Subtyping psychotic disorders using a data-driven approach reveals divergent cortical and cellular signatures

Structural brain abnormalities in psychosis are well-replicated but heterogenous posing a barrier to uncovering the pathophysiology, etiology, and treatment of psychosis. To parse neurostructural heterogeneity and assess for the presence of anatomically-derived subtypes, we applied a data-driven method, similarity network fusion (SNF), to structural neuroimaging data in a broad cohort of individuals with psychosis (schizophrenia spectrum disorders (SSD) n=280; bipolar disorder with psychotic features (BD) n=101). SNF identified two transdiagnostic subtypes in psychosis (subtype 1: n=158 SSD, n=75 BD; subtype 2: n=122 SSD, n=26 BD) that exhibited divergent patterns of abnormal cortical surface area and subcortical volumes. Compared to controls (n=243), subtype 1 showed moderate enlargement of surface area in frontal and parietal areas and larger dorsal striatal volumes, whereas subtype 2 demonstrated markedly smaller surface areas in frontal and temporal areas and subcortical volumes, including hippocampus, amygdala, thalamus and ventral striatum. When comparing subtypes on clinical characteristics, subtype 2 had more severe negative symptoms, greater neuropsychological impairment, and lower estimated premorbid intellectual functioning compared to subtype 1. Integrating cell-type data imputed from gene expression in the Allen Human Brain Atlas revealed an association between interregional reductions in surface area and layer 5 glutamatergic neuron abundance, critical for corticostriatal network connectivity and cognitive function, whereas reductions in cortical thickness spatially coupled with glia cell and interneuron abundance, in subtype 2. These outcomes indicate that regional variations in surface area, linked to different cell-types than cortical thickness, may be an important biomarker for understanding the pathophysiological trajectories of psychotic disorders.