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Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological case-control study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and non-significant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage. [ABSTRACT FROM AUTHOR]

Background: Studies typically highlight area level variation in the incidence of non-affective but not affective psychoses. We compared neighbourhood-level variation for both types of disorder, and the specific effects of neighbourhood urbanicity and ethnic density, using Danish national registry data., Methods: Population based cohort (2,224,464 people) followed from 1980 to 2013 with neighbourhood exposure measured at age 15 and incidence modelled using multilevel Poisson regression., Results: Neighbourhood variation was similar for both disorders with an adjusted median risk ratio of 1.37 (95% CI 1.34-1.39) for non-affective psychosis and 1.43 (1.38-1.49) for affective psychosis. Associations with neighbourhood urbanicity differed: living in the most compared to the least urban quintile at age 15 was associated with a minimal increase in subsequent affective psychosis, IRR 1.13 (1.01-1.27) but a substantial increase in rates of non-affective psychosis, IRR 1.66 (1.57-1.75). Mixed results were found for neighbourhood ethnic density: for Middle Eastern migrants there was an increased average incidence of both affective, IRR 1.54 (1.19-1.99), and non-affective psychoses, 1.13 (1.04-1.23) associated with each decrease in ethnic density quintile, with a similar pattern for African migrants, but for European migrants ethnic density appeared to be associated with non-affective psychosis only., Conclusions: While overall variation and the effect of neighbourhood ethnic density were similar for both types of disorder, associations with urbanicity were largely confined to non-affective psychosis. This may reflect differences in aetiological pathways although the mechanism behind these differences remains unknown., Competing Interests: Declaration of competing interest The study authors have nothing to disclose., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Our aim was to, firstly, identify characteristics at first-episode of psychosis that are associated with later antipsychotic treatment resistance (TR) and, secondly, to develop a parsimonious prediction model for TR., Methods: We combined data from ten prospective, first-episode psychosis cohorts from across Europe and categorised patients as TR or non-treatment resistant (NTR) after a mean follow up of 4.18 years (s.d. = 3.20) for secondary data analysis. We identified a list of potential predictors from clinical and demographic data recorded at first-episode. These potential predictors were entered in two models: a multivariable logistic regression to identify which were independently associated with TR and a penalised logistic regression, which performed variable selection, to produce a parsimonious prediction model. This model was internally validated using a 5-fold, 50-repeat cross-validation optimism-correction., Results: Our sample consisted of N = 2216 participants of which 385 (17 %) developed TR. Younger age of psychosis onset and fewer years in education were independently associated with increased odds of developing TR. The prediction model selected 7 out of 17 variables that, when combined, could quantify the risk of being TR better than chance. These included age of onset, years in education, gender, BMI, relationship status, alcohol use, and positive symptoms. The optimism-corrected area under the curve was 0.59 (accuracy = 64 %, sensitivity = 48 %, and specificity = 76 %)., Implications: Our findings show that treatment resistance can be predicted, at first-episode of psychosis. Pending a model update and external validation, we demonstrate the potential value of prediction models for TR., Competing Interests: Declaration of competing interest The Authors declare no Competing Non-Financial Interests but the following Competing Financial Interests: J.T.R.W. is an investigator on a grant from Takeda Pharmaceuticals Ltd. to Cardiff University, for a project unrelated to the work presented here. S.E.S. is employed on this grant. M.D.F. has received a fee for educational seminars from Lundbeck and Janssen. O.A.A. is a consultant to HealthLytix and has received speakers honorarium from Lundbeck and Sunovion. T.R.E.B. has been a member of an advisory board for Gedeon Richter. C.B.E. received honoraria for conferences from Forum pour la formation médicale, Janssen-Cilag, Lundbeck, Otsuka, Sandoz, Servier, Sunovion, Sysmex Suisse AG, Takeda, Vifor-Pharma, and Zeller in the past 3 years. B.C.F. has received honoraria for participation as a consultant and/or as a speaker at educational events from ADAMED, Mylan, Angelini, Janssen Johnson & Johnson, Lundbeck, and Otsuka Pharmaceuticals. R.M.M. has received payments for non-promotional lectures from Janssen, Otsuka, Sunovian, and Lundbeck. J.H.M. has received research funding from H Lundbeck., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Low self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic experiences in daily life., Methods: Experience sampling data were collected from 46 individuals presenting with an at-risk mental state (ARMS), 51 individuals with first-episode psychosis (FEP), and 53 controls, to investigate associations between (fluctuations in) self-esteem and psychotic experiences within and across FEP, ARMS, and controls, using linear mixed models., Results: In all three groups we found that lower momentary self-esteem was associated with a greater intensity of psychotic experiences (adj. β FEP  = -0.15, 95% CI -0.20 to -0.10, p = 0.000; adj. β ARMS  = -0.20, 95% CI -0.26 to -0.15, p = 0.000; adj. β controls  = -0.12, 95% CI -0.17 to -0.07, p = 0.000). Variability in momentary self-esteem was associated with a greater intensity of psychotic experiences only in ARMS (adj. β ARMS  = 0.08, 95% CI 0.04 to 0.11, p = 0.000) and controls (adj. β controls  = 0.04, 95% CI 0.01 to 0.08, p = 0.023). For instability this association held only in controls (adj. β controls  = 0.03, 95% CI 0.00 to 0.05, p = 0.020). Furthermore, findings may suggest a reciprocal temporal association between self-esteem and psychotic experiences., Conclusions: Our findings suggest that self-esteem may be an important mechanism targetable by ecological momentary interventions to reduce the intensity of psychotic experiences and potentially prevent illness progression at an early stage., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Premorbid functioning and cognitive measures may reflect gradients of developmental impairment across diagnostic categories in psychosis. In this study, we sought to examine the associations of current cognition and premorbid adjustment with symptom dimensions in a large first episode psychosis (FEP) sample. We used data from the international EU-GEI study. Bifactor modelling of the Operational Criteria in Studies of Psychotic Illness (OPCRIT) ratings provided general and specific symptom dimension scores. Premorbid Adjustment Scale estimated premorbid social (PSF) and academic adjustment (PAF), and WAIS-brief version measured IQ. A MANCOVA model examined the relationship between symptom dimensions and PSF, PAF, and IQ, having age, sex, country, self-ascribed ethnicity and frequency of cannabis use as confounders. In 785 patients, better PSF was associated with fewer negative (B = -0.12, 95% C.I. -0.18, -0.06, p < 0.001) and depressive (B = -0.09, 95% C.I. -0.15, -0.03, p = 0.032), and more manic (B = 0.07, 95% C.I. 0.01, 0.14, p = 0.023) symptoms. Patients with a lower IQ presented with slightly more negative and positive, and fewer manic, symptoms. Secondary analysis on IQ subdomains revealed associations between better perceptual reasoning and fewer negative (B = -0.09, 95% C.I. -0.17, -0.01, p = 0.023) and more manic (B = 0.10, 95% C.I. 0.02, 0.18, p = 0.014) symptoms. Fewer positive symptoms were associated with better processing speed (B = -0.12, 95% C.I. -0.02, -0.004, p = 0.003) and working memory (B = -0.10, 95% C.I. -0.18, -0.01, p = 0.024). These findings suggest that the negative and manic symptom dimensions may serve as clinical proxies of different neurodevelopmental predisposition in psychosis., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Initial affective and psychotic reactivity to daily stressors is altered in psychosis, and most notably in early psychosis. In addition to altered initial stress reactivity, results from studies using Experience Sampling Methodology (ESM) and psychophysiological measures indicate that impaired recovery from mild stressors may also be a risk factor for mental illness. The current ESM study investigated affective recovery from daily stressors in chronic psychosis patients (CP; n = 162), individuals at early stages of psychosis (EP; n = 127), and healthy volunteers (HV; n = 220) assessing fluctuations in negative affect (NA), tension, and suspiciousness ten times a day on six consecutive days. Recovery was operationalized for all three variables as the return to baseline (i.e., level at t -1 ) following the first stressful event of a day (i.e., t 0 ). The EP group showed a delayed recovery of NA (t 1 -t 3 : B = 0.185; p = .007 and B = 0.228; p = .002) and suspiciousness (t 1 : B = 0.223; p = .010 and B = 0.291; p = .002) compared to HV and CP, respectively. Delayed recovery was detected for tension as well (t 1 -t 2 : EP > HV: B = 0.242; p = .040 and EP > CP: B = 0.284; p = .023), but contrary to both other momentary states, this effect disappeared when controlling for subsequent stressful events. There were no significant differences in recovery between HV and CP. These results suggest that in EP, stressful daily events have longer-lasting effects on overall negative affect and subclinical psychotic-like experiences. Future studies should incorporate physiological and endocrine measures in order to integrate recovery patterns of the different stress systems., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls., Methods: We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history., Results: A statistically significant interaction between childhood abuse and psychosis on CARg was found (F (2,262)  = 4.60, p = 0.011, ω 2  = 0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD., Conclusions: Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The role of insight dimensions - illness recognition (IR), symptoms relabelling (SR), treatment compliance (TC) - in suicide risk in first-episode psychosis (FEP) remains unclear., Method: The AESOP (n = 181) and GAP (n = 112) FEP cohorts were followed-up over 10- and 5 years. Survival analysis modelled time to first suicidal event in relation to baseline scores on the Schedule for the Assessment of Insight, whilst adjusting for demographic, clinical, psychopathological and neuropsychological variables., Results: AESOP: those with previous suicide attempts scored higher on IR (7.6 ± 1.9 vs. 5.9 ± 3.0, p < 0.01) and total insight scores (TIS) (17.2 ± 5.0 vs. 13.4 ± 6.7, p = 0.03). IR (r = 0.23, p < 0.01), SR (r = 0.18, p = 0.04) and TC (r = 0.26, p < 0.01) correlated with depression. Univariable analyses: IR (HR = 1.14, 95% CI = 0.98-1.34, p = 0.09), TC (HR = 1.30, 95% CI = 0.99-1.71, p = 0.06) and TIS (HR = 1.06, 95% CI = 0.99-1.13, p = 0.08) were linked with suicidal behaviour. Multivariable regression models: depression (HR = 1.55, 95% CI = 1.22-1.97, p < 0.01) predicted suicidal behaviour. GAP: SR (6.4 ± 3.1 vs. 4.5 ± 3.4, p = 0.03) and TIS (16.8 ± 6.4 vs. 12.8 ± 7.4, p = 0.03) were higher in those with suicidal antecedents. IR (r = 0.32, p < 0.01) and SR (r = 0.27, p = 0.01) correlated with depression. Univariable analyses: TC (HR = 1.36, 95% CI = 1.01-1.83, p = 0.04) and TIS (HR = 1.06, 95% CI = 0.99-1.14, p = 0.08) were associated with suicidal behaviour. Multivariable regression models: previous suicide attempts (HR 5.17, 95% CI 1.32-20.29, p = 0.02) and depression (HR 1.16, 95% CI = 1.00-1.35, p = 0.04) predicted suicidal behaviour., Conclusions: Suicide attempts prior to FEP and depression at that point were associated with baseline insight levels and predicted risk of suicidal behaviour over the follow-up, which was not linked with insight. This may explain the apparent association of insight with suicidality in FEP., (Copyright © 2018. Published by Elsevier B.V.)

Background: Incidence of psychotic disorders is higher in many migrant groups; however little is known about internal migrants (IM). This study aims to describe the IR in natives (NA), IM and external migrants (EM)., Method: All patients aged 18-64years, with First Episode Psychosis (FEP), who made contact with the Bologna West psychiatric services, between 2002 and 2010, were included., Results: 187 cases were included. Age and sex adjusted IR of psychosis per 100,000per year were: 12.6 for NA, 25.3 for IM and 21.4 for EM. The IRR was 1.93 (1.19-3.13, P=0.007) for IM and 1.79 (1.06-3.02, P=0.03) for EM compared to NA., Conclusion: Rates of psychosis were significantly elevated in IM as well as in EM. This result adds evidence as to the role of migration itself (versus ethnicity) on the risk of psychosis., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Recent research conducted in high-income countries suggests psychotic experiences are common in the general population, but evidence from low- and middle-income countries (LMIC) remains limited. Sri Lanka is a LMIC affected by three decades of civil conflict and, in 2004, a devastating tsunami. This study aimed to investigate the prevalence of psychotic experiences in a general population sample in Sri Lanka and associations with conflict- and tsunami-related trauma. This is a first National Mental Health Survey conducted in Sri Lanka. A cross-sectional, multi-stage, cluster sampling design was used to estimate the prevalence of psychotic symptoms. Data on socio-demographic characteristics, conflict- and tsunami-related trauma, and psychotic experiences were collected using culturally validated measures in a sample of 5927 participants. The weighted prevalence of psychotic symptoms was 9.7%. Exposure to one or more conflict-related events (adj. OR 1.79, 95% CI 1.40-2.31, p<0.001) and loss or injury of a family member or friend through conflict (adj. OR, 1.83, 95% CI 1.42-2.37, p<0.001) were associated with increased odds of reporting psychotic experiences. Psychotic experiences were more common in individuals directly exposed to tsunami disaster (adj. OR, 1.68, 95% CI 1.04-2.73, P=0.035) and in those who had a family member who died or was injured as result of tsunami (adj. OR, 1.42, 95% CI 1.04-1.94, p=0.029). Our findings suggest that psychotic experiences are common in the Sri Lankan population. Exposure to traumatic events in armed conflicts and natural disasters may be important socio-environmental factors in the development of psychotic experiences., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: The Brain-derived Neurotrophic Factor (BDNF) modulates cognitive processes and is associated with increased risk of schizophrenia. Childhood trauma (CT) is frequent in patients with psychosis and severely affects course and outcome., Aims: We investigated the hypothesis that BDNF is associated with both CT and cognitive deficits in a sample of first-episode psychosis (FEP) cases and unaffected controls., Method: Participants with FEP and healthy controls were recruited between August 2008 and July 2011 from South London, UK. Childhood traumatic events were detected using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q). Neuropsychological data were also collected. BDNF plasma levels were measured from fasting blood samples., Results: Data were available on 87 FEP patients and 152 controls. Our results showed a significant effect of separation (F=5.5; df=1,115; p=.02), physical (F=4.7; df=1, 118; p=.03) and sexual abuse (F=5.4; df=1,117; p=.02) on BDNF levels with lower levels among those who experienced the traumatic event compared to those who did not. Physical abuse predicted lower plasma levels of BDNF (β=-.30; p=.03) whereas sexual and/or physical abuse showed a trend (β=-.26; p=.06) in FEP patients but not in unaffected controls. No association between BDNF plasma levels and cognitive functions was found among patients with FEP and controls., Conclusion: Our findings suggest the possible involvement of BDNF in the onset of first-episode psychosis in individuals exposed to early trauma and propose BDNF as a potential clinical biomarker to detect the detrimental effects of CT on human brain plasticity., (Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.)

Individuals with psychotic illnesses are known to have a reduced fertility. It is unclear whether this is due to biological or social factors. Most fertility studies have been conducted in chronic schizophrenia, where confounders like medication and hospitalisation make this difficult to elicit. A less severe reduction of fertility has been observed in some ethnic minorities, but results are inconsistent. We sought to investigate pre-morbid fertility in an ethnically diverse sample of individuals with first-onset psychosis. Data were derived from 515 people with a first psychotic episode (FEP) and 383 controls. We made case-control comparisons of differences in the proportion of those with children (fertility rates) and mean number of children (MNC). Analyses were then stratified by diagnosis, gender and ethnicity, and adjusted for potential confounders. We found that FEP showed a reduced fertility rate (age-adjusted OR of having children 0.47 [95% CI=0.39, 0.56]), irrespective of diagnosis, and there was little evidence of confounding by gender, ethnicity, religious background, education level, or history of past relationships (fully adjusted OR=0.55, 95% CI=0.37, 0.80). Women had a somewhat greater reduction in fertility rates than men (Men: age-adjusted OR 0.61 [95% CI 0.42, 0.89]; Women: age-adjusted OR 0.46 [95% CI 0.31, 0.69]) and we could not find any evidence of ethnic differences in the degree of fertility reduction. FEP who had previously experienced a stable relationship had an MNC that was comparable to that of the general population and had a later onset of illness. This is the largest case-control study to date to investigate fertility in first-onset psychosis. Our data suggests that fertility is affected, even prior to the onset of a psychotic illness, and there are likely to be biological and environmental factors involved, but the former seem to have a stronger influence., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: Substance abuse is a well established risk factor for First-Episode Psychosis (FEP), but its influence on FEP course is less clear. Starting from our baseline observation that substance users were younger than non-users at the psychosis onset, we hypothesized that substance use at baseline could be an independent risk factor for a worse clinical course., Methods: An incidence cohort of patients with FEP collected in an 8year period (2002-2009) at the Bologna West Community Mental Health Centers (CMHCs) was assessed at baseline and at 12month follow-up. Drop-out, hospitalizations and service utilization were used as clinical outcomes., Results: Most of the patients were still in contact with CMHC at 12month follow up. Substance users had a significantly higher rate of hospitalizations during the follow-up after adjusting for age, gender and other potential confounders (OR 5.84, 95% CI 2.44-13.97, p≤0.001)., Conclusions: This study adds to previous evidence showing the independent effect of substance use on FEP course. The identification of a "potentially modifiable" environmental predictor of the course of the illness such as substance use at psychosis onset allows us to envisage the possibility of ameliorating the course of the illness by managing this factor., (Copyright © 2014 Elsevier B.V. All rights reserved.)