Individualized prediction of illness course at the first psychotic episode: a support vector machine MRI study

• Published in: Psychological medicine Vol. 42; no. 5; pp. 1037 - 1047
• Main Authors: Mourao-Miranda, J., Reinders, A. A. T. S., Rocha-Rego, V., Lappin, J., Rondina, J., Morgan, C., Morgan, K. D., Fearon, P., Jones, P. B., Doody, G. A., Murray, R. M., Kapur, S., Dazzan, P.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.05.2012
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Brain - physiopathology; Brain Mapping - methods; Classification; Clinical decision making; Cohort Studies; Disease Progression; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted - methods; Individuality; Individualized; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Mental depression; Mental disorders; NMR; Nuclear magnetic resonance; Observer Variation; Original; Pipelines; Predictive Value of Tests; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - diagnosis; Psychotic Disorders - physiopathology; Psychotic symptoms; Reproducibility of Results; Schizophrenia; Support Vector Machine; prediction; First-episode psychosis; schizophrenia; MRI; outcome; Psychosis; First episode; Prediction; Schizophrenia; Medical imagery; Nuclear magnetic resonance imaging
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291711002005

To date, magnetic resonance imaging (MRI) has made little impact on the diagnosis and monitoring of psychoses in individual patients. In this study, we used a support vector machine (SVM) whole-brain classification approach to predict future illness course at the individual level from MRI data obtained at the first psychotic episode. One hundred patients at their first psychotic episode and 91 healthy controls had an MRI scan. Patients were re-evaluated 6.2 years (s.d.=2.3) later, and were classified as having a continuous, episodic or intermediate illness course. Twenty-eight subjects with a continuous course were compared with 28 patients with an episodic course and with 28 healthy controls. We trained each SVM classifier independently for the following contrasts: continuous versus episodic, continuous versus healthy controls, and episodic versus healthy controls. At baseline, patients with a continuous course were already distinguishable, with significance above chance level, from both patients with an episodic course (p=0.004, sensitivity=71, specificity=68) and healthy individuals (p=0.01, sensitivity=71, specificity=61). Patients with an episodic course could not be distinguished from healthy individuals. When patients with an intermediate outcome were classified according to the discriminating pattern episodic versus continuous, 74% of those who did not develop other episodes were classified as episodic, and 65% of those who did develop further episodes were classified as continuous (p=0.035). We provide preliminary evidence of MRI application in the individualized prediction of future illness course, using a simple and automated SVM pipeline. When replicated and validated in larger groups, this could enable targeted clinical decisions based on imaging data.