TY - JOUR
T1 - Multimodal prediction of the need of clozapine in treatment resistant schizophrenia; a pilot study in first-episode psychosis
AU - Panula, Jonatan M.
AU - Gotsopoulos, Athanasios
AU - Alho, Jussi
AU - Suvisaari, Jaana
AU - Lindgren, Maija
AU - Kieseppä, Tuula
AU - Raij, Tuukka T.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/12
Y1 - 2024/12
N2 - As many as one third of the patients diagnosed with schizophrenia do not respond to first-line antipsychotic medication. This group may benefit from the atypical antipsychotic medication clozapine, but initiation of treatment is often delayed, which may worsen prognosis. Predicting which patients do not respond to traditional antipsychotic medication at the onset of symptoms would provide fast-tracked treatment for this group of patients. We collected data from patient records of 38 first-episode psychosis patients, of whom seven did not respond to traditional antipsychotic medications. We used clinical data including medical records, voxel-based morphometry MRI data and inter-subject correlation fMRI data, obtained during movie viewing, to predict future treatment resistance. Using a neural network model, we correctly predicted future treatment resistance in six of the seven treatment resistance patients and 25 of 31 patients who did not require clozapine treatment. Prediction improved significantly when using imaging data in tandem with clinical data. The accuracy of the neural network model was significantly higher than the accuracy of a support vector machine algorithm. These results support the notion that treatment resistant schizophrenia could represent a separate entity of psychotic disorders, characterized by morphological and functional changes in the brain which could represent biomarkers detectable at early onset of symptoms.
AB - As many as one third of the patients diagnosed with schizophrenia do not respond to first-line antipsychotic medication. This group may benefit from the atypical antipsychotic medication clozapine, but initiation of treatment is often delayed, which may worsen prognosis. Predicting which patients do not respond to traditional antipsychotic medication at the onset of symptoms would provide fast-tracked treatment for this group of patients. We collected data from patient records of 38 first-episode psychosis patients, of whom seven did not respond to traditional antipsychotic medications. We used clinical data including medical records, voxel-based morphometry MRI data and inter-subject correlation fMRI data, obtained during movie viewing, to predict future treatment resistance. Using a neural network model, we correctly predicted future treatment resistance in six of the seven treatment resistance patients and 25 of 31 patients who did not require clozapine treatment. Prediction improved significantly when using imaging data in tandem with clinical data. The accuracy of the neural network model was significantly higher than the accuracy of a support vector machine algorithm. These results support the notion that treatment resistant schizophrenia could represent a separate entity of psychotic disorders, characterized by morphological and functional changes in the brain which could represent biomarkers detectable at early onset of symptoms.
KW - First-episode psychosis
KW - Inter-subject correlation analysis
KW - Machine learning
KW - Neural networks
KW - Treatment resistant schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=85198248717&partnerID=8YFLogxK
U2 - 10.1016/j.bionps.2024.100102
DO - 10.1016/j.bionps.2024.100102
M3 - Article
AN - SCOPUS:85198248717
SN - 2666-1446
VL - 11
SP - 1
EP - 10
JO - Biomarkers in Neuropsychiatry
JF - Biomarkers in Neuropsychiatry
M1 - 100102
ER -