Background: Alterations in brain connectivity occur early during psychosis and underlie the clinical manifestations of the illness as well as patient functioning and outcome. After a first episode of psychosis (FEP), different trajectories are possible and best described by the clinical-staging model that places the patient along a continuum of conditions: from non-remitting chronic symptoms to full-remission, often followed by relapses. However, little is known about the differences in brain connectivity that could underlie these differences in clinical outcome. Methods: In this study, we included resting-state fMRI and DSI data from a cohort of 128 healthy controls (HC) and 88 patients with early psychosis (EP) stratified based on their ability to remit after the FEP. In particular we focused on differences between stage IIIb,c remitting-relapsing (EP3R) and stage IIIa non-remitting (EP3NR) patients. We investigated alterations in resting-state functional connectivity (FC), and combined information derived from fMRI and DSI into generative whole-brain models of each condition to explore the underlying mechanisms. Results: Opposite alterations in FC could be found in patients as compared to HC, depending on their stage. In non-remitting patients (EP3NR), we observed a reduction of FC, aligned with the reduced structural connectivity found in previous studies, while remitting-relapsing patients (EP3R) showed increased FC, potentially indicating a relevant compensatory mechanism. By means of a whole-brain network model, we showed that in HC a subset of areas is characterized by increased stability to prevent an oversynchronisation of the network, while in EP3 patients such property is lost. This alteration was more relevant in the EP3R than in EP3NR patients, probably indicating a compensatory response to the reduced effective conductivity (global coupling) highlighted by the model in both EP3 conditions as compared to controls. Conclusions: These findings highlight the significance of categorizing patients into subgroups based on the progression of their psychotic disorders, providing insights into the factors contributing to heterogeneity in functional alterations. They enhance our understanding of the interplay between structural and functional properties, shedding light on the mechanisms of psychosis emergence, remission and progression, with potential implications for future therapeutic advancements.

Brain network connectivity underlying remission in early psychosis: a whole brain model approach