Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Psychiatry, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Neuroimage Clin. 2023;40:103515. doi: 10.1016/j.nicl.2023.103515. Epub 2023 Sep 23.
Antipsychotic drugs are the first-choice therapy for psychotic episodes, but antipsychotic treatment response (AP-R) is unpredictable and only becomes clear after weeks of therapy. A biomarker for AP-R is currently unavailable. We reviewed the evidence for the hypothesis that functional magnetic resonance imaging functional connectivity (fMRI-FC) is a predictor of AP-R or could serve as a biomarker for AP-R in psychosis.
A systematic review of longitudinal fMRI studies examining the predictive performance and relationship between FC and AP-R was performed following PRISMA guidelines. Technical and clinical aspects were critically assessed for the retrieved studies. We addressed three questions: Q1) is baseline fMRI-FC related to subsequent AP-R; Q2) is AP-R related to a change in fMRI-FC; and Q3) can baseline fMRI-FC predict subsequent AP-R?
In total, 28 articles were included. Most studies were of good quality. fMRI-FC analysis pipelines included seed-based-, independent component- / canonical correlation analysis, network-based statistics, and graph-theoretical approaches. We found high heterogeneity in methodological approaches and results. For Q1 (N = 17) and Q2 (N = 18), the most consistent evidence was found for FC between the striatum and ventral attention network as a potential biomarker of AP-R. For Q3 (N = 9) accuracy's varied form 50 till 93%, and prediction models were based on FC between various brain regions.
The current fMRI-FC literature on AP-R is hampered by heterogeneity of methodological approaches. Methodological uniformity and further improvement of the reliability and validity of fMRI connectivity analysis is needed before fMRI-FC analysis can have a place in clinical applications of antipsychotic treatment.
抗精神病药物是精神病发作的首选治疗方法，但抗精神病药物治疗反应（AP-R）是不可预测的，只有在几周的治疗后才会变得清晰。目前还没有 AP-R 的生物标志物。我们回顾了以下假说的证据，即功能磁共振成像功能连接（fMRI-FC）是 AP-R 的预测因子，或者可以作为精神病中 AP-R 的生物标志物。
根据 PRISMA 指南，对纵向 fMRI 研究进行了系统评价，这些研究检查了 FC 与 AP-R 的预测性能和关系。对检索到的研究进行了技术和临床方面的严格评估。我们提出了三个问题：Q1）基线 fMRI-FC 与随后的 AP-R 相关；Q2）AP-R 与 fMRI-FC 的变化相关；Q3）基线 fMRI-FC 能否预测随后的 AP-R？
共纳入 28 篇文章。大多数研究质量良好。fMRI-FC 分析管道包括基于种子的、独立成分/典型相关分析、网络统计和图论方法。我们发现方法学方法和结果存在高度异质性。对于 Q1（N=17）和 Q2（N=18），最一致的证据是纹状体和腹侧注意网络之间的 FC 作为 AP-R 的潜在生物标志物。对于 Q3（N=9），准确性从 50%到 93%不等，预测模型基于各种大脑区域之间的 FC。
目前关于 AP-R 的 fMRI-FC 文献受到方法学方法异质性的阻碍。在 fMRI 连接分析的可靠性和有效性得到进一步提高之前，需要进行方法学统一，并需要进行 fMRI-FC 分析，以便在抗精神病药物治疗的临床应用中占有一席之地。
