Psychosis Progression is Complex: A Call for Personalized Approaches

A study conducted by researchers at the University of Seville has investigated alterations in the cerebral cortex of individuals diagnosed with psychosis. The findings suggest that the progression of psychosis is complex and non-linear, influenced by the interplay of brain development, symptoms, cognitive function, and treatment.

The research indicates a potential need for personalized approaches to understand the condition and optimize long-term therapeutic strategies.

Study Overview

The research was led by Claudio Alemán Morillo and Rafael Romero García from the Neuroimaging and Brain Networks Laboratory at the University of Seville. The findings of the study were published in the British Journal of Psychiatry.

Understanding Psychosis

Psychosis is characterized by symptoms such as hallucinations and delusions, which can lead to a loss of contact with reality, commonly observed in conditions like schizophrenia. The study noted that the manifestations and evolution of psychosis often differ significantly among individuals following a first psychotic episode.

Key Research Findings

• Cortical Volume Reduction: At the time of a first psychotic episode, patients exhibited reduced cortical volume. This reduction was particularly noted in brain regions rich in serotonin and dopamine receptors, neurotransmitters considered relevant to psychosis pathophysiology and the action of antipsychotic medications.
• Cellular Involvement: Data also suggest that neurons and other brain cells involved in inflammatory and immunological processes may contribute to the disease.

Treatment Effects: Structural differences observed in the brain tended to decrease during treatment, suggesting that clinical intervention may slow the rate of brain deterioration. However, more pronounced differences persisted in individuals who received higher doses of antipsychotic medication over time. This observation suggests that these differences may be associated with symptom severity, indicating that those with more severe symptoms often necessitate higher medication doses.

Cognitive Impairments: Cognitive impairments were observed from early stages of the disease. Many participants showed improvement in both symptoms and cognition during follow-up, suggesting partial recovery of these functions with clinical stabilization. This improvement was less significant in those requiring higher-dose treatments.

Methodology

The research utilized magnetic resonance images to measure the volume of various cerebral cortex regions. The study included 357 patients diagnosed with schizophrenia and 195 control subjects. A significant aspect of the study involved a ten-year follow-up period, allowing for the analysis of long-term brain changes and their relationship to clinical symptoms and cognitive performance, which included attention, memory, and processing speed. The study introduced a percentile-based analysis method to identify atypical brain volumes, a technique described as similar to how percentiles are used in pediatrics.

Implications for Personalized Care

The study's findings collectively suggest the need for personalized approaches to understand the disease and optimize long-term therapeutic strategies for individuals with psychosis.