Purpose
Most current local and international clinical guidelines do not recommend neuroimaging should be used as a routine investigation of all patients presenting with a first-episode psychosis (FEP),1-4 although controversy persists5
Imaging should only be performed if there is clinical suspicion of intracranial pathology, likely to be identifiable on imaging and known to be associated with psychosis, such as a space occupying lesion, infarction, infection (e.g. encephalitis or cerebral abscess), trauma, autoimmune disorders (e.g. lupus cerebritis) or metabolic disorders (e.g. Wilson Disease)
Although there is some...
Methods and materials
A retrospective study was performed in which patients admitted to our mental health unit with a diagnosis of FEP from 31st May 2017 to 31st May 2019 were identified via medical record search
Inclusion criteria: patients aged 16 and above with a diagnosis of FEP or an admission with a primary psychotic disorder (as per DSM-V), non-organic or organic psychosis and no evidence of prior contact with mental health services, as documented on the hospital discharge summary or in the clinical notes
Exclusion criteria: patients...
Results
91 (69%) of 132 included patients (age range 17 to 74 years) received neuroimaging with 85 receiving CT imaging and 15 undergoing MRI (9 patients received both)
58 of CT studies were ordered by the emergency department prior to formal psychiatric admission while 27 scans were ordered by the psychiatric treating team
Most MRIs were ordered by the psychiatric treating team after clinical, psychiatric and laboratory test evaluation
40% of CT imaging and 60% of MRI imaging requests (43% of all imaging studies) were associated...
Conclusion
This study demonstrates that neuroimaging is still used as a routine screening investigation for the majority of patients presenting with FEP
The findings are in keeping with previous studies as well as a large recent systematic review,7 demonstrating that neuroimaging in this patient group has a low diagnostic yield (well below 1%)and findings are highly unlikely to alter clinical management
MRI was rarely performed in this study despite it being recommended as the first line imaging modality, although it is acknowledged CT may have a...
References
Government of Western Australia. Diagnostic Imaging Pathways - Psychosis (First Episode). Western Australia: Government of Western Australia; 2014. Available from: http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/neurological?id=87
National Institute of Health and Care Excellence. Structural neuroimaging in first-episode psychosis (technology appraisal guidance). United Kingdom: National Institute of Health and Care Excellence; 2008. Available from: https://www.nice.org.uk/guidance/ta136
Addington D, Abidi S, Garcia-Ortega I, Honer WG, Ismail Z. Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders. Can J Psychiatry 2017;62(9):594-603.
American Psychiatric Association. Practice Guidelines for...