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Background: Postpartum psychotic‐ or mood disorders are psychiatric emergencies associated with risk of suicide and infanticide. Except from case reports, there are only few descriptions of its treatment. Therefore, we aimed to describe the treatment of women admitted with postpartum psychotic‐ or mood disorder in Denmark with emphasis on the use of electroconvulsive therapy (ECT). Methods: We conducted a register‐based cohort study of all women with incident postpartum psychotic‐ or mood disorder (no prior diagnoses of psychotic‐ or mood disorder or treatment with ECT) requiring admission in the period from 2011 to 2018. For these patients, we described the treatment and the 6‐month readmission risk. Results: We identified 91 women with postpartum psychotic‐ or mood disorder with a median admission length of 27 days (interquartile range: 10–45). Of those, 19% received ECT with a median time from admission to first ECT of 10 days (interquartile range: 5–16). The median number of ECT sessions was eight (interquartile range: 7–12). In the 6 months following discharge, 90% of the women received some form of psychopharmacological treatment (62% antipsychotics, 56% antidepressants, 36% anxiolytics/sedatives, 19% lithium, and 9% mood stabilizing antiepileptics), and 31% were readmitted. Conclusion: Psychiatric admission for incident postpartum psychotic‐ or mood disorder is rare in Denmark. Among those admitted, ECT and psychopharmacological treatment is commonly used. The 6‐month readmission risk is high, warranting close follow‐up. The fact that there is no international consensus on the optimal treatment of postpartum psychotic‐ or mood disorder is problematic and calls for action. [ABSTRACT FROM AUTHOR]

Introduction: Delirium is an acute neuro‐psychiatric disturbance precipitated by a range of physical stressors, with high morbidity and mortality. Little is known about its relationship with severe mental illness (SMI). Methods: We conducted a retrospective cohort study using linked data analyses of the UK Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. We ascertained yearly hospital delirium incidence from 2000 to 2017 and used logistic regression to identify associations with delirium diagnosis in a population with SMI. Results: The cohort included 249,047 people with SMI with median follow‐up time in CPRD of 6.4 years. A total of 85,979 patients were eligible for linkage to HES. Delirium incidence increased from 0.04 (95% CI 0.02–0.07) delirium associated admissions per 100 person‐years in 2000 to 1.05 (95% CI 0.93–1.17) per 100 person‐years in 2017, increasing most notably from 2010 onwards. Delirium was associated with older age at study entry (OR 1.05 per year, 95% CI 1.05–1.06), SMI diagnosis of bipolar affective disorder (OR 1.66, 95% CI 1.44–1.93) or other psychosis (OR 1.56, 95% CI 1.35–1.80) relative to schizophrenia, and more physical comorbidities (OR 1.08 per additional comorbidity of the Charlson Comorbidity Index, 95% CI 1.02–1.14). Patients with delirium received more antipsychotic medication during follow‐up (1–2 antipsychotics OR 1.65, 95% CI 1.44–1.90; >2 antipsychotics OR 2.49, 95% CI 2.12–2.92). Conclusions: The incidence of recorded delirium diagnoses in people with SMI has increased in recent years. Older people prescribed more antipsychotics and with more comorbidities have a higher incidence. Linked electronic health records are feasible for exploring hospital diagnoses such as delirium in SMI. [ABSTRACT FROM AUTHOR]

Introduction: Family studies provide a suitable approach to analyzing candidate endophenotypes of schizophrenia, including cognitive features. Objective: To characterize different neurocognitive functions in a group of patients with first episode of psychosis (FEP), their first‐degree relatives (parents and siblings), and healthy controls (HC), in order to identify potential endophenotypes for schizophrenia spectrum disorders (SSD). Methods: Participants were assessed in the context of a national project in Spain called PAFIP‐FAMILIAS. They completed the same neuropsychological battery, which included tests of verbal memory, visual memory, processing speed, working memory, executive functions, motor dexterity, attention, and theory of mind. Group comparisons were performed using one‐way ANOVA, followed by tests of multiple comparisons when appropriate. Results: One hundred thirty‐three FEP patients were included, as well as 244 of their first‐degree relatives (146 parents and 98 siblings) and 202 HC. In general, relatives showed an intermediate performance between the HC and the FEP patients in all neurocognitive domains. However, the domains of executive functions and attention stood out, as relatives (especially parents) showed similar performance to FEP patients. This was replicated when selecting patients subsequently diagnosed with schizophrenia and their relatives. Conclusion: These findings suggest that executive and attention dysfunctions might have a family aggregation and could be relevant cognitive endophenotypes for psychotic disorders. The study shows the potential of exploring intra‐family neuropsychological performance supporting neurobiological and genetic research in SSD. [ABSTRACT FROM AUTHOR]

Aim: To understand the relationship between serious mental illness and oral health self‐care behaviours using meta‐analytic methods and a narrative synthesis of available literature. Method: The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines [PROSPERO reference: CRD42020176779]. Search terms pertaining to serious mental illness and oral health were entered into EMBASE, PsycINFO, Medline and CINAHL. Eligible studies included a sample of people with a serious mental illness and a quantitative measure of an oral health self‐care behaviour (eg dental visits, toothbrushing). The Effective Public Health Practice Project tool was utilised to appraise the quality of the literature. Studies in the meta‐analysis contained a non‐clinical or general population comparator sample. Results: People with a serious mental illness were significantly less likely to visit the dentist (OR 0.46, 95% CI 0.32–0.065, p > 0.001) or brush their teeth (OR 0.19, 95% CI 0.08–0.42, p < 0.001) when compared to non‐clinical comparator samples. Few studies explored other oral health self‐care behaviours (eg flossing and mouth washing), but uptake was generally low in people with a serious mental illness. The study quality of included studies was variable. Conclusions: The research showed a reduced uptake of oral health self‐care behaviours in people with a serious mental illness. Suboptimal oral health can negatively impact on physical, social and psychological functioning. Further research is needed to understand the reasons for low rates of oral health self‐care behaviours in this population. [ABSTRACT FROM AUTHOR]

ObjectiveCannabis use has been examined as a predictor of psychosis in clinical high-risk (CHR) samples, but little is known about the impact of other substances on this relationship.MethodSubstance use was assessed in a large sample of CHR participants (N = 370, mean age = 18.3) enrolled in the multisite North American Prodrome Longitudinal Study Phase 1 project. Three hundred and forty-one participants with cannabis use data were divided into groups: No Use (NU, N = 211); Cannabis Use without impairment (CU, N = 63); Cannabis Abuse/Dependence (CA/CD, N = 67). Participants (N = 283) were followed for ≥2 years to determine psychosis conversion.ResultsAlcohol (45.3%) and cannabis (38.1%) were the most common substances. Cannabis use groups did not differ on baseline attenuated positive symptoms. Seventy-nine of 283 participants with cannabis and follow-up data converted to psychosis. Survival analysis revealed significant differences between conversion rates in the CA/CD group compared with the No Use (P = 0.031) and CU group (P = 0.027). CA/CD also significantly predicted psychosis in a regression analysis, but adjusting for alcohol use weakened this relationship.ConclusionThe cannabis misuse and psychosis association was confounded by alcohol use. Non-impairing cannabis use was not related to psychosis. Results highlight the need to control for other substance use, so as to not overstate the cannabis/psychosis connection.

Objectives: Several theories propose that visual acuity impairment is associated with psychosis. Visual impairment could lead to psychosis or the converse, or they may share underlying pathology or risk factors. In the first evidence synthesis in this area for over 25 years, we collated studies measuring the association between visual acuity impairment and psychosis. Methods: We searched the MEDLINE, EMBASE, PsycINFO, and Web of Science databases for studies published from 1992 to 2020, using the Newcastle Ottawa Scale to assess risk of bias. We narratively synthesized findings and meta-analyzed sufficiently homogenous results. Results: We included 40 papers, which reported on 31 studies. Evidence from seven cohort studies was inconsistent, which precluded meta-analysis of this study design. These contradictory results also made it difficult to draw conclusions regarding a temporal association. We found evidence for an association from eight cross-sectional studies treating visual acuity impairment as the exposure and psychosis as the outcome [pooled odds ratio (OR) =1.76, 95% confidence interval (CI): 1.34-2.31], and four with the reverse exposure and outcome (OR: 1.85, 95% CI: 1.17-2.92). Seven case-control studies with mixed findings were found, but only two primarily addressed our research question, and these findings were mixed. Conclusions: Although evidence supports a cross-sectional association between visual acuity impairment and psychosis, further research is needed to clarify the temporal direction, given the mixed findings in cohort studies. Understanding the association may give insights into prevention strategies for people at risk of visual acuity impairment and psychosis. [ABSTRACT FROM AUTHOR]

Objective: To use data from electronic health records (EHRs) to describe the demographic, clinical and functional correlates of childhood sexual abuse (CSA) in patients with severe mental illness (SMI), and compare their clinical outcomes (admissions and receipt of antipsychotic medications) to those of patients with no recorded history of CSA. Methods: We applied a string‐matching technique to clinical text records of 7000 patients with SMI (non‐organic psychotic disorders or bipolar disorder), identifying 619 (8.8%) patients with a recorded history of CSA. Data were extracted from both free‐text and structured fields of patients' EHRs. Results: Comorbid diagnoses of major depressive disorder, post‐traumatic stress disorder and personality disorders were more prevalent in patients with CSA. Positive psychotic symptoms, depressed mood, self‐harm, substance use and aggression were also more prevalent in this group, as were problems with relationships and living conditions. The odds of inpatient admissions were higher in patients with CSA than in those without (adjusted OR = 1.95, 95% CI: 1.64–2.33), and they were more likely to have spent more than 10 days per year as inpatients (adjusted OR = 1.32, 95% CI: 1.07–1.62). Patients with CSA were more likely to be prescribed antipsychotic medications (adjusted OR = 2.48, 95% CI: 1.69–3.66) and be given over 75% of the maximum recommended daily dose (adjusted OR = 1.72, 95% CI: 1.44–2.04). Conclusion: Data‐driven approaches are a reliable, promising avenue for research on childhood trauma. Clinicians should be trained and skilled at identifying childhood adversity in patients with SMI, and addressing it as part of the care plan. [ABSTRACT FROM AUTHOR]

Objective: Psychotic experiences, such as hallucinations, occur commonly in children and have been related to bullying victimization. However, whether bullying perpetration, peer rejection, or peer acceptance are related to hallucinatory experiences has remained under‐examined. We used a novel peer nomination method to examine whether (i) bullying perpetration and (ii) social positions within peer networks were associated with future hallucinatory experiences. Methods: This prospective study was embedded in the population‐based Generation R Study. Bullying perpetration, peer rejection, and peer acceptance were assessed using peer nominations at age 7 years (N = 925). Using a social network analysis, we estimated social positions within peer rejection and acceptance networks. Bullying victimization was assessed using self‐reports. Self‐reported hallucinatory experiences were assessed at age 10 years. Analyses were adjusted for sociodemographic covariates. Results: Higher levels of bullying perpetration were prospectively associated with an increased burden of hallucinatory experiences (OR = 1.22, 95% CI 1.05–1.43, p = 0.011). Bullies had a 50% higher, and bully‐victims had a 89% higher odds, of endorsing hallucinatory experiences three years later than children who were not involved in bullying (ORbully = 1.50, 95% CI 1.01–2.24, p = 0.045; ORbully‐victim = 1.89, 95% CI 1.15–3.10, p = 0.012). Unfavorable positions within peer rejection networks, but not peer acceptance networks, were associated with an increased risk for hallucinatory experiences (ORpeer rejection = 1.24, 95% CI 1.07–1.44, pFDR‐corrected = 0.024). Conclusion: Using peer reports, we observed that bullies and socially rejected children have a higher likelihood to report hallucinatory experiences in pre‐adolescence. Children who are both a bully and a victim of bullying (ie, bully‐victims) may be particularly vulnerable for psychotic experiences. [ABSTRACT FROM AUTHOR]

Objective: The period immediately after the onset of first‐episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2‐years follow‐up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. Methods: We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. Results: We identified three distinct trajectories: Non‐SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow‐up assessments. Conclusion: Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at‐risk population. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review and meta‐analysis of the existing evidence on the association between age at migration and the risk of psychotic disorders. Methods: Observational studies were eligible for inclusion if they presented data on the association between age at migration and the risk of psychotic disorders among first‐generation migrant groups. We used two random effects meta‐analyses to pool effect estimates for each stratum of age at migration relative to (i) a native‐born reference category and (ii) the youngest age stratum (0 to 2 years). Results: Ten studies met inclusion criteria, and five were included in the meta‐analysis. The risk of psychotic disorder among people who migrate prior to age 18 is nearly twice as high as the native‐born population, with no evidence of effect modification by age strata. People who migrate during early adulthood (19 to 29 years) have a similar risk of psychotic disorder as the native‐born population (IRR = 0.93, 95% CI = 0.60, 1.44) and a lower risk relative to those who migrate during infancy (0 to 2 years) (IRR = 0.58, 95% CI = 0.33, 1.04). Conclusions: Migrant status is one of few well‐established risk factors for psychotic disorder, yet we have limited understanding of the underlying etiology. The findings of this review advance our understanding of this association and identify high‐risk groups to target for intervention. [ABSTRACT FROM AUTHOR]

Objective: Cannabis is an acknowledged risk factor for some mental disorders, but for others the evidence is inconclusive. Prescribed medicinal drugs can be used as proxies for mental disorders. In this study, we investigate how use of cannabis is prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics. Methods: Data on cannabis exposure and relevant confounders were obtained from 2,602 individuals in the longitudinal Young in Norway Study, providing survey data from four data collection waves between 1992 and 2006. Data were coupled with information about prescriptions for psychotropic drugs from the Norwegian Prescription Database between 2007 and 2015. Results: Past year cannabis use increased the risk of prescription of antipsychotics (OR = 5.56, 95 % CI 1.64 – 18.87), mood stabilizers (OR = 5.36, 95 % CI 1.99 – 14.44) and antidepressants (OR = 2.10, 95 % CI 1.36 – 3.25), after accounting for sociodemographic variables, conduct problems, additional drug use, mental distress, and prescriptions the year before cannabis use was measured. Conclusions: In this study of young adults from the general population, past year cannabis use was associated with later prescriptions of antipsychotics, mood stabilizers, and antidepressants. [ABSTRACT FROM AUTHOR]

Objective: Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta‐analysis on the association between CM and treatment outcome in psychotic disorders. Methods: Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. Results: Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. Conclusions: Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta‐analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders. [ABSTRACT FROM AUTHOR]

Objective: To test whether duration of untreated psychosis (DUP) < 3 months, recommended by the World Health Organization/International Early Psychosis Association, enhances the effects of an extended early intervention service (EEIS) on symptom remission. Method: We examined data from a randomized controlled trial in which patients who received 2 years of treatment in EIS for psychosis were subsequently randomized to either 3 years of EEIS or 3 years of regular care (RC). Using a DUP cut‐off ≤ 12 weeks (approximately < 3 months), patients were split into two groups. Length of positive, negative and total symptom remission were the outcomes. Results: Patients (N = 217) were mostly male (68%) with schizophrenia spectrum disorder (65%); 108 (50%) received EEIS (58 had DUP ≤12 weeks; 50 had DUP >12 weeks). Interaction between treatment condition (EEIS vs. RC) and DUP cut‐off ≤ 12 weeks was only significant in multiple linear regression model examining length of negative symptom remission as the outcome (adjusted β = 36.88 [SE = 15.88], t = 2.32, P = 0.02). EEIS patients with DUP ≤12 weeks achieved 25 more weeks of negative symptom remission than EEIS patients with DUP >12 weeks. Conclusion: Having a short DUP may be critical in deriving long‐term benefits from EIS for psychosis, including EEIS settings. This work empirically supports policy recommendations of reducing DUP <3 months. [ABSTRACT FROM AUTHOR]

Objective: Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low‐ and middle‐income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts. Method: We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N = 146 999) using cross‐sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences. Results: Victimization was associated with greater odds of psychotic experiences, OR (95% CI) = 1.72 (1.50–1.98), and was significantly more strongly associated with psychotic experiences in non‐urban, OR (95% CI) = 1.93 (1.60–2.33), compared to urban settings, OR (95% CI) = 1.48 (1.21–1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization. Conclusions: In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make‐up. [ABSTRACT FROM AUTHOR]

Objective There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. Method A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. Results In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). Conclusion While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation. [ABSTRACT FROM AUTHOR]

Objective Electroconvulsive therapy ( ECT) remains underutilized because of fears of cognitive and medical risks, including the risk of death. In this study, we aimed to assess the mortality rate of ECT by means of a systematic review and pooled analysis. Method The study was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The ECT-related mortality rate was calculated as the total number of ECT-related deaths reported in the included studies divided by the total number of ECT treatments. Results Fifteen studies with data from 32 countries reporting on a total of 766 180 ECT treatments met the inclusion criteria. Sixteen cases of ECT-related death were reported in the included studies yielding an ECT-related mortality rate of 2.1 per 100 000 treatments (95% CI: 1.2-3.4). In the nine studies that were published after 2001 (covering 414 747 treatments), there was only one reported ECT-related death. Conclusion The ECT-related mortality rate was estimated at 2.1 per 100 000 treatments. In comparison, a recent analysis of the mortality of general anesthesia in relation to surgical procedures reported a mortality rate of 3.4 per 100 000. Our findings document that death caused by ECT is an extremely rare event. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness. Method PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports. Results Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P < 0.001, 22 studies, n = 44 718). There were significantly fewer bed days after clozapine treatment compared to before clozapine treatment in both controlled (MD = −34.41 days; 95% CI: −68.22 to −0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = −52.86 days; 95% CI: −79.86 days to −25.86 days, P < 0.001, n = 2917). Clozapine and control medicines had a similar time to rehospitalisation (−19.90 days; 95% CI: −62.42 to 22.63 days, P = 0.36). Conclusion Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder., Methods: Mortality and basic demographics were available for a population of N = 10,914 SMH users in the north of The Netherlands from 2010 until 2017. To estimate mortality over the adult lifespan, parametric Gompertz distributions were fitted on observed mortality using interval regression. Life years lost were computed by calculating the difference between integrals of the survival functions for the general population and the study sample, thus correcting for age. Survival for the general population was obtained from Statistics Netherlands (CBS)., Results: SMH users were estimated to lose 9.5 life years (95% CI: 9.4-9.6). Every major diagnosis category was associated with a significant loss of life years, ranging from 7.2 (95% CI: 6.4-7.9) years for anxiety patients to 11.7 (95% CI: 11.0-12.5) years for bipolar disorder patients. Significant differences in mortality were observed between male SMH users and female SMH users, with men losing relatively more life years: 11.0 (95% CI: 10.9-11.2) versus 8.3 (95% CI: 8.2-8.4) respectively. This difference was also observed between sexes within every diagnosis, although the difference was insignificant for bipolar disorder., Conclusion: There were significant differences in mortality between SMH users and the general population. Substantial differences were observed between sexes and between diagnoses. Additional attention is required, and possibly specific interventions are needed to reduce the amount of life years lost by SMH users., (© 2023 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

Objective To test whether spatial and social neighbourhood patterning of people at ultra-high risk (UHR) of psychosis differs from first-episode psychosis (FEP) participants or controls and to determine whether exposure to different social environments is evident before disorder onset. Method We tested differences in the spatial distributions of representative samples of FEP, UHR and control participants and fitted two-level multinomial logistic regression models, adjusted for individual-level covariates, to examine group differences in neighbourhood-level characteristics. Results The spatial distribution of controls ( n = 41) differed from UHR ( n = 48; P = 0.04) and FEP participants ( n = 159; P = 0.01), whose distribution was similar ( P = 0.17). Risk in FEP and UHR groups was associated with the same neighbourhood-level exposures: proportion of single-parent households [FEP adjusted odds ratio (aOR): 1.56 95% CI: 1.00-2.45; UHR aOR: 1.59; 95% CI: 0.99-2.57], ethnic diversity (FEP aOR: 1.27; 95% CI: 1.02-1.58; UHR aOR: 1.28; 95% CI: 1.00-1.63) and multiple deprivation (FEP aOR: 0.88; 95% CI: 0.78-1.00; UHR aOR: 0.86; 95% CI: 0.76-0.99). Conclusion Similar neighbourhood-level exposures predicted UHR and FEP risk, whose residential patterning was closer to each other's than controls. Adverse social environments are associated with psychosis before FEP onset. [ABSTRACT FROM AUTHOR]

Objective Despite widespread use internationally, there is no convincing evidence that community treatment orders ( CTO) (legal regimes making out-patient treatment compulsory), reduce readmission rates or have wider patient benefit. The primary and secondary outcomes of the Oxford Community Treatment Order Evaluation Trial ( OCTET) (hospitalisation) showed no benefit. This article will, first, test the effect of community compulsion on wider clinical and social outcomes and on patients' experiences of services and the use of treatment pressure and second, explore differential effects in different groups of patients. Method OCTET is a RCT of CTO effectiveness. Three hundred and thirty-six patients were randomised and data for the 333 eligible patients were collected from interviews and medical records at baseline, 6 and 12 months. Results There was no significant difference at 12 months between the two arms in any of the reported outcomes, except a small difference in patients' view of the effectiveness of treatment pressure, which is unlikely to be clinically meaningful. Two statistically significant interactions were found in the subgroup analysis: symptoms interacted with age and with education, but no pattern was demonstrated. Conclusion CTOs do not have benefit on any of the tested outcomes, or for any subgroup of patients. Their continued use should be carefully reconsidered. [ABSTRACT FROM AUTHOR]

Objective We aimed to investigate associations between family history of psychosis and long-term occupational, social and global (i.e. combined occupational, social and clinical) outcome in schizophrenia. Method A systematic search to identify potentially relevant studies was conducted using seven electronic databases and a manual search of literature. Only observational studies with a follow-up period of at least 2 years were included. Results The search identified 4081 unique potentially relevant articles, of which 14 met our inclusion criteria. The presence of family history of psychosis was associated with poor occupational and global outcome ( n = 3; r = 0.17; P = 0.008, n = 11; r = 0.13; P = 0.002, respectively). Conclusion This was the first systematic review on the effects of family history of psychosis on occupational and social outcome in schizophrenia. Based on the review, the presence of family history of psychosis has a relatively small but statistically significant association with long-term occupational and global outcome in patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso-Mateos JL. Evidence for the early clinical relevance of hallucinatory-delusional states in the general population. Objective: To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. Method: General population-based household surveys of randomly selected adults between 18 and 65 years of age were carried out. Setting: 52 countries participating in the World Health Organization's World Health Survey were included. Participants: 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. Results: Compared with isolated delusions and hallucinations, co-occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92-0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0-3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5-14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3-22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9-12.4). Co-occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8-2.3). Conclusion: The results suggest that the co-occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state. [ABSTRACT FROM AUTHOR]

Baker AL, Hiles SA, Thornton LK, Hides L, Lubman DI. A systematic review of psychological interventions for excessive alcohol consumption among people with psychotic disorders. Objective: Excessive alcohol consumption is common among people with psychotic disorders. While there is an extensive literature on the efficacy of psychological treatments for excessive drinking, few studies have examined interventions addressing this issue among people with psychotic disorders. Method: Systematic searches in PubMed and PsycINFO were conducted to identify randomized controlled trials comparing manual-guided psychological interventions for excessive alcohol consumption among individuals with psychotic disorders. Of the 429 articles identified, seven met inclusion criteria. Data were extracted from each study regarding study sample characteristics, design, results, clinical significance of alcohol consumption results, and methodological limitations. Results: Assessment interviews, brief motivational interventions, and lengthier cognitive behavior therapy have been associated with reductions in alcohol consumption among people with psychosis. While brief interventions (i.e. 1-2 sessions) were generally as effective as longer duration psychological interventions (i.e. 10 sessions) for reducing alcohol consumption, longer interventions provided additional benefits for depression, functioning, and other alcohol outcomes. Conclusion: Excessive alcohol consumption among people with psychotic disorders is responsive to psychological interventions. It is imperative that such approaches are integrated within standard care for people with psychosis. [ABSTRACT FROM AUTHOR]

Donoghue K, Mazzoncini R, Hart J, Zanelli J, Morgan C, Dazzan P, Morgan KD, Murray RM, Jones PB, Doody GA. The differential effect of illicit drug use on cognitive function in first-episode psychosis and healthy controls. Objective:: Illicit drug use can result in impairment in cognitive function in healthy individuals. Individuals with a psychotic disorder also show a deficit in cognitive function. Drug use may simply contribute to the characteristic cognitive deficit found in psychosis or alternatively result in a 'double deficit'. This study aims to investigate the association between drug use and cognitive function at the first-episode of psychosis and in community-matched controls. Method:: One hundred and seventy-seven patients at the first episode of psychosis completed a battery of neuropsychological tests. Those that had used drugs in the previous year ( n = 80) were compared with those who had not used drugs in the previous year ( n = 97). A subsample of the first-episode psychosis patients were compared with community-matched controls ( n = 110) according to drug-use status. Results:: Patients with a first episode of psychosis who had used drugs performed equally to those who had not used drugs on neuropsychological tests. In contrast, healthy controls who had used drugs in the previous year performed worse on tests of executive function and working memory compared with those controls that had not used drugs. Conclusion:: There are differential associations of illicit drug misuse with cognitive function for first-episode psychosis patients and healthy controls. [ABSTRACT FROM AUTHOR]

Lardinois M, Lataster T, Mengelers R, van Os J, Myin-Germeys I. Childhood trauma and increased stress sensitivity in psychosis. The notion that traumatic experiences in childhood may predict later psychotic outcomes would be strengthened if a plausible mechanism could be demonstrated. Because increased stress sensitivity is part of the behavioural expression of psychosis liability, the possible mediating role of childhood trauma was investigated. Fifty patients with psychosis were studied with the experience sampling method to assess stress reactivity in daily life, defined as emotional and psychotic reactivity to stress. Traumatic experiences in childhood were assessed with the Childhood Trauma Questionnaire. A significant interaction was found between stress and CT on both negative affect (event stress: β = 0.04, P < 0.04; activity stress: β = 0.12, P < 0.001) and psychotic intensity (event stress: β = 0.06, P < 0.001; activity stress: β = 0.11, P < 0.001), showing that a history of CT is associated with increased sensitivity to stress. A history of childhood trauma in patients with psychosis is associated with increased stress reactivity later in life, suggestive for an underlying process of behavioural sensitization. [ABSTRACT FROM AUTHOR]