Stratification and prediction of remission in first-episode psychosis patients

the OPTiMiSE cohort study

the OPTiMiSE Study Group

Research output: Contribution to journalArticle

Abstract

Early response to first-line antipsychotic treatments is strongly associated with positive long-term symptomatic and functional outcome in psychosis. Unfortunately, attempts to identify reliable predictors of treatment response in first-episode psychosis (FEP) patients have not yet been successful. One reason for this could be that FEP patients are highly heterogeneous in terms of symptom expression and underlying disease biological mechanisms, thereby impeding the identification of one-size-fits-all predictors of treatment response. We have used a clustering approach to stratify 325 FEP patients into four clinical subtypes, termed C1A, C1B, C2A and C2B, based on their symptoms assessed using the Positive and Negative Syndrome Scale (PANSS) scale. Compared to C1B, C2A and C2B patients, those from the C1A subtype exhibited the most severe symptoms and were the most at risk of being non-remitters when treated with the second-generation antipsychotic drug amisulpride. Before treatment, C1A patients exhibited higher serum levels of several pro-inflammatory cytokines and inflammation-associated biomarkers therefore validating our stratification approach on external biological measures. Most importantly, in the C1A subtype, but not others, lower serum levels of interleukin (IL)-15, higher serum levels of C-X-C motif chemokine 12 (CXCL12), previous exposure to cytomegalovirus (CMV), use of recreational drugs and being younger were all associated with higher odds of being non-remitters 4 weeks after treatment. The predictive value of this model was good (mean area under the curve (AUC) = 0.73 ± 0.10), and its specificity and sensitivity were 45 ± 0.09% and 83 ± 0.03%, respectively. Further validation and replication of these results in clinical trials would pave the way for the development of a blood-based assisted clinical decision support system in psychosis.

Original languageEnglish (US)
Article number20
JournalTranslational Psychiatry
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019

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Psychotic Disorders
Cohort Studies
Antipsychotic Agents
Serum
Clinical Decision Support Systems
Therapeutics
Chemokine CXCL12
CXC Chemokines
Interleukin-15
Street Drugs
Cytomegalovirus
Area Under Curve
Cluster Analysis
Biomarkers
Clinical Trials
Cytokines
Inflammation
Sensitivity and Specificity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Biological Psychiatry

Cite this

Stratification and prediction of remission in first-episode psychosis patients : the OPTiMiSE cohort study. / the OPTiMiSE Study Group.

In: Translational Psychiatry, Vol. 9, No. 1, 20, 01.01.2019.

Research output: Contribution to journalArticle

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