M17. PREDICTION OF NEUROLEPTIC AND ANTIDEPRESSANT TREATMENT RESPONSES VIA FMRI OF THE EXTENDED REWARD SYSTEM

Abstract Background Neuroimaging techniques have been developed as important tools to assess brain dysfunctions that underlie mental disorders. In particular, modern functional magnetic resonance imaging (fMRI) holds the promise to provide neurofunctional biomarkers for improved differential diagnosis and optimized treatment of schizophrenic and affective disorders. Methods Neurofunctional connectivity MRI of the extended human reward system (Makris et al., 2008) was conducted in a large transnosological cohort of patients suffering from schizophrenia, bipolar disorder or major depressive disorder. Responses to neuroleptic treatments in patients with schizophrenic or bipolar disorder were determined retrospectively, while treatment responses to different antidepressants were directly assessed in a prospective naturalistic clinical study. Results Responders to neuroleptic treatment with aripiprazole showed significantly higher reward-related activation in a larger set of brain regions (including ventral striatum, hippocampus, amygdala, pregenual ACC and anteroventral PFC) in comparison to non-responders to aripiprazole. This finding proved to be specific for this neuroleptic treatment when compared to treatments with other atypical or typical neuroleptics. Pre-treatment reward-related activation of the nucleus accumbens, the ventral tegmental area and the amygdala showed a substance-class specific correlation with subsequent antidepressant treatment responses to SSRIs and/or agomelatine. Discussion These findings of ongoing studies exemplify the high potential of neuroimaging techniques to foster the development of precision medicine in psychiatry. The identification of neuroimaging markers associated with specific treatment responses may allow the development of “tailored”, i.e. stratified treatment approaches.