Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
Schizophr Res. 2019 Sep;211:10-20. doi: 10.1016/j.schres.2019.07.020. Epub 2019 Jul 19.
Treatment-resistant schizophrenia (TRS) and treatment-responsive schizophrenia may exhibit distinct pathophysiology. Several functional magnetic resonance imaging (fMRI) studies have used resting-state functional connectivity analyses (rs-FC) in TRS patients to identify markers of treatment resistance. However, to date, existing findings have not been systematically evaluated.
A systematic literature search using Embase, MEDLINE, PsycINFO, ProQuest, PUBMED, and Scopus was performed. The query sought fMRI articles investigating rs-FC in treatment response or resistance in patients with schizophrenia. Only studies that examined treatment response, operationalized as the explicit categorization of patients by their response to antipsychotic medication, were considered eligible. Pairwise comparisons between patient groups and controls were extracted from each study.
The search query identified 159 records. Ten studies met inclusion criteria. Five studies examined not TRS (NTRS), and 8 studies examined TRS. Differences in rs-FC analysis methodology precluded direct comparisons between studies. However, disruptions in areas involved in visual and auditory information processing were implicated in both patients with TRS and NTRS. Changes in connectivity with sensorimotor network areas tended to appear in the context of TRS but not NTRS. Moreover, there was some indication that this connectivity could be affected by clozapine.
Functional connectivity may provide clinically meaningful biomarkers of treatment response and resistance in schizophrenia. Studies generally identified similar areas of disruption, though methodological differences largely precluded direct comparison between disruption effects. Implementing data sharing as standard practice will allow future reviews and meta-analyses to identify rs-FC correlates of TRS.
治疗抵抗性精神分裂症（TRS）和治疗反应性精神分裂症可能表现出不同的病理生理学。几项功能磁共振成像（fMRI）研究使用静息态功能连接分析（rs-FC）来识别 TRS 患者的治疗抵抗标志物。然而，迄今为止，现有的研究结果尚未得到系统评估。
使用 Embase、MEDLINE、PsycINFO、ProQuest、PUBMED 和 Scopus 进行系统文献检索。检索查询旨在寻找 fMRI 研究，这些研究调查了精神分裂症患者治疗反应或抵抗中的 rs-FC。只有那些检查治疗反应的研究（将患者根据其对抗精神病药物的反应明确分类）才被认为符合条件。从每项研究中提取了患者组与对照组之间的成对比较。
搜索查询确定了 159 条记录。10 项研究符合纳入标准。其中 5 项研究检查了非 TRS（NTRS），8 项研究检查了 TRS。rs-FC 分析方法的差异使得无法直接比较研究之间的差异。然而，TRS 和 NTRS 患者都存在涉及视觉和听觉信息处理的区域的功能连接中断。与感觉运动网络区域的连接变化往往出现在 TRS 中，但不是 NTRS。此外，有一些迹象表明，这种连接可能受到氯氮平的影响。
功能连接可能为精神分裂症的治疗反应和抵抗提供具有临床意义的生物标志物。尽管研究通常确定了相似的破坏区域，但方法学差异在很大程度上阻止了破坏效应的直接比较。实施数据共享作为标准做法将使未来的综述和荟萃分析能够确定 TRS 的 rs-FC 相关性。
