Specialised MRI can predict who will develop treatment-resistant schizophrenia - study

A specialised brain scan can accurately predict whether a patient with psychosis will develop treatment-resistant schizophrenia, Dutch researchers have found.

Neuromelanin-sensitive MRI scans, or NM-MRI for short, target a brain pigment called neuromelanin. This pigment can provide visual evidence of healthy dopamine function.

Dopamine is a hormone that is part of the reward system in the brain. Too much dopamine can lead to aggression and poor impulse control associated with psychosis.

The study authors, led by Marieke van der Plim, a postdoctoral researcher at the University of Amsterdam, believe that NM -MRI could be a game changer.

"There is an urgent need for markers to identify unresponsive schizophrenia patients at an early stage and to facilitate timely initiation of clozapine, the only antipsychotic with proven efficacy in unresponsive patients," they write in The American Journal of Psychiatry.

Unlike patients who respond to treatment, patients with treatment-resistant schizophrenia do not show an increase in dopamine function. According to the researchers, this suggests that neuromelanin levels - a control measure of dopamine function - may be an early marker of treatment resistance.

The study included 62 patients aged 18 to 35 who had a first psychotic episode. All of them were diagnosed with schizophrenia. These patients were compared with a control group of 20 healthy volunteers.

All patients underwent a clinical interview, IQ test and NM -MRI scan, while the patients with psychosis received antipsychotic treatment.

After six months, response to treatment was assessed. Those who continued to have moderate or severe symptoms in one of five domains, including delusions, hallucinations, postures, and unusual thoughts, after two courses of antipsychotic medication were considered unresponsive to treatment.

Patients who did not respond to a single antipsychotic or experienced serious side effects or were switched to clozapine during follow-up were also considered non-responders.

Of the 62 patients, 47 were considered to have responded.

At baseline NM -MRI, 15 of the non-responders appeared to have significantly reduced signal in a region of the brain called the substantia nigra. It is rich in dopamine neurons and regulates emotions and reward-related behaviour, among other things.

Based on the neuromelanin data, the researchers were able to predict with 68 per cent accuracy which patients would respond to the treatment.

In 28 patients who responded to treatment and nine patients who did not respond to treatment who underwent repeat scans, the NM -MRI signal did not change for six months.

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