Search

Background The category ‘brief psychotic disorder’ (BPD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a short-lived psychotic condition in which delusions, hallucinations, disorganised speech or grossly disorganised or catatonic behaviour are present for at least 1 day but less than 1 month. BPD is a relatively uncommon disease accounting for 2–7% of first-episode psychoses (FEP) and it has been poorly investigated in comparison with other psychotic disorders, probably due to its low prevalence and associated good prognosis. However, FEP patients with BPD have low diagnostic stability at follow-up and a high transition rate (around 55%) to long-lasting psychotic disorders, mainly to schizophrenia. This study explored the proportion of diagnostic transition to schizophrenia after 3 years in a cohort of FEP patients with BPD, to determine whether there were early predictive factors for such transition in this BPD population. Methods A 36-month prospective observational study of patients with first-episode BPD was conducted. The sample included subjects aged 18–60 from the intervention programme of first-episode psychosis non-affective psychosis (PAFIP) of the University Hospital Marques de Valdecilla (Spain). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-IV (SCID-I) at 6 months following admission into the PAFIP programme. Sociodemographic, premorbid and baseline clinical variables were collected and patients were followed over 3 years while they received treatment in the PAFIP programme. A DSM-IV diagnostic reassessment was performed on those patients who completed the follow-up and subjects were classified according to whether or not they had developed schizophrenia after 3 years. Univariate screening was performed to determine variables eligible for the predictive model, and factors that reached statistical or marginal significance (p ≤ 0.1) were selected for multivariate logistic regression analysis. Significant statistical level was set at 0.05. All statistical evaluation was performed using MedCalc Statistical Software (version 19.0.7). Results Of the 569 patients enrolled in the PAFIP programme between 2001 and 2018, 59 met the criteria for BPD. Of those, 40 (67.8%) completed the 36-month follow-up and 16 (40%) maintained their initial BPD diagnosis. Among the patients who developed other mental disorders by the end of the study period (60%; n = 24), the proportion of transition to schizophrenia was 62.5% (n = 15). Being younger at psychosis onset, living alone, a poor premorbid adjustment, acute onset of psychotic symptomatology, and higher severity of hallucinatory behaviour were variables that showed univariate associations with subsequent development of schizophrenia. A multivariate logistic regression model revealed that transition to schizophrenia was independently significantly associated with younger age at psychosis onset (OR = 0.83, 95% CI 0.69–0.99; p = 0.048), living alone (OR = 14.3, 95% CI 1.09–186.77; p = 0.042) and greater hallucinatory activity (OR = 1.81, 95% CI 1.07–3.07; p = 0.028). Discussion Our main findings were that 37.5% of patients who presented an initial BPD diagnosis developed schizophrenia in the following 36 months. Being younger at psychosis onset, living alone and experiencing greater hallucinatory activity at baseline were independent predictors of diagnostic transition to schizophrenia in this BPD population. Individuals with BPD presenting these risk factors should therefore be targeted for intensive interventions similar to those performed on patients with first-episode schizophrenia.

Background The concept ‘non-affective acute remitting psychosis’ (NARP) embraces a broad set of non-affective psychotic conditions characterised by acute onset (i.e. the change from a non-psychotic to a clearly psychotic state occurred in a period of 2 weeks or less) and brief duration (less than 6 months from onset with full recovery). The prevalence of NARP ranges 5–9% of all first-episode psychosis (FEP) and, due to its limited duration and complete remission, it has generally good prognosis. However, research surrounding predictive indicators of NARP remains scarce. This study examined the clinical and sociodemographic characteristics of NARP patients, to determine whether there are early predictors that could differentiate this disorder from schizophrenia. Methods This research was part of a larger epidemiological 3-year longitudinal study of first-episode non-affective psychosis (PAFIP) conducted at the University Hospital Marques de Valdecilla (Spain). The sample included all patients aged 18–60 enrolled in the PAFIP programme who fullfilled NARP criteria at the end of the study period and their baseline clinical and sociodemographic characteristics were compared with those of patients with acute short-lived psychosis at admission who developed schizophrenia during follow-up. Univariate comparisons between groups were performed using Student’s t-test, Mann-Whitney’s U-test and the Chi-square test, according to distribution and variable type. Multivariate logistic regression analysis was conducted to determine the potential independent effect of each significant or marginally significant (p ≤ 0.1) variable from the univariate analysis. Statistical significance was set as p ≤ 0.05. All statistical procedures were performed using MedCalc Statistical Software (version 19.0.7). Results Of the 391 patients enrolled in the PAFIP programme between 2001 and 2018 who completed the follow-up, 31 met the criteria for NARP at the end of the study period. Mean age was 31.28 years (SD ± 9.44) and gender distribution was slightly higher for females (54.8%; n = 17). According to DSM criteria, NARP patients were classified thus: schizophreniform disorder 48.4% (n = 15), brief psychotic disorder 35.5% (n = 11) and psychotic disorder not otherwise specified 16.1% (n = 5). Univariate comparisons yielded significant differences between NARP patients and those with schizophrenia in terms of negative and activation/excitement symptomatology and in levels of insight, psychosocial functioning and premorbid adjustment. Multivariate logistic regression analysis revealed that fewer negative symptoms at admission (i.e. lower scores on Brief Psychiatric Rating Scale [BPRS] negative symptom subscale; OR = 0.75, 95% CI 0.59–0.95; p = 0.017) and better premorbid adjustment (i.e. lower scores on Cannon-Spoor’s Premorbid Adjustment Scale [PAS]; OR = 0.62, 95% CI 0.41–0.95; p = 0.011) significantly predicted the presence of NARP. Moreover, better insight into having a psychotic disorder (i.e. lower scores on Scale to Assess Unawareness of Mental Disease [SUMD]) marginally predicted NARP diagnosis (OR = 0.81, 95% CI 0.65–1.01; p = 0.056). Discussion Patients who met the NARP criteria accounted for 7.9% of FEP. Better premorbid adjustment, greater awareness of mental disorder and lower negative symptomatology at admission were independent prognostic factors that differentiated NARP from schizophrenia in FEP patients with acute and short-lived psychosis. Our findings would enable early identification of NARP patients and could therefore be of value in developing more specific interventions in this population.

Background Machine learning classifications of first-episode psychosis (FEP) using neuroimaging have predominantly analyzed brain volumes. Some studies examined cortical thickness data, but most of them have used parcellation approaches with data from single sites, which limits claims of generalizability. To address these limitations, we conducted a large-scale, multi-site analysis of cortical thickness comparing parcellations and vertex-wise approaches. By leveraging the multi-site nature of the study, we further investigated how different demographical and site-dependent variables affected predictions. Finally, we assessed relationships between the predictions and clinical variables. Methods 428 subjects (147 females, mean age 27.14) with FEP and 448 (230 females, mean age 27.06) healthy controls were enrolled in 8 centers by the ClassiFEP group. All subjects underwent a structural MRI (sMRI) session and were clinically assessed. Cortical thickness parcellation (68 areas) and full cortical maps (20484 vertices) were extracted. Supervised (linear Support Vector Machine) classification was used to differentiate FEP from HC, within a repeated nested Cross-Validation (CV) framework through the NeuroMiner software. In both inner and outer CVs, a 10-fold CV cycle was employed. We performed repeated nested CV at the outer cross-validation cycle by randomly permuting the participants within their groups (10 permutations) and repeating the CV cycle for each of these permutations. As feature preprocessing, regression of covariates (age, sex, and site), Principal Component Analysis and Scaling were applied. All preprocessing steps were implemented within the CV. Further analyses were conducted by stratifying the sample for MRI scanner, sex and by performing random resampling with increasingly reduced sample sizes. Results Vertex-wise thickness maps outperformed parcellation-based methods with a balanced accuracy (BAC) of 66.2% and an Area Under the Curve of 72%, compared to a BAC of 59% and an Area Under the Curve of 61% obtained with the ROI-based approach. The two BACs were significantly different based on the McNemar’s Test. By stratifying our sample for MRI scanner, we increased the overall BAC to more than 70% and we also increased generalizability across sites. Temporal areas resulted the most influential regions in the classification. The predictive decision scores presented significant correlations with age at onset, duration of treatment and the presence of affective vs non-affective psychosis. Discussion Cortical thickness could represent a valid measure to classify FEP subjects, showing temporal areas as potential markers in the early stages of psychosis. The assessment of site-dependent variables allowed us to increase the across-site generalizability of the model, thus attempting to address an important machine learning limitation, especially in the framework of large multi-site cohort and big data analysis.

Background Structural abnormalities in first episode psychosis (FEP) tend to be subtle and widespread. Most studies investigating structural abnormalities in this clinical population have used small samples, and therefore may be under-powered. In addition, most studies have examined participants at a single research site, and therefore the results may be specific to the local sample investigated. Consequently, findings from existing studies have often been heterogeneous. This study aimed to overcome these issues by testing for neuroanatomical abnormalities in individuals with FEP relative to healthy controls that are expressed consistently across five independent datasets. Methods Structural Magnetic Resonance Imaging data were acquired from a total of 572 patients with FEP and 502 age and gender comparable healthy controls (HC) at five sites - London (UK), Utrecht (Netherlands), Chengdu (China) and two independent sites at Santander (Spain). Voxel-based morphometry (VBM) as implemented in Statistical Parametric Mapping software (SPM12) was used to investigate differences in gray matter volume (GMV) between the two groups. The statistical analysis was carried out using an analysis of variance (ANCOVA), with diagnostic group and scanning site as factors, and age and gender as covariates of no interest. Neuroanatomical alterations in patients with FEP relative to HC common to the five datasets were identified by comparing the total FEP group against the total HC group, and then using the inclusive masking option (at p

Background Studies have established the high risk of suicide in first episode psychosis (FEP). Between 15%-26% of FEP patients attempt suicide at least once before their first contact with psychiatric services and 2–5% die from suicide. Also, many patients with schizophrenia spectrum disorders lack insight into having a mental disorder. However, the relationship between insight changes and suicidal behaviour in FEP remains poorly understood. Methods Information about suicidal behaviour was available on a cohort of 397 FEP patients. Three dimensions of insight (into mental illness, the need for treatment, and the social consequences) were measured at: baseline, 1 and 3 years after the initiation of treatment. Survival analyses examined time to suicidal behavior in relation to i) insight at baseline, ii) the closest insight measure to the suicide attempt, and iii) changes in insight during the follow-up. Results No associations were found between baseline insight dimensions and time to suicidal behaviour. However, poor insight at the evaluation closest to the suicide attempt was associated with an increased risk of suicide. Stability of insight did not affect the risk of suicidal behaviour, while changes in either direction were linked with an increased risk of suicidal behaviour, particularly worsening insight. Discussion Insight in psychosis is a dynamic concept and we demonstrated the relationship between insight and suicide risk to be equally dynamic. Poor insight seems to increase the risk, especially when insight levels change. Repeated insight assessment to detect change from early psychosis may play a role in suicide prevention.

Background In recent years, the effect of cannabis use on cognitive functions in patients with psychosis has been widely studied, but results are somewhat contradictory. On the other hand, it has also been studied the relevance of the age of onset of consume, suggesting that the early age of onset of consumption may be related to a greater cognitive impairment. Methods 349 patients with a first episode of non-affective psychosis were studied. Patients were classified in cannabis users and non-users. Users were divided according to their age at the beginning of use of cannabis in: early-onset (age

Background Suicide represents the main cause of premature dead in first episode psychosis (FEP) patients. However, our understanding of suicidal behaviour in this population is limited. During the last decade, several works have related suicidal behaviour in FEP patients with structural abnormalities in frontal and temporal areas as well as specific structures such as hippocampus, insula and amygdala. The main aim of this work was to analyse the possible structural brain abnormalities associated with suicide-related-behaviour in a large sample of FEP patients. Methods We use a voxel-based morphometry (VBM) analysis in 146 FEP individuals: 24 FEP with and 122 without suicidal behaviour. All images were taken in the same 3T Phillips scanner. The CAT 12 toolbox, which is implemented in SPM12 was used for VBM analysis of the data. A two-sample t-test was set with sex, age, handedness, total intracraneal volume and global disability score as nuisance covariables. We applied threshold-free cluster enhancement (TFCE) with 5000 permutations and corrected for multiple comparisons (FWE) at p

Background Deficits in auditory-verbal memory have been reported by the vast majority of published research in schizophrenia and also detected in first episode psychosis (FEP), confirming they are already present at the early stages of the illness. However, the specific neurocognitive constructs underlying defective verbal memory and their neuroanatomical correlates remains poorly understood in schizophrenia spectrum disorders patients. Methods Data on the Rey Auditory Verbal Learning Test (RAVLT), a widely used verbal memory measure that provides a range of performance indexes to evaluate distinct memory processes including: a) acquisition/learning b) sensitivity to interference c) retrieval; d) retention or rate of forgetting; e) and retrieval efficiency was available for 388 FEP patients and 184 healthy controls (HC). In 218 FEP patients and 146 HC, structural magnetic resonance imaging data were analysised using Voxel based morphometry (VBM) toolbox. Results The FEP group showed significantly lower results on acquisition/learning, delayed recall as well as higher rates of forgetting. They also exhibited a significant sensitivity to retroactive but not proactive interference. We also found significant correlations between bilateral frontal lobe morphometry and proactive interference as well as between right frontal lobe morphometry and retroactive interference. Rate of forgetting was significantly correlated with right occipital cortex morphometry. Those with higher rates of forgetting and proactive and retroactive interference demonstrated further gray matter reductions in frontal and occipital cortical areas. Discussion The application of a process oriented approach to the neuropsychological evaluation of verbal memory allows a finer-grained analysis of the neurocognitive constructs underlying defective verbal memory in FEP. The results suggest specific relationships between different neuroanatomical structures and discrete memory processes with these structures playing an important role in verbal memory deficits found in FEP.

Background Prevent symptom relapse and promote functional recovery are the two main goals of early intervention services in first episode of psychosis. Identify patterns of recovery will be important in developing and implementing targeted recovery focused interventions. The goal of this study was to explore trajectories of recovery following a first episode of psychosis. Methods A sample of 373 FEP patients was followed over 3 years. Recovery profiles in terms of symptomatic and functional remission were explored. Relapses during follow-up were considered. Results Four recovery trajectories were identified: good stable (26%), good unstable (21%), poor unstable (10%), poor stable (43%). Those who met criteria for good stable recovery more likely have less severe baseline negative symptoms (OR= 2.092; 95% CI = 0.99–4.419) and not be diagnosed with schizophrenia (OR= 2.242; 95% CI = 1.015–4.954); short DUP (OR= 2.152; 95% CI = 0.879–5.27) and low premorbid IQ (OR = 2.281; 95% CI = 0.954–5.457) increased the likelihood of good unstable recovery; less severe baseline negative symptoms (OR= 3.851; 95% CI = 1.422–10.435) and single status (OR= 4.307; 95% CI = 1.014–18.293) increased the likelihood of a poor unstable recovery when these three trajectories were compared with a poor stable recovery. Poor unstable trajectory was significantly associated with a high relapse rate (73%). Discussion Our results shed light on identifying different recovery profiles in FEP. Despite evidence for early intervention effectiveness, we should explore ways to prevent relapse and improve long-term recovery, particularly attending the role of timing in the design of interventions.

Background Structural abnormalities in First Episode of Non- Affective Psychosis (FEP) are shown to be present at the time of onset of the illness. Although there are multiple cross-sectional studies in chronic patients there is no clear evidence how these alterations progress years after the appearance of the first episode. Methods Data for the present investigation were obtained from an ongoing epidemiological and longitudinal intervention programme of first-episode psychosis (PAFIP) conducted at the Marqués de Valdecilla University Hospital (HUMV), Spain. Images for 62 FEP patients and 47 healthy controls were acquired at baseline and 10 year follow-up on the same 1.5-T whole-body scanner (SIGNA, GE, Milwaukee, WS, USA). Three-dimensional T1-weighted images, using a spoiled gradient-recalled acquisition in the steady state (GRASS) (SPGR) sequence, were acquired in the coronal plane with the following parameters: TE=5 msec, TR =24 msec, NEX=2, rotation angle =45°, FOV= 26 x 19.5 cm, slice thickness =1.5 mm and a matrix of 256 x 192. Structural imaging data for each subject was analyzed using serial longitudinal Statistical Parametric Mapping software (SPM12). After segmenting the mid-point average and multiply the result by the jacobian maps, DARTEL was applied to spatially normalise de diferences. T-test between both groups was performed, allowing voxel-wise comparison of progressive structural change. All results were p

Background Metabolic alterations are common in patients suffering from psychosis. The rise in glycemic lipids may be related to and observed increased in the prevalence of hepatic steatosis measured by the Fatty Liver Index. However, we have recently reported a probable protective effect of cannabis smoking on weight gain and related metabolic alterations in a sample of patients drug-naïve suffering from a first episode of psychosis. We aimed to explore the effect of cannabis smoking on hepatic steatosis in a sample of first-episode non-affective psychosis patients. Methods Anthropometric measurements, glycemic and lipid parameters, and liver steatosis index (FLI), were obtained at baseline and after 3 years of having initiated treatment. Patients were divided into two groups depending on self-reported cannabis use (cannabis users and non-users). Results Cannabis users presented at baseline lower FLI (F=4.26, p=0.040) than non-users. These differences were also observed after 3 years of treatment (F=6.61, p=0.011). Discussion Our results support the hypothesis that cannabis has a protective effect against hepatic steatosis. However, before being transferred to clinical practice, this study should be replicated, using larger samples.

Background: For the first time in Spain, a large-scale survey (5205 people) was carried out to establish the real needs of those directly affected by the illness. The form contained 9 questions: personal and social dimension, psychotherapeutic treatment, rehabilitation, medical treatment, or help that they receive from professionals.