Falkenberg Irina, Valli Isabel, Raffin Marie, Broome Matthew R, Fusar-Poli Paolo, Matthiasson Pall, Picchioni Marco, McGuire Philip
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Schizophr Res. 2017 Mar;181:86-93. doi: 10.1016/j.schres.2016.09.023. Epub 2016 Sep 29.
Clinical outcomes in people identified as at ultra-high risk (UHR) for psychosis are remarkably heterogeneous, and are difficult to predict on the basis of the presenting clinical features. Individuals at UHR are at risk of poor functional outcome regardless of development of psychotic disorder. The aim of the present study was to assess whether there is a relationship between functional neuroimaging measures at presentation and functional outcome as measured by the GAF three years after scanning.
Functional magnetic resonance imaging (fMRI) data were collected during an object working memory task in 34 ultra-high risk (UHR) subjects and 20 healthy controls. On the basis of their GAF scores at follow up, the UHR participants were divided into subgroups with good and poor functional outcomes, respectively.
At baseline, the UHR group differed from controls in showing altered frontal and cuneus/posterior cingulate activation. Significant group x task interactions were found in the left cuneus and posterior cingulate gyrus, reflecting differential responses to the task conditions. Within the UHR sample, the subgroup with a poor functional outcome exhibited altered activation in frontal, temporal and striatal regions, and reduced deactivation within default-mode network regions, relative to those with a good outcome. Within the whole UHR sample, in these regions the local task response was correlated with the GAF score at follow up.
The findings suggest a potential role of functional neuroimaging in the prediction of outcomes in people at high clinical risk of psychosis.
被确定为超高风险（UHR）精神病患者的临床结局显著异质，且难以根据呈现的临床特征进行预测。无论是否发展为精神障碍，UHR个体都有功能结局不良的风险。本研究的目的是评估扫描时的功能神经影像学测量与扫描三年后用大体功能评定量表（GAF）测量的功能结局之间是否存在关联。
在一项物体工作记忆任务期间，收集了34名超高风险（UHR）受试者和20名健康对照者的功能磁共振成像（fMRI）数据。根据随访时的GAF评分，将UHR参与者分别分为功能结局良好和不良的亚组。
在基线时，UHR组与对照组不同，表现为额叶和楔叶/后扣带回激活改变。在左侧楔叶和后扣带回发现显著的组x任务交互作用，反映了对任务条件的不同反应。在UHR样本中，功能结局不良的亚组相对于结局良好的亚组，在额叶、颞叶和纹状体区域表现出激活改变，默认模式网络区域内的失活减少。在整个UHR样本中，在这些区域局部任务反应与随访时的GAF评分相关。
研究结果表明功能神经影像学在预测高临床风险精神病患者的结局方面具有潜在作用。
