Predicting Antipsychotic Response: Could EEG Help?

“When we start a new treatment in someone that’s acutely ill, we don’t really know if it’s going to work or not,” Jose Rubio, MD, PhD, said. Clinicians who started a new treatment in an acutely ill patient often cannot anticipate how well it will work, making prognostic tools that might flag likely nonresponders an area of interest.

Electroencephalography (EEG) analyzed by microstates was one such approach. According to Rubio, pilot data appeared strong enough to suggest that the method might help indicate whether a medication would be effective for a given patient, although these findings remained preliminary. Published reviews of pharmaco-EEG likewise described EEG as a promising but heterogeneous basis for predicting antipsychotic response, with further investigation needed.¹

Rubio noted that a grant submission planned to collect data from patients starting a new antipsychotic for acute psychosis. “We want to see whether our metric really generalizes across different settings and if it really augments the predictions that doctors can now do with clinical information alone,” Rubio said.

Imaging biomarkers were also under investigation: prior work examined baseline striatal functional connectivity as a possible predictor of antipsychotic response in acutely psychotic patients.² In a clinical trial in progress, Rubio and colleagues hypothesized that functional magnetic resonance imaging might predict treatment response well enough to guide treatment selection. Patients predicted not to respond to a first-line drug would be randomized to clozapine or to treatment as usual, and the trial would test whether clozapine in this group led to better outcomes. Rubio expressed enthusiasm for both lines of work, though their clinical value remained to be confirmed.

Explaining biology to patients could be difficult as well because mechanistic detail may become abstract and complex. Rubio suggested that tardive dyskinesia was a comparatively simple example, as it could be framed around likely upregulation or downregulation with treatment and a plan to adjust dopamine levels. Rubio noted that the tendency to move quickly into detail was not necessarily helpful with patients, and he advised keeping explanations as succinct as possible and tailored to the situation.

Dr Rubio is an assistant professor of psychiatry at the Zucker School of Medicine at Hofstra University.

References

1. De Pieri M, Rochas V, Sabe M, et al. Pharmaco-EEG of antipsychotic treatment response: a systematic review. Schizophrenia (Heidelb). 2023;9(1):85.

2. Sarpal DK, Argyelan M, Robinson DG, et al. Baseline striatal functional connectivity as a predictor of response to antipsychotic drug treatment. Am J Psychiatry. 2016;173(1):69-77.