Brain Imaging in Adolescents and Young Adults With First-Episode Psychosis: A Retrospective Cohort Study

Objective: Despite the lack of clear guidelines, neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]) is frequently performed in subjects presenting with first-episode psychosis (FEP). The objective of this study was to determine if the use of neuroimaging adds diagnostic yield in adolescents and young adults presenting with FEP.

Methods: The sample consisted of 443 subjects aged 15-24 with FEP (DSM-IV-TR and DSM-5) and no focal neurologic findings. Consecutive charts from January 1, 1998, to June 30, 2016, were reviewed retrospectively. A positive finding was defined as a result leading to urgent follow-up or intervention.

Results: Twenty-five (5.6%) of 443 subjects showed incidental findings unrelated to psychosis. The prevalence of positive findings from neuroimaging was 0%, indicating no diagnostic yield from neuroimaging.

Conclusions: Routine neuroimaging did not provide diagnostic information leading to a change in clinical management and should not be recommended in the investigation of FEP.