Neuroimaging study identifies novel psychosis-related brain activity in adolescents

Researchers at King’s College London have carried out the largest neuroimaging study examining psychotic-like experiences in adolescents to date, and identified previously undiscovered changes in brain activity occurring between the ages of 14 and 19 years.

Occasional psychotic-like experiences are relatively common in healthy adults and adolescents, but when these experiences become highly frequent this can indicate the beginning of a psychotic illness. Late adolescence is a critical time for the onset of psychotic illness, as this is when psychotic symptoms typically begin to manifest.

The authors, who published their findings today in JAMA Psychiatry, suggest that the brain changes observed in 14 year olds, which can be related to the development of psychosis, occurs much earlier than previously thought in adolescents.

Dr Evangelos Papanastasiou, first author of the study from the Institute of Psychiatry, Psychology & Neuroscience at King’s said: ‘Our findings are consistent with the neurodevelopmental model of psychosis, which advocates that abnormal brain development, from early childhood, through adolescence to adulthood, can be linked to the development of psychosis.’

The study, which recruited 298 healthy adolescents, used a functional neuroimaging technique during a task involving reward processing. The researchers scanned the adolescents at the age of 14 and then later at the age of 19, to investigate long-term changes in brain activation.

Interestingly, adolescents with a higher frequency of psychotic-like experiences at age 14 showed reduced brain activation in three prefrontal areas of the brain during the task. However, by the age of 19 these adolescents showed both increase in the activation of the prefrontal regions and a decrease in the activation of a region in the dorsal striatum, during the same task, compared to adolescents without psychotic-like experiences. This is considered as a compensatory cognitive control mechanism, where ‘higher’ prefrontal cortical areas are recruited in order to contextualize abnormal experiences, generated by ‘lower’ subcortical areas.

Professor Sukhwinder Shergill, the senior author of the study from the Institute of Psychiatry, Psychology & Neuroscience added: ‘An improved understanding of these compensatory changes during adolescence would be very helpful in developing strategies to reduce the transition to illness.’

Biological markers (biomarkers) accompanied by psychotic-like experiences, such as the ones discovered in this study, may provide useful for improving early diagnosis of psychotic illness. Currently there are no biomarkers for psychosis, but in the future there is hope to combine data from patient interviews, neuroimaging studies, and possibly genetic testing to increase the accuracy of predictive diagnoses.

This study was funded by the European Union, Economic Research Council, Medical Research Council, Swedish Research Council and National Institute for Health Research.

Paper reference: Papanastasiou E et al. (2018). The neural basis of psychotic-like experiences in adolescence; an fMRI study of reward processing. JAMA Psychiatry. DOI:10.1001/jamapsychiatry.2018.1973

For further media information please contact Institute of Psychiatry, Psychology & Neuroscience, King’s College London on ioppn-pr@kcl.ac.uk or 020 7848 5377.

News story by Anna McLaughlin.