/13/2022]
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17
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Suvisaari J, Mantere O, Keinänen J, Mäntylä T, Rikandi E, Lindgren M, Kieseppä T, Raij TT. Is It Possible to Predict the Future in First-Episode Psychosis? Front Psychiatry 2018; 9:580. [PMID: 30483163 PMCID: PMC6243124 DOI: 10.3389/fpsyt.2018.00580] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/23/2018] [Indexed: 12/26/2022] Open
Abstract
The outcome of first-episode psychosis (FEP) is highly variable, ranging from early sustained recovery to antipsychotic treatment resistance from the onset of illness. For clinicians, a possibility to predict patient outcomes would be highly valuable for the selection of antipsychotic treatment and in tailoring psychosocial treatments and psychoeducation. This selective review summarizes current knowledge of prognostic markers in FEP. We sought potential outcome predictors from clinical and sociodemographic factors, cognition, brain imaging, genetics, and blood-based biomarkers, and we considered different outcomes, like remission, recovery, physical comorbidities, and suicide risk. Based on the review, it is currently possible to predict the future for FEP patients to some extent. Some clinical features-like the longer duration of untreated psychosis (DUP), poor premorbid adjustment, the insidious mode of onset, the greater severity of negative symptoms, comorbid substance use disorders (SUDs), a history of suicide attempts and suicidal ideation and having non-affective psychosis-are associated with a worse outcome. Of the social and demographic factors, male gender, social disadvantage, neighborhood deprivation, dysfunctional family environment, and ethnicity may be relevant. Treatment non-adherence is a substantial risk factor for relapse, but a small minority of patients with acute onset of FEP and early remission may benefit from antipsychotic discontinuation. Cognitive functioning is associated with functional outcomes. Brain imaging currently has limited utility as an outcome predictor, but this may change with methodological advancements. Polygenic risk scores (PRSs) might be useful as one component of a predictive tool, and pharmacogenetic testing is already available and valuable for patients who have problems in treatment response or with side effects. Most blood-based biomarkers need further validation. None of the currently available predictive markers has adequate sensitivity or specificity used alone. However, personalized treatment of FEP will need predictive tools. We discuss some methodologies, such as machine learning (ML), and tools that could lead to the improved prediction and clinical utility of different prognostic markers in FEP. Combination of different markers in ML models with a user friendly interface, or novel findings from e.g., molecular genetics or neuroimaging, may result in computer-assisted clinical applications in the near future.
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Affiliation(s)
- Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaakko Keinänen
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Teemu Mäntylä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eva Rikandi
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuukka T Raij
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
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18
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Lerner Y, Bleich-Cohen M, Solnik-Knirsh S, Yogev-Seligmann G, Eisenstein T, Madah W, Shamir A, Hendler T, Kremer I. Abnormal neural hierarchy in processing of verbal information in patients with schizophrenia. NEUROIMAGE-CLINICAL 2017; 17:1047-1060. [PMID: 29349038 PMCID: PMC5768152 DOI: 10.1016/j.nicl.2017.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 01/10/2023]
Abstract
Previous research indicates abnormal comprehension of verbal information in patients with schizophrenia. Yet the neural mechanism underlying the breakdown of verbal information processing in schizophrenia is poorly understood. Imaging studies in healthy populations have shown a network of brain areas involved in hierarchical processing of verbal information over time. Here, we identified critical aspects of this hierarchy, examining patients with schizophrenia. Using functional magnetic resonance imaging, we examined various levels of information comprehension elicited by naturally presented verbal stimuli; from a set of randomly shuffled words to an intact story. Specifically, patients with first episode schizophrenia (N = 15), their non-manifesting siblings (N = 14) and healthy controls (N = 15) listened to a narrated story and randomly scrambled versions of it. To quantify the degree of dissimilarity between the groups, we adopted an inter-subject correlation (inter-SC) approach, which estimates differences in synchronization of neural responses within and between groups. The temporal topography found in healthy and siblings groups were consistent with our previous findings - high synchronization in responses from early sensory toward high order perceptual and cognitive areas. In patients with schizophrenia, stimuli with short and intermediate temporal scales evoked a typical pattern of reliable responses, whereas story condition (long temporal scale) revealed robust and widespread disruption of the inter-SCs. In addition, the more similar the neural activity of patients with schizophrenia was to the average response in the healthy group, the less severe the positive symptoms of the patients. Our findings suggest that system-level neural indication of abnormal verbal information processing in schizophrenia reflects disease manifestations.
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Affiliation(s)
- Yulia Lerner
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neurosceince, Tel Aviv University, Tel Aviv, Israel.
| | - Maya Bleich-Cohen
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Shimrit Solnik-Knirsh
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Galit Yogev-Seligmann
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Eisenstein
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alon Shamir
- MAZOR Mental Health Center, Acre, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Talma Hendler
- Tel Aviv Center for Brain Functions, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neurosceince, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kremer
- MAZOR Mental Health Center, Acre, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Valli I, Marquand AF, Mechelli A, Raffin M, Allen P, Seal ML, McGuire P. Identifying Individuals at High Risk of Psychosis: Predictive Utility of Support Vector Machine using Structural and Functional MRI Data. Front Psychiatry 2016; 7:52. [PMID: 27092086 PMCID: PMC4824756 DOI: 10.3389/fpsyt.2016.00052] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/23/2016] [Indexed: 01/20/2023] Open
Abstract
The identification of individuals at high risk of developing psychosis is entirely based on clinical assessment, associated with limited predictive potential. There is, therefore, increasing interest in the development of biological markers that could be used in clinical practice for this purpose. We studied 25 individuals with an at-risk mental state for psychosis and 25 healthy controls using structural MRI, and functional MRI in conjunction with a verbal memory task. Data were analyzed using a standard univariate analysis, and with support vector machine (SVM), a multivariate pattern recognition technique that enables statistical inferences to be made at the level of the individual, yielding results with high translational potential. The application of SVM to structural MRI data permitted the identification of individuals at high risk of psychosis with a sensitivity of 68% and a specificity of 76%, resulting in an accuracy of 72% (p < 0.001). Univariate volumetric between-group differences did not reach statistical significance. By contrast, the univariate fMRI analysis identified between-group differences (p < 0.05 corrected), while the application of SVM to the same data did not. Since SVM is well suited at identifying the pattern of abnormality that distinguishes two groups, whereas univariate methods are more likely to identify regions that individually are most different between two groups, our results suggest the presence of focal functional abnormalities in the context of a diffuse pattern of structural abnormalities in individuals at high clinical risk of psychosis.
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Affiliation(s)
- Isabel Valli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands; Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Marie Raffin
- Service de Psychiatrie de l'enfant et de l'adolescent, CHU Pitié-Salpêtrière , Paris , France
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Marc L Seal
- Developmental Imaging Research Group, Murdoch Children Research Institute, University of Melbourne , Melbourne, VIC , Australia
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
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