Sundermann Benedikt, Bode Jens, Lueken Ulrike, Westphal Dorte, Gerlach Alexander L, Straube Benjamin, Wittchen Hans-Ulrich, Ströhle Andreas, Wittmann André, Konrad Carsten, Kircher Tilo, Arolt Volker, Pfleiderer Bettina
Department of Clinical Radiology, University Hospital Münster, Münster, Germany.
Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Front Psychiatry. 2017 Jun 9;8:99. doi: 10.3389/fpsyt.2017.00099. eCollection 2017.
The approach to apply multivariate pattern analyses based on neuro imaging data for outcome prediction holds out the prospect to improve therapeutic decisions in mental disorders. Patients suffering from panic disorder with agoraphobia (PD/AG) often exhibit an increased perception of bodily sensations. The purpose of this investigation was to assess whether multivariate classification applied to a functional magnetic resonance imaging (fMRI) interoception paradigm can predict individual responses to cognitive behavioral therapy (CBT) in PD/AG.
This analysis is based on pretreatment fMRI data during an interoceptive challenge from a multicenter trial of the German PANIC-NET. Patients with DSM-IV PD/AG were dichotomized as responders ( = 30) or non-responders ( = 29) based on the primary outcome (Hamilton Anxiety Scale Reduction ≥50%) after 6 weeks of CBT (2 h/week). fMRI parametric maps were used as features for response classification with linear support vector machines (SVM) with or without automated feature selection. Predictive accuracies were assessed using cross validation and permutation testing. The influence of methodological parameters and the predictive ability for specific interoception-related symptom reduction were further evaluated.
SVM did not reach sufficient overall predictive accuracies (38.0-54.2%) for anxiety reduction in the primary outcome. In the exploratory analyses, better accuracies (66.7%) were achieved for predicting interoception-specific symptom relief as an alternative outcome domain. Subtle information regarding this alternative response criterion but not the primary outcome was revealed by univariate comparisons.
In contrast to reports on other neurofunctional probes, SVM based on an interoception paradigm was not able to reliably predict individual response to CBT. Results speak against the clinical applicability of this technique.
基于神经影像数据应用多变量模式分析进行结果预测的方法有望改善精神障碍的治疗决策。患有广场恐怖症的惊恐障碍（PD/AG）患者通常对身体感觉的感知增强。本研究的目的是评估应用于功能磁共振成像（fMRI）内感受范式的多变量分类是否可以预测PD/AG患者对认知行为疗法（CBT）的个体反应。
本分析基于德国PANIC-NET多中心试验中内感受挑战期间的治疗前fMRI数据。根据CBT（每周2小时）6周后的主要结果（汉密尔顿焦虑量表降低≥50%），将符合DSM-IV PD/AG的患者分为反应者（n = 30）或无反应者（n = 29）。fMRI参数图用作响应分类的特征，使用有或没有自动特征选择的线性支持向量机（SVM）。使用交叉验证和置换检验评估预测准确性。进一步评估方法学参数的影响以及对特定内感受相关症状减轻的预测能力。
SVM对主要结果中焦虑减轻的总体预测准确性不足（38.0 - 54.2%）。在探索性分析中，作为替代结果领域，预测内感受特异性症状缓解的准确性更高（66.7%）。单变量比较揭示了关于此替代反应标准而非主要结果的细微信息。
与其他神经功能探针的报告相反，基于内感受范式的SVM无法可靠地预测个体对CBT的反应。结果表明该技术在临床上不适用。
