Predicting treatment response in psychosis using fMRI: A comprehensive review

Clinical Snapshot

Key Findings

• Effect Size: Not quantified - qualitative review

• Primary Outcome: fMRI measures can predict pharmacological treatment response in psychosis

• Nnt Or Sensitivity: Prediction accuracy enhanced by machine learning techniques but specific values not provided

• Confidence Interval: Not reported

Clinical Application

Limited by need for specialized fMRI facilities and expertise in neuroimaging analysis Relevant to Australian mental health services with access to advanced neuroimaging, though implementation would require significant infrastructure investment and training Patients with psychosis and schizophrenia requiring pharmacological treatment

Abstract

In recent years, the use of functional Magnetic Resonance Imaging (fMRI) methods to predict treatment response in schizophrenia (SCZ) through statistical and machine learning (ML) algorithms has increased. We conducted a comprehensive literature review to assess the role of various fMRI measures in predicting pharmacological treatment response in psychosis. Literature available on PubMed from January 1990 to December 2023 was reviewed, and 21 fMRI studies were included. The results suggest that many studies have employed ML techniques, which may enhance the accuracy of treatment outcome predictions. Additionally, several studies utilizing resting-state fMRI have identified potential associations of functional connectivity patterns across multiple large-scale networks, including the default mode network (DMN), the salience network (SN), the central executive network (CEN), and sensory-motor circuits. These findings suggest that altered connectivity within and between these networks may be relevant for personalized treatment strategies in patients with psychosis, although further investigation is needed to confirm their predictive value. Future research should focus on developing robust and generalizable models to more reliably optimize treatment outcomes in psychosis.

References

1. 1.Serio, F., Sampaio, I. W., Maggioni, E., D'Agostino, A., Brambilla, P., & Del Fabro, L. (2026). Predicting treatment response in psychosis using fMRI: A comprehensive review. Journal of Psychiatric Research, 126, Article 058. https://doi.org/10.1016/j.jpsychires.2026.01.058