Structural magnetic resonance imaging predictors of responsiveness to cognitive behaviour therapy in psychosis
Received 17 April 2009; received in revised form 7 August 2009; accepted 8 August 2009. published online 07 September 2009.
Abstract
Background
Responsiveness to cognitive behaviour therapy (CBT) in psychosis may have a neurological basis. This study aimed to determine whether improvement in symptoms following CBT for psychosis (CBTp) in people with schizophrenia is positively associated with pre-therapy grey matter volume in brain regions involved in cognitive processing.
Methods
Sixty outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their standard care (SC), and 25 healthy participants underwent magnetic resonance imaging. Subsequently, 30 patients received CBTp (CBTp+SC; 25 completers) for 6–8months and 30 continued with their standard care (SC; 19 completers). Symptoms in all patients were assessed (blindly) at entry and follow-up.
Results
The CBTp+SC and SC groups did not differ clinically at baseline, and only the CBTp+SC group showed improved symptoms at follow-up. Severity of baseline symptoms was not associated with CBTp responsiveness. Reduction with CBTp in positive symptoms was associated with greater right cerebellum (lobule VII) grey matter volume, in negative symptoms with left precentral gyrus and right inferior parietal lobule grey matter volumes, and in general psychopathology with greater right superior temporal gyrus, cuneus and cerebellum (Crus I) grey matter volumes. Grey matter volume in these brain areas did not correlate with the severity of baseline symptoms.
Conclusion
Grey matter volume of the frontal, temporal, parietal and cerebellar areas that are known to be involved in the co-ordination of mental activity, cognitive flexibility, and verbal learning and memory predict responsiveness to CBTp in patients with psychosis.
dCentre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, UK
Corresponding author. Department of Psychology, PO78, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel.: +44 207 848 0233; fax: +44 207 848 0860.
ABSTRACT