Routine brain scanning may improve clinical care for people with psychosis

Routine brain scanning in people experiencing psychosis could help to identify underlying physical conditions that are causing their symptoms, according to a new study.

Researchers led by Dr. Graham Blackman and Professor Philip McGuire at the University of Oxford's Department of Psychiatry reviewed the results of more than 1,600 patients with a first episode of psychosis who had undergone an MRI brain scan.

They found that around 6% of patients had a scan abnormality which led to a different diagnosis or a change to their clinical care. The paper, "Prevalence of neuroradiological abnormalities in first episode psychosis," has been published in the journal JAMA Psychiatry.

Dr. Blackman, an NIHR (National Institute for Health and Care Research) clinical lecturer at the university, says, "Patients presenting with psychosis may have another physical illness or condition causing their symptoms that can be identified using MRI scanning. A failure to detect these causes at an early stage can have serious consequences, such as a delay in providing the appropriate treatment. Our findings suggest that MRI scans should be considered as part of the initial assessment of all people with first-episode psychosis to ensure that they get the right diagnosis and the right treatment."

Although it is considered good practice to carry out a brain scan in new patients with psychosis, this is not mandatory. Previously, a NICE Technology Appraisal was unable to recommend scanning in all patients, as at that time it was unclear how common clinically relevant brain abnormalities in people with first-episode psychosis are.

Professor McGuire adds, "We feel that this study addresses a critical knowledge gap in this area by showing that clinically relevant abnormalities occur frequently enough to justify making MRI scanning a routine part of the assessment of people presenting with psychosis for the first time. This new evidence has important implications for clinical care in psychosis and a review of the NICE guidance in this area would be helpful."

Following these findings, the researchers are now evaluating the utility of offering all people with a first episode of psychosis at Oxford Health NHS Trust an MRI brain scan as part of their initial clinical assessment.