Quantitative Proton Spectroscopy of White Matter at 4 Tesla in First Episode Psychosis Part II: A Clinical Study

Schizophrenia and other psychotic disorders are disabling psychiatric conditions directly affecting approximately 4% of the population and indirectly affecting many more family members, friends, and other supporters. Onset can be early in life, most often in late adolescence or the early adult years, and if ineffectively treated is often followed by lifetime disability in educational or occupational pursuits. The economic burden of schizophrenia is high, with annual direct costs of at least $2 billion in Canada. Indirect costs are even higher ($6.8 billion), and include lost productivity of patients and their family members, and increased involvement of people with the criminal justice system, which significantly adds to the importance of effectively and efficiently treating these disorders by our public health care system. The personal suffering combined with the rising costs associated with this illness underscore the necessity of a path of investigation to better understand the biological underpinnings of all psychotic disorders, which subsequently and in parallel, will allow for the further study of developing, implementing, and evaluating effective rehabilitation programs. The course of schizophrenia is variable, with as many patients tending to improve or stabilize with treatment in the long term, as those who show further deterioration. Understanding this variability in outcomes is extremely important as it could allow for early identification of those patients with a potentially more severe illness, precipitating more intensive management. To better understand the underpinnings of this outcome variabitity, we will prospectively monitor patients with first episode psychosis (FEP) for a period of one year, in order to co-register cognitive deficits and functional disability measures with in vivo neurochemical levels in the frontal white matter (WM), using a brain imaging technique called proton magnetic resonace spectroscopy (1H-MRS).