This project aimed to ascertain whether Magnetic Resonance Imaging (MRI) could create a paradigm shift in psychiatric practice for psychotic disorders. Psychotic disorders are mental illnesses that are characterised by hallucinations and delusions, with disturbances to the thinking process, insight, and judgement of the individual. A prompt and accurate diagnosis for psychoses is critical for effective patient management, treatment and subsequently, patient outcomes. Unlike most diseases, there are presently no reliable biomarkers that offer a definitive diagnosis for psychoses.
The current symptom-based approach and is hindering the effectiveness of diagnosis due to validity and reliability issues. As psychoses are classified based upon clinical presentation, the diagnosis between brain disease, trauma and different psychotic disorders become blurred. Research from this project has suggested the potential use of structural and functional MRI techniques in determining a biomarker to overcome these issues.
Psychoses are classified as either organic or functional. Organic psychoses are characterised by brain abnormalities that are induced by physical defects including brain trauma or illnesses, such as Alzheimer’s disease. Substance abuse can also generate psychosis. However, brain function that precipitates delusions and hallucinations are more frequently associated with specific psychiatric disorders, categorised as functional psychoses which incorporates schizophrenia and mood disorders, such as Bipolar Disorder (BD). The World Health Organisation (WHO) (2001) acknowledged schizophrenia as the most common of the psychoses, affecting 21 million people worldwide.
Table of Contents
Chapter One: Introduction
1.1 Introduction
1.2 Background
1.3 Aetiology
1.4 Current Diagnosis
1.5 Psychoradiology
1.6 Rationale
1.7 Project question
1.7.1 Hypothesis
1.7.2 Null Hypothesis
1.8 Aims
1.9 Objectives
1.10 Summary
Chapter Two: Methodology
2.1 Introduction
2.2 The Nature of a Literature Review
2.3 Research Design
2.3.1 Alternative Project Methods
2.4 Rationale for Systematic Literature Review
2.5 Sources of Information
2.6 Search Strategy
2.6.1 Search Technique
2.6.2 Search Terms
2.6.3 Search Criteria
2.7 Critical Evaluation of Literature
2.7.1 Bias
2.7.2 Validity and Reliability
2.8 Data Extraction and Analysis
2.9 Ethical Consideration
2.10 Summary
Chapter Three: Literature Review
3.1 Introduction
3.2 Structural Brain Changes
3.2.1 Falkenberg et al. (2017)
3.2.2 Schnack et al. (2014)
3.2.3 Rimol et al. (2012)
3.2.4 Sprooten et al. (2013)
3.2.5 Koutsouleris et al. (2015)
3.2.6 dePierrefeu et al. (2018)
3.2.7 Elfaki et al. (2013)
3.3 Functional Brain Changes
3.3.1 Collin et al. (2018)
3.3.2 Das et al. (2018)
3.3.3 Sarpal et al. (2016)
3.3.4 Cao et al. (2018)
3.4 Summary
Chapter Four: Discussion
4.1 Introduction
4.2 Variations in a Psychotic Brain
4.2.1 Functional Changes
4.2.2 Structural Changes
4.3 Explanation of Variabilities amongst Findings
4.3.1 Inclusion Criteria
4.3.2 Antipsychotic Medication
4.3.3 Machine-learning Algorithms
4.4 Differential Diagnosis
4.4.1 Organic Psychosis
4.4.2 Functional Psychosis
4.5 Project Limitations
4.6 Summary
Chapter Five: Conclusion
5.1 Introduction
5.2 Key Findings
5.2.1 Functional Changes
5.2.2 Structural Changes
5.2.3 Differential Diagnosis
5.3 Acceptance or Rejection of Hypothesis
5.4 Contribution of the Findings in Answering the Project Question
5.5 Meeting the Objectives
5.6 Summary
Chapter Six: Recommendations
6.1 Introduction
6.2 Study Design
6.3 Antipsychotic Medication
6.4 Summary
Objectives and Core Topics
This systematic literature review aims to determine whether Magnetic Resonance Imaging (MRI) can serve as a diagnostic tool to induce a paradigm shift in the treatment of psychotic disorders, moving current practices from symptom-based diagnosis toward image-based nosology. The primary research question investigates the clinical viability of structural and functional MRI as a reliable biomarker for identifying, distinguishing, and predicting the prognosis of psychoses.
- Role of structural and functional MRI in diagnosing psychotic disorders.
- Identification of neuroanatomical biomarkers for psychoses.
- Differentiation between schizophrenia and Bipolar Disorder (BD) using neuroimaging.
- Impact of antipsychotic medication on brain morphology and function.
- Potential for machine-learning algorithms to enhance diagnostic accuracy.
- Challenges in clinical implementation and standardization of neuroimaging protocols.
Excerpt from the Book
3.2.1 Falkenberg et al. (2017)
Falkenberg et al. (2017) assessed the clinical significance of using sMRI as part of the initial clinical assessment of patients with First-Episode Psychosis (FEP). This was assessed in a RCT comprised of participants without an organic aetiology, between the expansive age ranges of 16-64, yet, was limited to South London. This area restriction may inhibit the representation to a larger geographic. The study consisted of a clinical sample (n=241) with 66 Health Controls (HC), and a research sample (n=108) with 98 HC.
The most clinically relevant findings were cysts, lesions, and defects to the ventricles and white matter (WM), which were relatively common in FEP patients. 15% of the clinical sample and 6% of the research sample displayed these abnormalities. However, these abnormalities were also evident in 5.5% of HC; thus, it is unknown whether findings are indicative of psychosis. Patients in the clinical sample had a higher proportion of defects in comparison to the research sample. A possible explanation for these differences might be that the clinical samples were scanned using a 3-Tesla (T) MRI scanner, while the research samples were examined using a 1.5-T scanner. The higher-field strength scanner (3-T) may influence the detection of more subtle abnormalities. It is also plausible that the rates of abnormal findings were reduced by the exclusion of patients with organic aetiology, patients who were too unwell, or patients being treated without consent.
Summary of Chapters
Chapter One: Introduction: Defines the research scope regarding the use of MRI in psychiatric practice, identifying current diagnostic challenges and formulating the core research question and hypothesis.
Chapter Two: Methodology: Describes the systematic literature review (SLR) approach, including the search strategy, data extraction methods, and critical appraisal tools (CASP) used to evaluate studies.
Chapter Three: Literature Review: Critically evaluates eleven peer-reviewed studies focused on structural and functional brain changes in patients with psychotic disorders.
Chapter Four: Discussion: Analyzes the findings from the literature, explores the sources of variability (such as medication and machine-learning), and addresses the complexities of differential diagnosis.
Chapter Five: Conclusion: Summarizes the key findings, accepts the project hypothesis, and evaluates the project's overall contribution to the field of psychoradiology.
Chapter Six: Recommendations: Provides actionable guidance for future research, emphasizing the need for standardized multi-site study designs and further investigation into the effects of antipsychotics.
Key Words
Magnetic Resonance Imaging, MRI, Psychosis, Psychotic Disorders, Schizophrenia, Bipolar Disorder, Biomarkers, Structural MRI, Functional MRI, Psychoradiology, Neuroimaging, Systematic Literature Review, Clinical Diagnosis, Brain Morphology, Connectome
Frequently Asked Questions
What is the primary focus of this research paper?
The paper focuses on evaluating the potential of Magnetic Resonance Imaging (MRI) to create a paradigm shift in psychiatric practice for psychotic disorders by identifying reliable imaging-based biomarkers.
What are the central themes discussed in the literature review?
The central themes are the structural and functional brain changes observed in patients with psychosis, including gray and white matter volume reductions and modular connectivity abnormalities.
What is the core research question of the project?
The project asks: "Could MRI create a paradigm shift in psychiatric practice for psychotic disorders?"
Which scientific methodology was employed to conduct this study?
The author conducted a systematic literature review (SLR) and utilized the Critical Appraisal Skills Programme (CASP) tool to evaluate eleven selected high-quality research studies.
What does the main body of the work cover?
The main body examines findings from both structural and functional MRI studies, discusses the variability in results due to medication and algorithms, and analyzes the role of imaging in differential diagnosis.
Which keywords best characterize this study?
Key terms include Magnetic Resonance Imaging, Psychoradiology, Schizophrenia, Biomarkers, Neuroimaging, and evidence-based clinical practice.
Why is there a focus on the distinction between schizophrenia and Bipolar Disorder?
The paper highlights that these disorders are often clinically confused, and finding a unique imaging biomarker (such as cortical thinning in schizophrenia) could lead to more accurate diagnosis and personalized treatment.
What is the role of antipsychotic medication in the findings of the reviewed studies?
Antipsychotics present a significant confounding factor, as they have been linked in several studies to changes in gray matter volume, making it difficult to isolate whether observed brain abnormalities are disease-related or medication-induced.
- Arbeit zitieren
- Ciara Farrelly (Autor:in), 2019, Could Magnetic Resonance Imaging create a paradigm shift in psychotic disorders in psychiatric practice?, München, GRIN Verlag, https://www.grin.com/document/492192
