Clinical Brain Abnormalities Identified in 6% of Patients' First Psychosis Episode

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The study suggests 1 in every 18 patients would need an MRI scan to detect such significant abnormalities.

Approximately 6% of patients with first-episode psychosis had an abnormality requiring a change in clinical management, according to a new study. The findings support the incorporation of MRI as part of the initial assessment for all individuals presenting with first-episode psychosis.

First-episode psychosis is a critical condition that warrants prompt and accurate diagnosis to ensure appropriate management and treatment as it affects many aspects of life, often prompting sleep abnormalities that are implicated in the development, manifestation, and recurrence of psychosis, according to another investigation.2

Some patients may have an underlying organic cause for their psychosis symptoms, which can be identified through neuroimaging. However, the prevalence of clinically relevant neuroradiological abnormalities in first-episode psychosis has been uncertain, fueling the debate on whether brain magnetic resonance imaging (MRI) should be a standard part of the initial assessment for all first-episode psychosis patients.

In this systematic review and meta-analysis, a team of researchers led by Graham Blackman, MBChB, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, aimed to determine the prevalence of clinically relevant neuroradiological abnormalities in patients with first-episode psychosis.

The team conducted an extensive search of electronic databases and relevant articles up to July 2021, identifying 12 independent studies which consisted of 13 samples and involved 1613 patients with first-episode psychosis.

The meta-analysis revealed that approximately 26.4% (95% CI, 16.3% - 37.9%) of patients with first-episode psychosis had some form of intracranial radiological abnormality, and 5.9% (95% CI, 3.2%-9.0%) of patients had a clinically relevant abnormality that required a change in clinical management or diagnosis.

Investigators noted this suggests that 1 in every 18 patients needed to be scanned to detect such significant abnormalities.

Further analysis indicated white matter abnormalities were the most common type of clinically relevant finding, with a prevalence of 0.9% (95% CI, 0% - 2.8%), followed by cysts, with a prevalence of 0.5% (95% CI, 0% - 1.4%). The high degree of heterogeneity among the studies for these outcomes (95%; 73%, respectively) underscores the importance of conducting further research in this area.

With almost 6% of patients experiencing first-episode psychosis showing clinically relevant neuroradiological abnormalities, it becomes evident that MRI can play a crucial role in the initial assessment of these patients, investigators wrote. Identifying such abnormalities early on can significantly impact treatment decisions and improve patient outcomes.

They further emphasized the necessity of considering MRI as part of the routine evaluation for all patients presenting with this psychiatric condition. Detecting these abnormalities promptly can prevent potential complications that may arise from untreated organic causes of psychosis.

“This systematic review and meta-analysis found that around 6% of patients presenting with psychosis have a clinically relevant radiological abnormality on MRI, with a corresponding NNA of 18,” the study stated. “These findings provide a rationale for the use of MRI in the clinical assessment of all patients presenting with psychosis. As the availability of MRI increases and its costs decrease, it is becoming increasingly difficult to justify not making MRI a mandatory part of the clinical assessment of first-episode psychosis.”


  1. Blackman G, Neri G, Al-Doori O, et al. Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online July 12, 2023. doi:10.1001/jamapsychiatry.2023.2225
  2. Grossi G. New Data Reveal Sleep Disturbance Affects Patients at All Stages of Psychosis. HCPLive. January 23, 2023.