Neuroradiological abnormalities in individuals with first-episode psychosis – a retrospective cohort study

BACKGROUND: While psychosis mostly results from psychiatric conditions, certain organic disorders may also cause psychotic symptoms. Therefore, some diagnostic guidelines recommend people with first-episode psychosis (FEP) receive magnetic resonance imaging (MRI) of the brain as part of the diagnostic workflow. The aim of this study was to investigate the prevalence as well as the clinical relevance of radiological abnormalities in FEP. METHODS: This retrospective cohort study investigated electronic health records including radiological reports of MRI brain scans from FEP patients (aged 18–40) admitted for the first time to a psychiatric university hospital in Switzerland over a 10-year period. RESULTS: We identified a total of 812 patients admitted with FEP over a 10-year period. Of these, 421 (51.8%) received an MRI scan after admission with 84 (20.0%) of MRIs showing radiological abnormalities. The most common abnormalities were white matter changes (10.2%, n = 43), cystic lesions (2.6%, n = 11), and vascular abnormalities (1.4%, n = 6). However, only in 5 patients (1.2%) the MRI findings led to changes in diagnosis or treatment. CONCLUSIONS: Our findings align with previous studies, with a recent meta-analysis showing 26.4% radiological abnormalities in FEP and 5.9% being clinically relevant, though we found a lower rate of clinically significant abnormalities. This divergence is likely due to our cohort’s age restriction. The low rate of treatment changes highlights the need to investigate cost-effectiveness of neuroimaging as a screening procedure in FEP, as well as its recommendation as a standard procedure by current clinical guidelines.