Could MRI findings help diagnose and tailor treatment for people with schizophrenia?

Scientists at McGill University and research centres in China and have identified brain regions where structural abnormalities begin in people with schizophrenia. The findings could lead to changes in how schizophrenia is diagnosed and treated.People with schizophrenia present with some neuroanatomical abnormalities on MRI, such as a thinner cortex and smaller volumes in certain brain regions. In their paper, the researchers note that grey matter is reduced over time as the disease progresses. One theory to explain this is that grey matter loss begins in a specific brain region, or epicentre, then spreads “transneuronally” to other brain regions with the help of existing patterns in connectivity. Previous studies trying to pinpoint a potential epicentre had small sample sizes and included people with varying severity of schizophrenia and other mental health disorders.The McGill University and Chinese researchers studied cross-sectional brain MRIs from 1,124 patients with schizophrenia and 1,046 other individuals.They discovered that Broca’s area and the adjacent frontoinsular cortex are potential epicentres, areas where structural abnormalities are most likely to start in people with schizophrenia. These regions govern language and emotional processing. The study results also suggest that the illness can also develop in other brain areas.The researchers analysed another 4,000 MRIs from people diagnosed with other neurological or psychiatric disorders and found few similarities in structural changes in those areas. People with bipolar disorder, major depressive disorder and obsessive-compulsive disorder did show neuroanatomical abnormalities in those areas.“This tells us that everyone suffering from this condition has a unique starting point that may explain the differences in symptoms,” Dr. Lena Palaniyappan, professor of psychiatry at McGill and one of the lead authors of the study said in a press release.“But there is a common process that results in a more diffuse, though subtle, changes in brain structure,” he added. “This insight provides an important clue to the age-old question of whether schizophrenia is one illness or many illnesses.”The findings could help physicians better understand what patients will benefit from what treatments. Schizophrenia can present in a variety of different ways, and it is often difficult to know what treatment will be most appropriate or effective.“By using techniques like epicentre mapping, we can identify which parts of the brain are most affected, even before noticeable symptoms appear. This information can then help us to identify patients who are likely to do better with specific treatments,” said Jianfeng Feng, a professor at the Institute of Science and Technology for Brain-inspired Intelligence (ISTBI) at Fudan University in China and in the department of computer Science at University of Warwick, U.K. Feng led the consortium behind the research.One setback is that many patients with psychiatric illnesses don’t get MRIs, according to the authors. They suggest that MRI be collected for patients with schizophrenia and other mental illnesses. “Collecting good quality MRI data as a byproduct of routine healthcare for mental illnesses such as schizophrenia can help us overcome selection bias in neuroimaging studies. Implementing this will provide clear directions for clinical practice,” said Yuchao Jiang, post-doctoral researcher from Fudan University in China, who co-led the research with Dr. Palaniyappan.The 2017 Canadian guidelines for the assessment and diagnosis of patients with schizophrenia spectrum and other psychiatric disorders does recommend ordering neuroimaging after the first episode of psychosis based on specific aspects of the patients’ history (i.e., suspected encephalitis or seizures).The MRI study results were published in Science Advances.

Could MRI findings help diagnose and tailor treatment for people with schizophrenia?

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