Abstract

An Exploratory Study of the Potential Prognostic Usefulness of the Routinely Conducted Computed Tomography Scan in Patients Hospitalized for a First Episode of Psychosis

Author(s): Michael T. Compton , Sandra M. Goulding , Neil E. Whicker , Mark Mullins , Sandra Nathan , Kerry Ressler

Rationale: The clinical utility of routinely conducted computed tomography (CT) brain imaging during the evaluation of first-episode psychosis is often very limited, results typically relegated to ruling out gross intracranial pathology. Little is known about whether more commonplace findings and variants, often unreported in the radiological summary, could provide prognostic information. This study, focused on a low-income, predominantly African-American sample of public-sector, first-episode patients, addressed the understudied question of whether or not findings on routine clinical CT scans are associated with variables that may have prognostic importance. Methods: The sample included seventy-five consecutively admitted patients, aged 18–40 years, who were hospitalized for a first episode of psychosis. Sociodemographic and clinical data were obtained by a psychiatrist through a structured retrospective chart review based on dictated discharge summaries. Radiological variables were recorded by a neuroradiologist. The assessors were blinded to one another’s findings. Results: Pineal or epithalamus calcification was quite common (39 patients, 52%), compared to habenula region calcification (9, 12%), obvious brain volume loss (6, 8%), and cavum septum pellucidum/cavum vergae (2, 2.7%). Volume loss was associated with an older age at admission, a higher medication dosage at discharge, and a greater number of documented symptoms. Conclusions: Although the need for routinely conducted CT scans during the evaluation of first-episode psychosis continues to be debated, this study raises the question of whether or not routine CT scans should regularly assess specifically for brain volume loss and then report it to clinicians due to its potential prognostic value.

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