Dimensional distribution of cortical abnormality across antipsychotics treatment-resistant and responsive schizophrenia

Takashi Itahashi, Yoshihiro Noda, Yusuke Iwata, Ryosuke Tarumi, Sakiko Tsugawa, Eric Plitman, Shiori Honda, Fernando Caravaggio, Julia Kim, Karin Matsushita, Philip Gerretsen, Hiroyuki Uchida, Gary Remington, Masaru Mimura, Yuta Y. Aoki, Ariel Graff-Guerrero, Shinichiro Nakajima

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: One-third of patients with schizophrenia are treatment-resistant to non-clozapine antipsychotics (TRS), while the rest respond (NTRS). Examining whether TRS and NTRS represent different pathophysiologies is an important step toward precision medicine. Methods: Focusing on cortical thickness (CT), we analyzed international multi-site cross-sectional datasets of magnetic resonance imaging comprising 110 patients with schizophrenia (NTRS = 46, TRS = 64) and 52 healthy controls (HCs). We utilized a logistic regression with L1-norm regularization to find brain regions related to either NTRS or TRS. We conducted nested 10-fold cross-validation and computed the accuracy and area under the curve (AUC). Then, we applied the NTRS classifier to patients with TRS, and vice versa. Results: Patients with NTRS and TRS were classified from HCs with 65% and 78% accuracies and with the AUC of 0.69 and 0.85 (p = 0.014 and < 0.001, corrected), respectively. The left planum temporale (PT) and left anterior insula/inferior frontal gyrus (IFG) contributed to both NTRS and TRS classifiers. The left supramarginal gyrus only contributed to NTRS and right superior temporal sulcus and right lateral orbitofrontal cortex only to the TRS. The NTRS classifiers successfully distinguished those with TRS from HCs with the AUC of 0.78 (p < 0.001), while the TRS classifiers classified those with NTRS from HCs with the AUC of 0.69 (p = 0.015). Conclusion: Both NTRS and TRS could be distinguished from HCs on the basis of CT. The CT pathological basis of NTRS and TRS has commonalities, and TRS presents unique CT features.

Original languageEnglish
Article number102852
JournalNeuroImage: Clinical
Publication statusPublished - 2021 Jan


  • Classification
  • Cortical thickness
  • Schizophrenia
  • Treatment-resistant

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Clinical Neurology
  • Cognitive Neuroscience


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