Brain connectomics predict response to treatment in social anxiety disorder

Mol Psychiatry. 2016 May;21(5):680-5. doi: 10.1038/mp.2015.109. Epub 2015 Aug 11.

Abstract

We asked whether brain connectomics can predict response to treatment for a neuropsychiatric disorder better than conventional clinical measures. Pre-treatment resting-state brain functional connectivity and diffusion-weighted structural connectivity were measured in 38 patients with social anxiety disorder (SAD) to predict subsequent treatment response to cognitive behavioral therapy (CBT). We used a priori bilateral anatomical amygdala seed-driven resting connectivity and probabilistic tractography of the right inferior longitudinal fasciculus together with a data-driven multivoxel pattern analysis of whole-brain resting-state connectivity before treatment to predict improvement in social anxiety after CBT. Each connectomic measure improved the prediction of individuals' treatment outcomes significantly better than a clinical measure of initial severity, and combining the multimodal connectomics yielded a fivefold improvement in predicting treatment response. Generalization of the findings was supported by leave-one-out cross-validation. After dividing patients into better or worse responders, logistic regression of connectomic predictors and initial severity combined with leave-one-out cross-validation yielded a categorical prediction of clinical improvement with 81% accuracy, 84% sensitivity and 78% specificity. Connectomics of the human brain, measured by widely available imaging methods, may provide brain-based biomarkers (neuromarkers) supporting precision medicine that better guide patients with neuropsychiatric diseases to optimal available treatments, and thus translate basic neuroimaging into medical practice.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Brain / physiopathology*
  • Cognitive Behavioral Therapy* / methods
  • Connectome*
  • Female
  • Humans
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neural Pathways / physiopathology
  • Phobia, Social / diagnosis
  • Phobia, Social / physiopathology*
  • Phobia, Social / therapy*
  • Prognosis
  • Rest
  • Sensitivity and Specificity
  • Treatment Outcome
  • Young Adult