Clinical and neurobiologic predictors of long-term outcome in schizophrenia

BackgroundSchizophrenia is a severe neuropsychiatric disorder accompanied by debilitating cognitive and psychosocial impairments over the course of the disease. As disease trajectories exhibit considerable inter-individual heterogeneity, early clinical and neurobiological predictors of long-term outcome are desirable for personalized treatment and care strategies. MethodsIn a naturalistic longitudinal approach, 381 schizophrenia patients from the Iowa Lon-gitudinal Study (ILS) cohort underwent an extensive characterization, including repeated magnetic resonance imaging (MRI) scans, over a mean surveillance period of 11.07 years. We explored whether pre-diagnostic markers, clinical markers at the first psychotic episode, or magnetic resonance imaging (MRI) measures at the onset of the disease were predictive of relapse or remission of specific symptom patterns later in life. ResultsWe identified a set of clinical parameters - namely premorbid adjustment during adolescence, symptom patterns, and neuropsychological profiles at disease onset - that were highly correlated with future disease trajectories. In general, brain measures at baseline did not correlate with outcome. Progressive regional brain volume losses over the observation period, however, were highly correlated with relapse patterns and symptom severity. ConclusionsOur findings provide clinicians with a set of highly robust, easily acquirable, and cost-effective predictors for long-term outcome in schizophrenia. These results can be directly translated to a clinical setting to improve prospective care and treatment planning for schizophrenia patients. (Funding sources: NIH MH68380, MH31593, MH40856, and MH43271).