Institute of Behavioral Sciences, Feinstein Institutes for Medical Research, Manhasset, N.Y. (all authors); Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, N.Y. (all authors); Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, N.Y. (all authors).
Am J Psychiatry. 2023 Nov 1;180(11):827-835. doi: 10.1176/appi.ajp.20220719. Epub 2023 Aug 30.
OBJECTIVE: Identification of robust biomarkers that predict individualized response to antipsychotic treatment at the early stage of psychotic disorders remains a challenge in precision psychiatry. The aim of this study was to investigate whether any functional connectome-based neural traits could serve as such a biomarker. METHODS: In a discovery sample, 49 patients with first-episode psychosis received multi-paradigm fMRI scans at baseline and were clinically followed up for 12 weeks under antipsychotic monotherapies. Treatment response was evaluated at the individual level based on the psychosis score of the Brief Psychiatric Rating Scale. Cross-paradigm connectivity and connectome-based predictive modeling were employed to train a predictive model that uses baseline connectomic measures to predict individualized change rates of psychosis scores, with model performance evaluated as the Pearson correlations between the predicted change rates and the observed change rates, based on cross-validation. The model generalizability was further examined in an independent validation sample of 24 patients in a similar design. RESULTS: The results revealed a paradigm-independent connectomic trait that significantly predicted individualized treatment outcome in both the discovery sample (predicted-versus-observed r=0.41) and the validation sample (predicted-versus-observed r=0.47, mean squared error=0.019). Features that positively predicted psychosis change rates primarily involved connections related to the cerebellar-cortical circuitry, and features that negatively predicted psychosis change rates were chiefly connections within the cortical cognitive systems. CONCLUSIONS: This study discovers and validates a connectome-based functional signature as a promising early predictor for individualized response to antipsychotic treatment in first-episode psychosis, thus highlighting the potential clinical value of this biomarker in precision psychiatry.
目的:在精神疾病的早期阶段,识别能够预测抗精神病药物治疗个体化反应的稳健生物标志物仍然是精准精神病学的一个挑战。本研究旨在探讨是否存在任何基于功能连接组的神经特征可以作为这样的生物标志物。
方法:在一个发现样本中,49 名首发精神分裂症患者在基线时接受了多范式 fMRI 扫描,并在抗精神病药物单药治疗下进行了 12 周的临床随访。根据简明精神病评定量表的精神病评分,在个体水平上评估治疗反应。采用跨范式连接和基于连接组的预测建模来训练一个预测模型,该模型使用基线连接组学测量来预测精神病评分的个体化变化率,模型性能通过交叉验证评估为预测变化率与观察到的变化率之间的 Pearson 相关系数。该模型的泛化能力在一个类似设计的 24 名患者的独立验证样本中进一步得到了检验。
结果:结果揭示了一种与范式无关的连接组学特征,该特征在发现样本(预测值与观察值 r=0.41)和验证样本(预测值与观察值 r=0.47,均方误差=0.019)中均能显著预测个体化治疗结果。正向预测精神病变化率的特征主要涉及与小脑皮质电路相关的连接,而负向预测精神病变化率的特征主要是皮质认知系统内的连接。
结论:本研究发现并验证了一种基于连接组的功能特征作为首发精神分裂症个体化抗精神病药物治疗反应的有前途的早期预测指标,从而突出了这种生物标志物在精准精神病学中的潜在临床价值。
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