Researchers led by Dr Graham Blackman and Professor Philip McGuire at the University of Oxford reviewed the results of over 1,600 patients with a first episode of psychosis who had undergone an MRI brain scan.
They found that around six per cent of patients had a scan abnormality which led to a different diagnosis or a change to their clinical care.
Dr Blackman, an NIHR (National Institute for Health and Care Research) Clinical Lecturer at the University, says:
“Patients presenting with psychosis may have another physical illness or condition causing their symptoms that can be identified using MRI scanning. A failure to detect these causes at an early stage can have serious consequences, such as a delay in providing the appropriate treatment.
"Our findings suggest that MRI scans should be considered as part of the initial assessment of all people with first-episode psychosis to ensure that they get the right diagnosis and the right treatment.”
Although it is considered good practice to carry out a brain scan in new patients with psychosis, this is not mandatory. Previously, a NICE Technology Appraisal was unable to recommend scanning in all patients, as at that time it was unclear how common clinically relevant brain abnormalities in people with first-episode psychosis are.
Prof McGuire added: “We feel that this study addresses a critical knowledge gap in this area by showing that clinically relevant abnormalities occur frequently enough to justify making MRI scanning a routine part of the assessment of people presenting with psychosis for the first time. This new evidence has important implications for clinical care in psychosis and a review of the NICE guidance in this area would be helpful.”
Following these findings, the researchers are now evaluating the utility of offering all people with a first episode of psychosis at Oxford Health NHS Trust an MRI brain scan as part of their initial clinical assessment.
The paper has been published in the journal JAMA Psychiatry.