Prediction of functional outcome 18 months after a first psychotic episode: a proton magnetic resonance spectroscopy study.

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_7F2D6A77D5EC
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Prediction of functional outcome 18 months after a first psychotic episode: a proton magnetic resonance spectroscopy study.
Périodique
Archives of General Psychiatry
Auteur(s)
Wood S.J., Berger G.E., Lambert M., Conus P., Velakoulis D., Stuart G.W., Desmond P., McGorry P.D., Pantelis C.
ISSN
0003-990X (Print)
ISSN-L
0003-990X
Statut éditorial
Publié
Date de publication
2006
Peer-reviewed
Oui
Volume
63
Numéro
9
Pages
969-976
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Résumé
CONTEXT: Recent magnetic resonance imaging studies have attempted to relate volumetric brain measurements in early schizophrenia to clinical and functional outcome some years later. These studies have generally been negative, perhaps because gray and white matter volumes inaccurately assess the underlying dysfunction that might be predictive of outcome.
OBJECTIVE: To investigate the predictive value of frontal and temporal spectroscopy measures for outcome in patients with first-episode psychoses.
DESIGN: Left prefrontal cortex and left mediotemporal lobe voxels were assessed using proton magnetic resonance spectroscopy to provide the ratio of N-acetylaspartate (NAA) and choline-containing compounds to creatine and phosphocreatine (Cr) (NAA/Cr ratio). These data were used to predict outcome at 18 months after admission, as assessed by a systematic medical record audit.
SETTING: Early psychosis clinic.
PARTICIPANTS: Forty-six patients with first-episode psychosis.
MAIN OUTCOME MEASURES: We used regression models that included age at imaging and duration of untreated psychosis to predict outcome scores on the Global Assessment of Functioning Scale, Clinical Global Impression scales, and Social and Occupational Functional Assessment Scale, as well as the number of admissions during the treatment period. We then further considered the contributions of premorbid function and baseline level of negative symptoms.
RESULTS: The only spectroscopic predictor of outcome was the NAA/Cr ratio in the prefrontal cortex. Low scores on this variable were related to poorer outcome on all measures. In addition, the frontal NAA/Cr ratio explained 17% to 30% of the variance in outcome.
CONCLUSIONS: Prefrontal neuronal dysfunction is an inconsistent feature of early psychosis; rather, it is an early marker of poor prognosis across the first years of illness. The extent to which this can be used to guide treatment and whether it predicts outcome some years after first presentation are questions for further research.
Mots-clé
Adult, Aspartic Acid/analogs & derivatives, Aspartic Acid/metabolism, Choline/metabolism, Creatine/metabolism, Female, Follow-Up Studies, Functional Laterality, Hippocampus/metabolism, Humans, Magnetic Resonance Spectroscopy/statistics & numerical data, Male, Outcome Assessment (Health Care), Patient Readmission, Phosphocreatine/metabolism, Predictive Value of Tests, Prefrontal Cortex/metabolism, Prognosis, Psychiatric Status Rating Scales/statistics & numerical data, Psychotic Disorders/diagnosis, Psychotic Disorders/metabolism, Schizophrenia/diagnosis, Schizophrenia/metabolism, Temporal Lobe/metabolism
Pubmed
Web of science
Open Access
Oui
Création de la notice
26/03/2013 13:20
Dernière modification de la notice
20/08/2019 14:40
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