Neuroimaging may Reveal Early Abnormalities in Psychosis Patients: JAMA

A systematic review published in Journal of American Medical Association suggest that mandatory brain MRI scans should be considered as part of the initial assessment for all patients with first-episode psychosis (FEP), as the failure to detect these abnormalities early on can lead to serious clinical consequences.

The meta-analysis, which included twelve independent studies comprising a total of 1613 FEP patients, revealed that 26.4% of these individuals had an intracranial radiological abnormality. Moreover, 5.9% of patients had a clinically relevant abnormality that resulted in a change in clinical management or diagnosis. The study further indicated that, on average, four patients needed to be scanned to detect one clinically relevant abnormality.

Among the identified abnormalities, white matter abnormalities were the most common, with a prevalence of 0.9%, followed by cysts with a prevalence of 0.5%. The results of the meta-analysis also highlighted significant heterogeneity among the studies, indicating the need for further research to better understand these abnormalities and their implications.

The potential benefits of mandatory brain MRI scans for FEP patients are substantial. Identifying underlying organic causes early on can lead to more accurate diagnoses, appropriate treatment interventions, and improved patient outcomes. By implementing MRI as a standard part of the initial clinical assessment, healthcare professionals can ensure that no relevant abnormalities go undetected, preventing potential long-term complications.

However, the issue of mandatory brain MRI for FEP patients remains controversial. Critics argue that the prevalence of clinically relevant MRI abnormalities in this population is still unclear and may not justify the additional costs and resource allocation associated with widespread MRI screenings. Further studies and cost-effectiveness analyses are needed to address these concerns and provide a clearer picture of the potential benefits and drawbacks of implementing mandatory brain MRI scans.

In conclusion, this meta-analysis underscores the importance of neuroimaging in the early assessment of individuals with first-episode psychosis. With 5.9% of FEP patients showing clinically relevant abnormalities on MRI, the findings support the integration of brain imaging as a routine part of the diagnostic process.

Reference:

Blackman, G., Neri, G., Al-Doori, O., Teixeira-Dias, M., Mazumder, A., Pollak, T. A., Hird, E. J., Koutsouleris, N., Bell, V., Kempton, M. J., & McGuire, P. (2023). Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2023.2225