49 results on '"first episode psychosis (FEP)"'
Search Results
2. First episode psychosis caregiver perspectives on motivational interviewing for loved ones training: A qualitative study.
- Author
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Ipekci, Bediha, Thibeau, Heather, Barnard, Emily, Keshavan, Matcheri S., Bye, Akansha Vaswani, and Kline, Emily R.
- Subjects
- *
MOTIVATIONAL interviewing , *CAREGIVERS , *CAREGIVER attitudes , *BURDEN of care , *CONSENSUS (Social sciences) - Abstract
Background: Past research has found that family involvement in psychosis treatment leads to better patient outcomes. Thus, caregiver communication skills training can be a viable approach to reducing caregiver stress and increasing self‐efficacy and communication. Aim: The purpose of this qualitative study was to describe family caregivers' perceptions of changes in themselves and their family member with psychosis following their participation in Motivational Interviewing in Loved Ones (MILO), a brief four to five‐hour psychoeducational intervention for caregivers. Methods: Sixty‐three participants in the MILO trials provided written qualitative responses to the prompt, "Since learning the ideas and techniques in this course, what is the most significant change you noticed in yourself, your family, or your relationships?" Responses were collected immediately following MILO participation and 12 weeks later. Qualitative themes were identified through an iterative consensus process. Results: Most participants reported positive changes in multiple domains of their lives. Major themes included: (1) Changes in Self, (2) Changes in Relationships, (3) Changes in Mindset, (4) Use of MILO Skills, and (5) Challenges. Conclusion: Qualitative results support and add context to the previously reported quantitative results from this study. MILO is a promising family intervention that positively influenced family environment and communication in pilot trials. Adaptations of MILO for families outside of a highly educated North American context should be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. California Collaborative Network to Promote Data Driven Care and Improve Outcomes in Early Psychosis (EPI-CAL)
- Author
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University of California, San Francisco, National Institute of Mental Health (NIMH), and Washington University School of Medicine
- Published
- 2023
4. Relationship between thyroid-stimulating hormone, BDNF levels, and hippocampal volume in antipsychotic-naïve first-episode psychosis patients.
- Author
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Toll, Alba, Blanco-Hinojo, Laura, Berge, Daniel, Manzano, Ana, El Abidi, Khadija, Perez-Solà, Víctor, and Mané, Anna
- Subjects
HIPPOCAMPUS (Brain) ,BRAIN-derived neurotrophic factor ,THYROID hormones ,BRAIN injuries ,PSYCHOSES - Abstract
Introduction: Thyroid hormones play an essential role in hippocampal development, a key structure in psychosis. However, the role of these hormones in first-episode psychosis (FEP) has received limited attention. It has been hypothesized that thyroid hormones could cause morphological modifications in the hippocampal structure through the upregulation of brain-derived neurotrophic factor (BDNF). In this study, we primarily aimed to determine the relationship between thyroid-stimulating hormone (TSH) levels, peripheral BDNF levels, and hippocampal volume in antipsychotic-naïve FEP patients. We also aimed to determine whether TSH levels were associated with clinical symptomatology. Materials and methods: A total of 50 antipsychotic-naïve FEP patients were included in the study. At baseline, we collected fasting blood samples and registered sociodemographic and clinical variables (substance use, DUP, PANSS, GAF, and CDSS). Structural T1 MRI was performed at baseline to quantify brain volumes. No control group was used for this study. Results: Of the 50 patients, more than one-third (36%) presented alterations in TSH levels, mainly elevated levels (32% of patients). The TSH levels were inversely correlated with both peripheral BDNF and hippocampal volume. On the multivariate analysis, the model that best predicted the relative hippocampal volume was a single variable model (TSH levels). No significant association was observed between TSH levels and clinical symptomatology. Discussion: These results suggest that thyroid hormones could have a neuroprotective effect on the hippocampus in FEP patients, possibly through their effect by increasing BDNF concentrations, which could attenuate brain injury and neuroinflammation. Nevertheless, thyroid hormones could also affect hippocampal volume through other pathways. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. The effect of duration of untreated psychosis (DUP) on the risk for hospitalization after admission to a first episode service.
- Author
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Ferrara, Maria, Guloksuz, Sinan, Hazan, Hadar, Li, Fangyong, Tek, Cenk, Sykes, Laura Yoviene, Riley, Sarah, Keshavan, Matcheri, and Srihari, Vinod H.
- Subjects
- *
PSYCHIATRIC hospital care , *HOSPITAL care , *PSYCHOSES , *POISSON regression , *MEDICAL records - Abstract
Engagement with a first episode-psychosis service (FES) reduces the risk of psychiatric hospitalization. However, the role of the duration of untreated psychosis (DUP) in impacting this outcome is disputed. This study aimed to examine whether DUP was an effect modifier of the post-FES reduction of risk of hospitalization, and to explore associations between patients' characteristics and hospitalization post-FES. Individuals aged 16–35 with recent onset (< 3 years) of non-affective psychosis, admitted to the Program for Specialized Treatment Early in Psychosis (STEP), a FES serving the Greater New Haven area, Connecticut, between 2014 and 2019 were included (N = 189). Medical records were queried from 2013 through 2020 for number and duration of psychiatric hospitalizations. Poisson regression models were used to estimate incidence rate ratios for hospitalization rates across all explanatory variables. Negative binomial regression was used to compare the length of stay (LOS) before vs after STEP enrollment. STEP admission was associated with a significant 90 % reduction in the frequency and duration of hospitalizations. This effect was moderated by DUP: with 30-day prolongations in components of DUP (supply, demand, and total) there was less reduction in hospitalizations and LOS after FES enrollment (p <.0001). Only DUP supply (time from first antipsychotic use to STEP admission) differentiated those who were hospitalized during the first year after STEP enrollment from those who were not (median: 35 vs. 15 weeks, p =.003). To fully harness the positive impact of FES on hospitalization, a detailed effort should be pursued to reduce all DUP components. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. Use of Parent Connectors in First Episode Psychosis (FEP)
- Author
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National Institute of Mental Health (NIMH)
- Published
- 2022
7. Cognitive biases in first-episode psychosis with and without attention-deficit/hyperactivity disorder.
- Author
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Sanchez-Gistau, Vanessa, Cabezas, Angel, Manzanares, Nuria, Sole, Montse, Corral, Lia, Vilella, Elisabet, and Gutierrez-Zotes, Alfonso
- Subjects
COGNITIVE bias ,YOUTH with attention-deficit hyperactivity disorder ,ATTENTION-deficit hyperactivity disorder ,PSYCHOSES ,ANALYSIS of covariance ,RANK correlation (Statistics) ,METACOGNITION - Abstract
Introduction: Psychotic disorders such schizophrenia and attention-deficit/ hyperactivity disorder (ADHD) are neurodevelopmental disorders with social cognitive deficits. Specifically, biased interpretation of social information can result in interpersonal difficulties. Cognitive biases are prevalent in psychosis, but no previous study has investigated whether the type and severity of cognitive biases differ between subjects experiencing first-episode psychosis (FEP) with (FEP-ADHD
+ ) and without ADHD (FEP-ADHD− ). Methods: A total of 121 FEP outpatients at the Early Intervention Service of Reus were screened for childhood ADHD through the Diagnostic Interview for ADHD (DIVA). Cognitive biases were assessed by the Cognitive Biases Questionnaire for Psychosis (CBQp). CBQp scores of FEPs groups were compared with those of healthy controls (HCs) with an analysis of covariance. Spearman correlation analysis explored associations between CBQp scores and psychopathology. Results: Thirty-one FEPs met the criteria for childhood ADHD and reported significantly more cognitive bias [median (interquartile range): 47 (38–56)] than FEP-ADHD− [42 (37–48)] and HCs [38 (35.5–43)]. CBQp scores did not differ between FEP-ADHD-and HCs when adjusted for age and sex. After controlling for clinical differences, Intentionalising (F = 20.97; p < 0.001) and Emotional Reasoning biases (F = 4.17; p = 0.04) were more strongly associated with FEPADHD+ than FEP-ADHD− . Cognitive biases were significantly correlated with positive psychotic symptoms in both groups but only with depressive symptoms in FEP-ADHD− (r = 0.258; p = 0.03) and with poor functioning in FEP-ADHD+ (r = −0.504; p = 0.003). Conclusion: Cognitive bias severity increased from HCs to FEP-ADHD-patients to FEP-ADHD+ patients. FEP-ADHD+ patients may be a particularly vulnerable group in which metacognitive targeted interventions are needed. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
8. Reducing the Duration of Untreated Psychosis in the United States
- Author
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National Institute of Mental Health (NIMH) and Yulia Landa, Assistant Professor
- Published
- 2021
9. Cognitive biases in first-episode psychosis with and without attention-deficit/hyperactivity disorder
- Author
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Vanessa Sanchez-Gistau, Angel Cabezas, Nuria Manzanares, Montse Sole, Lia Corral, Elisabet Vilella, and Alfonso Gutierrez-Zotes
- Subjects
cognitive bias ,CBQp ,ADHD ,first episode psychosis (FEP) ,schizophrenia ,social cognition ,Psychology ,BF1-990 - Abstract
IntroductionPsychotic disorders such schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with social cognitive deficits. Specifically, biased interpretation of social information can result in interpersonal difficulties. Cognitive biases are prevalent in psychosis, but no previous study has investigated whether the type and severity of cognitive biases differ between subjects experiencing first-episode psychosis (FEP) with (FEP-ADHD+) and without ADHD (FEP-ADHD−).MethodsA total of 121 FEP outpatients at the Early Intervention Service of Reus were screened for childhood ADHD through the Diagnostic Interview for ADHD (DIVA). Cognitive biases were assessed by the Cognitive Biases Questionnaire for Psychosis (CBQp). CBQp scores of FEPs groups were compared with those of healthy controls (HCs) with an analysis of covariance. Spearman correlation analysis explored associations between CBQp scores and psychopathology.ResultsThirty-one FEPs met the criteria for childhood ADHD and reported significantly more cognitive bias [median (interquartile range): 47 (38–56)] than FEP-ADHD− [42 (37–48)] and HCs [38 (35.5–43)]. CBQp scores did not differ between FEP-ADHD-and HCs when adjusted for age and sex. After controlling for clinical differences, Intentionalising (F = 20.97; p
- Published
- 2023
- Full Text
- View/download PDF
10. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms
- Author
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Cornelia Larsson, Maria Lee, Tobias Lundgren, Sophie Erhardt, Carl M. Sellgren, Simon Cervenka, Jacqueline Borg, Sven Bölte, and Helena Fatouros-Bergman
- Subjects
First episode psychosis (FEP) ,Facial affect recognition (FAR) ,Cognition ,Emotion recognition ,Social cognition ,Antipsychotic drug-naïve ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
- Published
- 2022
- Full Text
- View/download PDF
11. Screening for Early Emerging Mental Experiences (SEE ME): A Model to Improve Early Detection of Psychosis in Integrated Primary Care
- Author
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Kristen A. Woodberry, Kelsey A. Johnson, and Lydia A. Shrier
- Subjects
first episode psychosis (FEP) ,early intervention (EI) ,prodrome ,serious mental illness (SMI) ,adolescents ,Pediatrics ,RJ1-570 - Abstract
Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage “SCREEN—TRIAGE—ENGAGE” model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS—FIND THE WORDS—MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engagement by trained mental health clinicians aims to improve the specificity of screen responses, enhance engagement in appropriate care, and reduce provider burden. Leveraging the low stigma of primary care, its reach to non-help-seeking adolescents and young adults, and the mental health training of clinicians within integrated care practices, SEE ME has potential to improve the benefit/risk ratio of early detection of psychosis by improving both the sensitivity and specificity of screening and clinical response. We review the rationale and design of this promising model.
- Published
- 2022
- Full Text
- View/download PDF
12. Growth in the Aftermath of Psychosis: Characterizing Post-traumatic Growth in Persons With First Episode Psychosis in Singapore
- Author
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Ying Ying Lee, Vanessa Seet, Yi Chian Chua, Swapna Kamal Verma, and Mythily Subramaniam
- Subjects
schizophrenia ,post-traumatic growth ,first episode psychosis (FEP) ,growth ,psychosis ,Psychiatry ,RC435-571 - Abstract
Experiencing first episode psychosis (FEP) is a highly traumatic life event. However, there is evidence to show that the outcome of psychosis is more nuanced than was conventionally thought. Young persons with FEP can grow from the experience of psychosis. In this study, we aim to characterize post-traumatic growth (PTG) in persons with FEP over 1 year. A total of 99 FEP clients receiving services from an early psychosis intervention team in Singapore were recruited. The PTG Inventory, among other scales, like Questionnaire on the Process of Recovery and Connor-Davidson Resilience Scale, were administered in this population. A total of 52 participants completed the questionnaire at two timepoints (one year apart). The Reliable Change Index was calculated for participants who completed both timepoints. Repeated measures of correlation were performed, which identified personal recovery and resilience to be associated with PTG in this sample. This clinical population exhibited PTG in the aftermath of psychosis. PTG was associated with personal recovery and resilience, but not clinical indicators, like symptoms and functioning. Data from this study suggests that recovery and growth from first episode psychosis is a possibility. Clinical implications, strengths and limitations of this study are discussed.
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- 2022
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- View/download PDF
13. Benefits of Social Contact in Individuals With Psychotic Symptoms: Do Closeness of the Contact and Empathic Skills Make the Difference?
- Author
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Krijnen, Lisa J. G., Lemmers-Jansen, Imke L. J., Fett, Anne-Kathrin J., and Krabbendam, Lydia
- Subjects
SOCIAL interaction ,AFFECT (Psychology) ,SOCIAL contact ,SOCIAL skills ,MENTAL health ,EMPATHY - Abstract
Objectives: Social contact is known to be beneficial for humans' mental health. Individuals with psychotic symptoms (PS) tend to show poorer social and interpersonal functioning. However, in this patient population, social contact may be crucial for their mental wellbeing and treatment success. Additionally, closeness of social contact (familiar versus less familiar others), rather than only the presence or absence of social contacts, may play an important role. Empathy may heighten the beneficial effects of social/close contact on mental health, facilitating interactions. We investigated the association between social contact and closeness of contact on mental health, defined as positive symptoms, positive affect and negative affect in PS and control participants, with empathy as a moderator. Methods: Participants were 16–30 years old. Information regarding social/close contact and mental health was obtained using the experience sampling method in individuals with PS (n = 29) and healthy controls (n = 28). Empathy was measured using a self-report questionnaire. Results: Social contact was associated with higher positive affect in the total sample. Contact with close as opposed to less close others was related to better mental health: It was associated with lower positive symptoms in the PS group, and with more positive affect in the total sample. Empathy moderated the association between closeness of contact and positive affect in the total sample, in which the combination of higher levels of empathy combined with the presence of close contact was associated with higher positive affect in the total sample. However, the direct association between empathy and positive affect was not significant per group of contact. Conclusion: The results suggest that social contact, but especially contact with a close other is important for mental health outcomes: Contact with close others is beneficial for positive affect in the total sample and for positive symptoms in individuals with PS. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
14. Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country
- Author
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Sridhar Vaitheswaran, Graeme Currie, Vijaya Raghavan Dhandapani, Greeshma Mohan, Thara Rangaswamy, and Swaran Preet Singh
- Subjects
First episode psychosis (FEP) ,Low- and middle-income country (LMIC) ,India ,Implementation research ,Consolidated framework for implementation research (CFIR) ,Mental healing ,RZ400-408 ,Public aspects of medicine ,RA1-1270 - Abstract
First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians’ local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders.
- Published
- 2021
- Full Text
- View/download PDF
15. Benefits of Social Contact in Individuals With Psychotic Symptoms: Do Closeness of the Contact and Empathic Skills Make the Difference?
- Author
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Lisa J. G. Krijnen, Imke L. J. Lemmers-Jansen, Anne-Kathrin J. Fett, and Lydia Krabbendam
- Subjects
first episode psychosis (FEP) ,clinical high risk (CHR) for psychosis ,social contact ,close contact ,positive psychotic symptoms ,positive and negative affect ,Psychology ,BF1-990 - Abstract
Objectives: Social contact is known to be beneficial for humans’ mental health. Individuals with psychotic symptoms (PS) tend to show poorer social and interpersonal functioning. However, in this patient population, social contact may be crucial for their mental wellbeing and treatment success. Additionally, closeness of social contact (familiar versus less familiar others), rather than only the presence or absence of social contacts, may play an important role. Empathy may heighten the beneficial effects of social/close contact on mental health, facilitating interactions. We investigated the association between social contact and closeness of contact on mental health, defined as positive symptoms, positive affect and negative affect in PS and control participants, with empathy as a moderator.Methods: Participants were 16–30 years old. Information regarding social/close contact and mental health was obtained using the experience sampling method in individuals with PS (n = 29) and healthy controls (n = 28). Empathy was measured using a self-report questionnaire.Results: Social contact was associated with higher positive affect in the total sample. Contact with close as opposed to less close others was related to better mental health: It was associated with lower positive symptoms in the PS group, and with more positive affect in the total sample. Empathy moderated the association between closeness of contact and positive affect in the total sample, in which the combination of higher levels of empathy combined with the presence of close contact was associated with higher positive affect in the total sample. However, the direct association between empathy and positive affect was not significant per group of contact.Conclusion: The results suggest that social contact, but especially contact with a close other is important for mental health outcomes: Contact with close others is beneficial for positive affect in the total sample and for positive symptoms in individuals with PS.
- Published
- 2021
- Full Text
- View/download PDF
16. An Observational Cohort of First Episode Psychosis in Iran: The Azeri Recent Onset Acute Phase Psychosis Survey (ARAS Cohort) Study Protocol
- Author
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Sara Farhang, Mehrdad Ghaemmaghami, Ali Reza Shafiee-Kandjani, Seyed Gholamreza Noorazar, Wim Veling, Ayyoub Malek, Mohammad Hossein Somi, Richard Bruggeman, and Behrooz Z. Alizadeh
- Subjects
schizophrenia ,first episode psychosis (FEP) ,social context ,cognition ,gene-environement interactions ,Psychiatry ,RC435-571 - Abstract
Background: Most of our knowledge about the etiology, course, treatment, and outcome of schizophrenia spectrum and other psychotic disorders stems from Western countries. Data from populations living in other geographical areas and low- and middle-income countries, with different genomes (ethnicity) and exposomes (e.g., culture and social support, drugs of abuse, religion), will add to our knowledge of this complex disorder.Methods: The Azeri Acute phase/Recent onset psychosis Survey (ARAS) has been initiated to study the course of the disorder in patients with recent-onset psychosis using validated diagnostic tools and a comprehensive outcome monitoring system, aiming to reveal indicators for understanding the risk and resilience factors and for choosing the best-personalized treatment strategy. All participants will be evaluated for clinical signs and symptoms as well as risk and resilience factors and will be followed up for 1, 3, and 5 years for outcomes in several domains. A hierarchical cluster method will be applied to identify the number of clusters for each outcome. Defined models will be applied to assess the predictive value of cognition on symptomatic and functional outcomes at follow-up.Discussion: The ARAS cohort will yield significant academic- (research and education) and care-related achievements. ARAS data and experience will have value both in being a useful model for other parts of this region and in an expansion of the currently available knowledge.
- Published
- 2021
- Full Text
- View/download PDF
17. An Observational Cohort of First Episode Psychosis in Iran: The Azeri Recent Onset Acute Phase Psychosis Survey (ARAS Cohort) Study Protocol.
- Author
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Farhang, Sara, Ghaemmaghami, Mehrdad, Shafiee-Kandjani, Ali Reza, Noorazar, Seyed Gholamreza, Veling, Wim, Malek, Ayyoub, Somi, Mohammad Hossein, Bruggeman, Richard, and Alizadeh, Behrooz Z.
- Subjects
PSYCHOSES ,MIDDLE-income countries ,SYMPTOMS ,HIERARCHICAL clustering (Cluster analysis) ,WESTERN countries - Abstract
Background: Most of our knowledge about the etiology, course, treatment, and outcome of schizophrenia spectrum and other psychotic disorders stems from Western countries. Data from populations living in other geographical areas and low- and middle-income countries, with different genomes (ethnicity) and exposomes (e.g., culture and social support, drugs of abuse, religion), will add to our knowledge of this complex disorder. Methods: The Azeri Acute phase/Recent onset psychosis Survey (ARAS) has been initiated to study the course of the disorder in patients with recent-onset psychosis using validated diagnostic tools and a comprehensive outcome monitoring system, aiming to reveal indicators for understanding the risk and resilience factors and for choosing the best-personalized treatment strategy. All participants will be evaluated for clinical signs and symptoms as well as risk and resilience factors and will be followed up for 1, 3, and 5 years for outcomes in several domains. A hierarchical cluster method will be applied to identify the number of clusters for each outcome. Defined models will be applied to assess the predictive value of cognition on symptomatic and functional outcomes at follow-up. Discussion: The ARAS cohort will yield significant academic- (research and education) and care-related achievements. ARAS data and experience will have value both in being a useful model for other parts of this region and in an expansion of the currently available knowledge. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
18. First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm
- Author
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Carlos González-Vivas, Gracián García-Martí, Pau Soldevila-Matías, Roberto Sanz-Requena, Eduardo J. Aguilar, María José Castro-Bleda, Luis Martí-Bonmatí, and Julio Sanjuan
- Subjects
first episode psychosis (FEP) ,fMRI—functional magnetic resonance imaging ,longitudinal ,emotional design model ,paradigm ,follow up ,Psychiatry ,RC435-571 - Abstract
Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level.
- Published
- 2020
- Full Text
- View/download PDF
19. First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm.
- Author
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González-Vivas, Carlos, García-Martí, Gracián, Soldevila-Matías, Pau, Sanz-Requena, Roberto, Aguilar, Eduardo J., Castro-Bleda, María José, Martí-Bonmatí, Luis, and Sanjuan, Julio
- Subjects
FUNCTIONAL magnetic resonance imaging ,HIPPOCAMPUS (Brain) - Abstract
Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
20. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
- Published
- 2022
- Full Text
- View/download PDF
21. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
- Published
- 2022
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22. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
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- 2022
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23. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
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- 2022
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24. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms. Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability. Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed. Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed. Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis.
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- 2022
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25. Hyperprolactinaemia in first episode psychosis - A longitudinal assessment.
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Lally, John, Ajnakina, Olesya, Stubbs, Brendon, Williams, Hugh R., Colizzi, Marco, Carra, Elena, Fraietta, Sara, Gardner-Sood, Poonam, Greenwood, Kathryn E., Atakan, Zerrin, Mondelli, Valeria, Ismail, Khalida, Howes, Oliver, Taylor, David M., Smith, Shubalade, Hopkins, David, Murray, Robin M., and Gaughran, Fiona
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HYPERPROLACTINEMIA , *PSYCHOSES , *ANTIPSYCHOTIC agents , *PROLACTIN , *BLOOD serum analysis , *LONGITUDINAL method , *DIAGNOSIS , *THERAPEUTICS , *DRUG therapy for psychoses , *PITUITARY diseases , *PATHOLOGICAL psychology , *RESEARCH funding , *TIME - Abstract
Little is known about hyperprolactinaemia (HPL) in first episode psychosis (FEP) patients. We investigated longitudinal changes in serum prolactin in FEP, and the relationship between HPL, and antipsychotic medication and stress. Serum prolactin was recorded in FEP patients at recruitment and again, 3 and 12months later. HPL was defined as a serum prolactin level >410mIU/L (~19.3ng/ml) for males, and a serum prolactin level >510mIU/L (~24.1ng/ml) for females. From a total of 174 people with serum prolactin measurements at study recruitment, 43% (n=74) had HPL, whilst 27% (n=21/78) and 27% (n=26/95) had HPL at 3 and 12months respectively. We observed higher serum prolactin levels in females versus males (p<0.001), and in antipsychotic treated (n=68) versus antipsychotic naïve patients (p<0.0001). Prolactin levels were consistently raised in FEP patients taking risperidone, amisulpride and FGAs compared to other antipsychotics. No significant relationship was observed between perceived stress scores (β=7.13, t=0.21, df=11, p=0.0.84 95% CI -72.91-87.16), or objective life stressors (β=-21.74, t=-0.31, df=8, p=0.77 95% CI -218.57-175.09) and serum prolactin. Our study found elevated rates of HPL over the course of the first 12months of illness. We found no evidence to support the notion that stress is related to elevated serum prolactin at the onset of psychosis. [ABSTRACT FROM AUTHOR]
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- 2017
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26. Corrigendum: Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process.
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Le PD, Choe K, Burrone MS, Bello I, Velasco P, Arratia T, Tal D, Mascayano F, Jorquera MJ, Schilling S, Ramírez J, Arancibia D, Fader K, Conover S, Susser E, Dixon L, Alvarado R, Yang LH, and Cabassa LJ
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[This corrects the article DOI: 10.3389/frhs.2022.958743.]., (© 2023 Le, Choe, Burrone, Bello, Velasco, Arratia, Tal, Mascayano, Jorquera, Schilling, Ramírez, Arancibia, Fader, Conover, Susser, Dixon, Alvarado, Yang and Cabassa.)
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- 2023
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27. No alteration of leukocyte telomere length in first episode psychosis
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Serge Adnot, Mohamed Lajnef, Jean-Romain Richard, Marion Leboyer, Stéphane Jamain, Andrei Szöke, Cécile Corfdir, Baptiste Pignon, Elisabeth Marcos, Antoine Pelissolo, Franck Schürhoff, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Henri Mondor, Fondation FondaMental [Créteil], and Pignon, Baptiste
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Oncology ,medicine.medical_specialty ,[SDV.MHEP.PSM] Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,Cumulative Exposure ,Disease ,Affect (psychology) ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,First episode psychosis (FEP) ,[SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN] ,mental disorders ,medicine ,Leukocytes ,Humans ,Chronic stress ,telomer ,Biological Psychiatry ,Telomere Shortening ,business.industry ,Confounding ,Telomere ,medicine.disease ,Pathophysiology ,030227 psychiatry ,schizophrenia ,Psychiatry and Mental health ,Psychotic Disorders ,Schizophrenia ,[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,[SDV.BBM.GTP] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN] ,business ,030217 neurology & neurosurgery - Abstract
International audience; Both shorter telomeres and schizophrenia have been associated with a decrease in life expectancy. Furthermore, several studies found a shorter telomere length (TL) in schizophrenia. Understanding whether or not telomere shortening is directly related to pathophysiology of schizophrenia or is a consequence of a cumulative exposure to chronic stress is of major importance. Comparing the TL of subjects at the very beginning of the disease (FEP) and control subjects could help to decide between these two hypotheses. The aim of the present study was to compare TL between FEP subjects (N=91) and controls (N=137). After accounting for multiple potential confounders, no significant association was observed between FEP and TL. Our result is consistent with the hypothesis that psycho-social stress / adversities and stressful situations in people with schizophrenia affect TL rather than that telomere erosion contributes to the development of this disorder.
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- 2021
28. Lowered paraoxonase 1 (PON1) activity is associated with increased cytokine levels in drug naïve first episode psychosis.
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Brinholi, Francis Fregonesi, Noto, Cristiano, Maes, Michael, Bonifácio, Kamila Landucci, Brietzke, Elisa, Ota, Vanessa Kiyomi, Gadelha, Ary, Cordeiro, Quirino, Belangero, Sintia Iole, Bressan, Rodrigo Affonseca, Vargas, Heber Odebrecht, Higachi, Luciana, de Farias, Carine Coneglian, Moreira, Estefânia Gastaldello, and Barbosa, Décio Sabbatini
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PARAOXONASE , *PHYSIOLOGICAL effects of cytokines , *PSYCHOSES , *PATHOLOGICAL physiology , *SCHIZOPHRENIA - Abstract
Background Activated immune-inflammatory pathways play an important role in the pathophysiology of schizophrenia. Paraoxonase 1 (PON1) activity is inversely associated with inflammatory responses in numerous clinical conditions. The aims of this study were to delineate serum arylesterase PON1 activity in drug-naïve first episode psychosis (FEP) patients and a healthy control group, and to assess whether there are inverse relationships between PON1 activity and cytokine levels. Methods A total of 51 drug-naïve FEP patients and 61 healthy controls were enrolled in this study. Levels of interleukin (IL)-4, IL-10, IL-6, tumor necrosis factor (TNF)-α and activity of PON1 were quantified. Results Compared to healthy controls, FEP patients showed lower serum PON1 activity and higher levels of IL-4, IL-10 and TNF-α. A significant inverse relationship between PON1 activity and IL-4, IL-6 and IL-10 levels was detected, but not for TNF-α. Subjects with very low PON1 activity (25th quartile) presented significantly higher levels of IL-6, IL-10 and IL-4 than those with higher PON1 activity (75th quartile). Conclusion The present study provides evidence that FEP is characterized by an inverse relationship between lowered activity of the anti-inflammatory/antioxidant enzyme PON1 and increased cytokine levels, including IL-6, IL-4 and IL-10. It is hypothesized that lowered PON1 activity may play a role in the immune-inflammatory response that accompanies FEP and that increased cytokine levels may further modulate PON1 activity. [ABSTRACT FROM AUTHOR]
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- 2015
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29. First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm
- Abstract
[EN] Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level.
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- 2020
30. Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process.
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Le PD, Choe K, Burrone MS, Bello I, Velasco P, Arratia T, Tal D, Mascayano F, Jorquera MJ, Schilling S, Ramírez J, Arancibia D, Fader K, Conover S, Susser E, Dixon L, Alvarado R, Yang LH, and Cabassa LJ
- Abstract
Background: In 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile., Methods: A qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews ( n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions ( n = 6) with individuals with FEP and caregivers ( n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack., Results: Participants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model., Conclusion: OnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Le, Choe, Burrone, Bello, Velasco, Arratia, Tal, Mascayano, Jorquera, Schilling, Ramírez, Arancibia, Fader, Conover, Susser, Dixon, Alvarado, Yang and Cabassa.)
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- 2022
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31. Distinct effects of duration of untreated psychosis on brain cortical activities in different treatment phases of schizophrenia: A multi-channel near-infrared spectroscopy study.
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Chou, Po-Han, Koike, Shinsuke, Nishimura, Yukika, Kawasaki, Shingo, Satomura, Yoshihiro, Kinoshita, Akihide, Takizawa, Ryu, and Kasai, Kiyoto
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PSYCHOSES , *BRAIN physiology , *SCHIZOPHRENIA treatment , *NEAR infrared spectroscopy , *BRAIN imaging , *VERBAL behavior testing - Abstract
Abstract: Background: Duration of untreated psychosis (DUP) has been shown to be associated with both poor short-term and long-term outcomes in schizophrenia. Even so, few studies have used functional neuroimaging to investigate DUP in schizophrenia. In the present study, we used near-infrared spectroscopy (NIRS) to investigate the influence of DUP on brain functions during a verbal fluency test (VFT) in patients with schizophrenia. Methods: A total of 62 patients with schizophrenia were included. They were categorized into either short treatment (≤6months, n =33) or long treatment (>6months, n =29) groups based on their duration of treatment. Hemodynamic changes over the frontotemporal regions during a VFT were measured using multi-channel NIRS. We examined the associations between DUP and hemodynamic changes in each group to explore if there were different effects of DUP on brain cortical activity at different treatment durations. Results: In the long treatment group, we found significant associations between a longer DUP and decreased cortical activity approximately at the left inferior frontal gyrus, left middle frontal gyrus, left postcentral gyrus, right precentral gyrus, bilateral superior temporal gyrus, and bilateral middle temporal gyrus, whereas no associations between DUP and brain cortical activity were observed in the short treatment group. Conclusions: Our results indicated that longer DUP may be associated with decreased level of cortical activities over the frontotemporal regions in the long-term. Early detection and intervention of psychosis that shortens DUP might help to improve the long-term outcomes in patients with schizophrenia. [Copyright &y& Elsevier]
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- 2014
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32. No sex differences in neuropsychological performance in first episode psychosis patients.
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Ayesa-Arriola, Rosa, Rodriguez-Sanchez, Jose Manuel, Gomez-Ruiz, Elsa, Roiz-Santiáñez, Roberto, Reeves, Lauren L., and Crespo-Facorro, Benedicto
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PSYCHOSES , *NEUROPSYCHOLOGICAL tests , *PEOPLE with schizophrenia , *LONGITUDINAL method , *PSYCHIATRY , *PATIENTS ,SEX differences (Biology) - Abstract
Abstract: Objective: The purpose of this study was to verify whether male patients with psychosis have greater neurocognitive impairment than female patients at illness onset. Method: Participants with a first episode of psychosis (74 women/86 men) and healthy controls (62 women/97 men) were assessed with an extensive neuropsychological test battery. Results: Women in the clinical group were older at illness onset and had achieved higher formal education than men. This trend was the same for the control group. The patient group presented with lower premorbid IQ compared to healthy controls, and performed below for most neuropsychological tests. Women scored higher than men on a test of verbal memory, whereas men scored higher than women on a test of reaction time, visual memory, and a planning task. There were no group-by-sex interactions for any of the neuropsychological tests. Conclusion: The present study shows that at the onset of psychosis there are no differences between males and females in neuropsychological performance. The differential pattern of cognitive performance observed is similar to that in healthy males and females. Furthermore, females with a late onset of psychosis may represent a subgroup with specific visuospatial and problem solving impairments. Significant outcomes: [1-] The present study does not give support to the hypothesis that male have worse neurocognitive functioning than female patients at illness onset. [2-] The neuropsychological profile of sex differences observed among patients is consistent with that observed among controls. [3-] We identified a subgroup of female patients with late onset that differed in their degree and pattern of cognitive impairment with regard to their male counterparts. Limitations: [1-] Factors other than neurocognitive functioning may underlie the more severe impairment observed in the onset and course of illness in men. [2-] Although the study used a broad battery of well established tests, this battery may lack sensitivity to detect sex differences. [3-] A longitudinal study is required to further explore whether sex specific deficits require special rehabilitation programs for patients with schizophrenia. [Copyright &y& Elsevier]
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- 2014
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33. Professional health care and nursing of people exhibiting schizophrenia when suicidal
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Plank, Paul
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Psychiatrische Gesundheits- und Krankenpflege ,Early Intervention ,Erste psychotische Episode (FEP) ,Schizophrenia ,First episode Psychosis (FEP) ,Schizophrenie ,Suizidalität ,Suicidality ,Psychiatric Health Care and Nursing - Abstract
Hintergrund: Das Suizidrisiko von Personen mit Schizophrenie ist speziell in der Frühphase der Erkrankung, welche als erste psychotische Episode (FEP) bezeichnet wird stark erhöht. Ziel dieser Arbeit war es ausgehend von dieser Problematik zentrale Charakteristika von Suizidalität bei FEP darzustellen und aufbauend darauf den Interventionsansatz Early Intervention bei FEP in Bezug auf seine Wirksamkeit auf Suizidalität und andere Symptome einer FEP zu untersuchen. Aufbauend auf diesen Erkenntnissen wurde die Rolle von Pflegepersonen in diesen Bereichen erläutert. Methode: Im Rahmen eines systematischen Literaturreview wurden in den Datenbanken PubMed©, CINHAL©, Google Scholar©, Medline© und Whiley Online Library© unterschiedliche Suchbegriffe unter Beachtung von vordefinierten Ein- und Ausschlusskriterien recherchiert. Zwölf Studien wurden eingeschlossen und zur Beantwortung der Forschungsfragen synthetisiert. Ergebnisse: Es konnten sechs Risikofaktoren für Suizidalität bei FEP identifiziert werden, welche von Pflegepersonen für eine systematische Risikoeinschätzung von Suizidalität bei FEP genutzt werden können – (1) zeitliche Hochrisikoperiode; (2) Depression; (3) Krankheitseinsicht im Behandlungsverlauf und Interaktion mit einer depressiven Symptomatik; (4) psychotische Symptomatik; (5) vorhergegangene Suizidversuche; (6) Adhärenz. Aufbauend darauf wurde die Wirksamkeit von Early Intervention Programmen bei Suizidalität und anderen Merkmalen einer FEP dargestellt. Pflegepersonen übernehmen hier zentrale Aufgaben in der Begleitung von Patient*innen hin zu einer Rehabilitation im Rahmen eines Case-Management. Schlussfolgerung: Pflegepersonen erfüllen essenzielle Aufgaben in der systematischen Risikoeinschätzung einer Suizidalität bei FEP, sowie in der professionellen Begleitung von Menschen mit FEP durch einen Case-Management Prozess bei Early Intervention Programmen. Dieses professionelle Handeln spielt eine zentrale Rolle dabei, dass Suizidalität und andere FEP assoziierte Symptome bei Betroffenen vermindert werden können. Background: The suicide risk of people with schizophrenia is especially increased in the early stages of the illness referred to as first episode psychosis (FEP). The aim of this literature review was to explore characteristics of suicidality in patients experiencing a FEP. Building on this the effectiveness of Early Intervention programs in reducing suicidality and other FEP associated symptoms was assessed. A special focus was to explore the role professional nurses fulfill in this context. Methods: A comprehensive literature review was conducted in the following databases PubMed©, CINHAL©, Google Scholar©, Medline©, Whiley Online Library© using different keywords in accordance to predefined in- and exclusion criteria. Twelve studies were included and consecutively discussed. Results: Six risk factors for suicidality when experiencing a FEP could be identified, which can be used by professional nurses for a systematic risk assessment for suicidality – (1) high risk period; (2) depression; (3) insight over the treatment period and its relation to depressive symptoms; (4) psychotic symptoms; (5) previous suicide attempts; (6) adherence. Based on this the effectiveness of Early Intervention Services in reducing suicidality and other symptoms associated with FEP was shown. Professional nurses and their work within case-management processes in early intervention services, play a key role in accompanying patients experiencing FEP towards rehabilitation. Conclusion: Professional nurses fulfill essential tasks in the systematic risk assessment of suicidality for patients experiencing FEP, as well as in the professional mentoring of patients with FEP during a comprehensive case-management process as part of early intervention programs. These contributions by nurses play a key role in reducing suicidality and other symptoms associated with FEP for affected patients.
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- 2020
34. Cannabis use and brain structural alterations of the cingulate cortex in early psychosis.
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Rapp, Charlotte, Walter, Anna, Studerus, Erich, Bugra, Hilal, Tamagni, Corinne, Röthlisberger, Michel, Borgwardt, Stefan, Aston, Jacqueline, and Riecher-Rössler, Anita
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CANNABIS (Genus) , *BRAIN anatomy , *BRAIN diseases , *PEOPLE with schizophrenia , *MAGNETIC resonance imaging of the brain , *CANNABINOID receptors ,PSYCHOSES risk factors - Abstract
Abstract: As cannabis use is more frequent in patients with psychosis than in the general population and is known to be a risk factor for psychosis, the question arises whether cannabis contributes to recently detected brain volume reductions in schizophrenic psychoses. This study is the first to investigate how cannabis use is related to the cingulum volume, a brain region involved in the pathogenesis of schizophrenia, in a sample of both at-risk mental state (ARMS) and first episode psychosis (FEP) subjects. A cross-sectional magnetic resonance imaging (MRI) study of manually traced cingulum in 23 FEP and 37 ARMS subjects was performed. Cannabis use was assessed with the Basel Interview for Psychosis. By using repeated measures analyses of covariance, we investigated whether current cannabis use is associated with the cingulum volume, correcting for age, gender, alcohol consumption, whole brain volume and antipsychotic medication. There was a significant three-way interaction between region (anterior/posterior cingulum), hemisphere (left/right cingulum) and cannabis use (yes/no). Post-hoc analyses revealed that this was due to a significant negative effect of cannabis use on the volume of the posterior cingulum which was independent of the hemisphere and diagnostic group and all other covariates we controlled for. In the anterior cingulum, we found a significant negative effect only for the left hemisphere, which was again independent of the diagnostic group. Overall, we found negative associations of current cannabis use with grey matter volume of the cingulate cortex, a region rich in cannabinoid CB1 receptors. As this finding has not been consistently found in healthy controls, it might suggest that both ARMS and FEP subjects are particularly sensitive to exogenous activation of these receptors. [Copyright &y& Elsevier]
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- 2013
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35. Cannabis use and cognitive functions in at-risk mental state and first episode psychosis.
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Bugra, H., Studerus, E., Rapp, C., Tamagni, C., Aston, J., Borgwardt, S., and Riecher-Rössler, A.
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CANNABIS (Genus) , *MARIJUANA abuse , *PSYCHOSES , *META-analysis , *SCHIZOPHRENIA , *COGNITIVE ability , *ANALYSIS of covariance - Abstract
Background: Meta-analyses suggest that schizophrenia patients with a history of cannabis use have less impaired cognitive functioning compared to patients without cannabis use. Aims: The objective of this study was to assess the association between recency and frequency of cannabis use and cognitive functioning in at-risk mental state for psychosis (ARMS) and first episode psychosis (FEP) individuals. Methods: One hundred thirty-six participants completed a cognitive test battery and were assessed for current and past cannabis use. Analyses of covariance models were applied to evaluate the main effects of cannabis use and patient group (ARMS vs. FEP) as well as their interactions on cognitive functioning. Results: No differences were observed in cognitive performance between current, former, and never users, and there were no significant interactions between cannabis use and patient group. Furthermore, within the group of current cannabis users, the frequency of cannabis use was not significantly associated with cognitive functioning. Conclusion: The results of the present study do not support the notion that FEP patients and ARMS individuals with a history of cannabis use have less impaired cognitive functioning compared to those without cannabis use. [ABSTRACT FROM AUTHOR]
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- 2013
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36. Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms.
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Larsson C, Lee M, Lundgren T, Erhardt S, Sellgren CM, Cervenka S, Borg J, Bölte S, and Fatouros-Bergman H
- Abstract
Introduction: Social dysfunction is a key feature of psychotic disorders such as schizophrenia linked to disability. Less is known about social functioning in the early stages of the disorder and if there is an association to psychotic symptoms., Aims: Investigate if antipsychotic drug-naïve or briefly medicated individuals with first-episode psychosis (FEP), have impaired facial affect recognition (FAR) compared to control participants and if psychotic symptoms are associated with the FAR ability., Method: Individuals with FEP (n = 67) and control participants (n = 51) performed a computer-aided FAR task on basic emotions. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Group performances were compared using age and gender as covariates. The associations between FAR and performance on the subscales of PANSS were analyzed., Results: Compared to control participants, individuals with FEP were impaired in general FAR (Beta = -2.04 [95 % conf: -3.75/-1.62], p < 0.001) and FAR of negative emotions (Beta = -1.74 [95 % conf: -3.08/-1.22], p < 0.001), driven by difficulties in recognition of anger and disgust. In both groups, there was a pattern of mistaking negative emotions for other negative emotions. There were no significant group differences in FAR of happiness. No significant associations between FAR and psychotic symptoms were observed., Discussion: The results indicate that FAR, an underlying mechanism of social functioning is impaired early in the course of psychotic disorders. Current findings do not support the hypothesis that misinterpretation of facial expressions in individuals with FEP underlies or contributes to symptoms of psychosis., Competing Interests: The authors declare the following conflict of interests: Sven Bölte was an author, consultant, or lecturer for Medice and Roche during the last 3 years. He receives royalties for textbooks and diagnostic tools from Hogrefe Publishers and is a shareholder in SB Education and Psychological Consulting and NeuroSupportSolutions International. Carl M. Sellgren is a scientific advisor to Outermost Therapeutics Inc., (© 2022 The Author(s).)
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- 2022
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37. Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country
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Vijaya Raghavan Dhandapani, Thara Rangaswamy, Greeshma Mohan, Graeme Currie, Sridhar Vaitheswaran, and Swaran P. Singh
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Service (business) ,Implementation research ,Service delivery framework ,Psychological intervention ,Service management ,India ,Service provider ,Focus group ,Article ,Nursing ,Consolidated framework for implementation research (CFIR) ,First episode psychosis (FEP) ,Low- and middle-income country (LMIC) ,Thematic analysis ,Public aspects of medicine ,RA1-1270 ,Psychology ,RZ400-408 ,Mental healing - Abstract
First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians’ local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders., Highlights • Implementation of interventions for First Episode Psychosis in India is explored systematically. • Resource constraints, cultural factors, lack of awareness, and stigma are the main barriers to the implementation. • Buy-in from the service providers, accommodating the needs and developing rapport with the service users are the facilitators.
- Published
- 2021
38. Sulcogyral patterns and morphological abnormalities of the orbitofrontal cortex in psychosis.
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Bartholomeusz, Cali F., Whittle, Sarah L., Montague, Alice, Ansell, Brendan, McGorry, Patrick D., Velakoulis, Dennis, Pantelis, Christos, and Wood, Stephen J.
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PSYCHOSES , *FRONTAL lobe , *GENETICS of schizophrenia , *MAGNETIC resonance imaging of the brain , *BRAIN abnormalities , *CEREBROSPINAL fluid , *ANATOMY , *GENETICS - Abstract
Abstract: Three types of OFC sulcogyral patterns have been identified in the general population. The distribution of these three types has been found altered in individuals at genetic risk of psychosis, first episode psychosis (FEP) and chronic schizophrenia. The aim of this study was to replicate and extend previous research by additionally investigating: intermediate and posterior orbital sulci, cortical thickness, and degree of gyrification/folding of the OFC, in a large sample of FEP patients and healthy controls. OFC pattern type was classified based on a method previously devised, using T1-weighted magnetic resonance images. Cortical thickness and local gyrification indices were calculated using FreeSurfer. Occurrence of Type I pattern was decreased and Type II pattern was increased in FEP patients for the right hemisphere. Interestingly, controls displayed an OFC pattern type distribution that was disparate to that previously reported. Significantly fewer intermediate orbital sulci were observed in the left hemisphere of patients. Grey matter thickness of orbitofrontal sulci was reduced bilaterally, and left hemisphere reductions were related to OFC pattern type in patients. There was no relationship between pattern type and degree of OFC gyrification. An interaction was found between the number of intermediate orbital sulci and OFC gyrification; however this group difference was specific to only the small subsample of people with three intermediate orbital sulci. Given that cortical folding is largely determined by birth, our findings suggest that Type II pattern may be a neurodevelopmental risk marker while Type I pattern may be somewhat protective. This finding, along with compromised orbitofrontal sulci thickness, may reflect early abnormalities in cortical development and point toward a possible endophenotypic risk marker of schizophrenia-spectrum disorders. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
39. Duration of untreated psychosis and cognitive functioning
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Rapp, Charlotte, Studerus, Erich, Bugra, Hilal, Aston, Jacqueline, Tamagni, Corinne, Walter, Anna, Pflueger, Marlon, Borgwardt, Stefan, and Riecher-Rössler, Anita
- Subjects
- *
PSYCHOSES , *COGNITIVE ability , *OPERATIONAL definitions , *MENTAL illness , *NEUROPSYCHOLOGY , *HEALTH outcome assessment - Abstract
Abstract: Background: Studies examining the influence of duration of untreated psychosis (DUP) or duration of untreated illness (DUI) on cognition vary with regard to results and methods. This study is the first in this field to include an at risk mental state with later transition to psychosis (ARMS-T) sample and to analyse how the DUI relates to their cognitive functioning. Because methodological operationalization of cognitive functioning in previous studies is highly heterogeneous, we aimed to compare different approaches. Method: 60 first episode psychosis (FEP) patients and 24 ARMS-T patients were examined. Associations between DUP, DUI and neurocognitive performance were tested by three different operationalizations of cognition: as the raw outcome measure of different neuropsychological tests, as outcome scores which were normed on a sample of 75 healthy participants, and as the deterioration index (DI). Results: There were no significant correlations between DUP or DUI and outcome of neuropsychological tests in both normed and raw scores. When adjusted for covariates, DUP and DUI also did not significantly predict any cognitive performance. There was no significant relationship between DUP or DUI and the DI index. However, longer DUP and DUI were significantly associated with stronger negative symptoms. Conclusions: This study could not confirm an association between duration of untreated psychosis or duration of untreated illness and neurocognitive performance in the ARMS-T and FEP samples. This could be because schizophrenic psychoses are neurodevelopmental disorders in which most cognitive deficits exist long before the onset of psychiatric symptoms. [Copyright &y& Elsevier]
- Published
- 2013
- Full Text
- View/download PDF
40. Screening for Early Emerging Mental Experiences (SEE ME): A Model to Improve Early Detection of Psychosis in Integrated Primary Care.
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Woodberry KA, Johnson KA, and Shrier LA
- Abstract
Early intervention in serious mental health conditions relies on the accurate identification of adolescents and young adults at high risk or with very recent onset of psychosis. Current early detection strategies have had limited success, identifying only a fraction of these individuals within the recommended 3- to 6-month window. Broader public health strategies such as population screening are hampered by low base rates and poor self-report screen specificity. Screening for Early Emerging Mental Experiences (SEE ME) is a three-stage "SCREEN-TRIAGE-ENGAGE" model for the early detection of psychosis in integrated primary care adolescent and young adult patients during the period of peak onset. It builds on the KNOW THE SIGNS-FIND THE WORDS-MAKE THE CONNECTION framework outlined on psychosisscreening.org and developed with input from community collaborators. Systematic screening aims to expand the reach of early detection and reduce reliance on provider knowledge. Triage and engagement by trained mental health clinicians aims to improve the specificity of screen responses, enhance engagement in appropriate care, and reduce provider burden. Leveraging the low stigma of primary care, its reach to non-help-seeking adolescents and young adults, and the mental health training of clinicians within integrated care practices, SEE ME has potential to improve the benefit/risk ratio of early detection of psychosis by improving both the sensitivity and specificity of screening and clinical response. We review the rationale and design of this promising model., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Woodberry, Johnson and Shrier.)
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- 2022
- Full Text
- View/download PDF
41. The relationship between the duration of untreated psychosis and family distress among families with a member suffering from first-episode psychosis.
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Rezaiemaram, P., Aguilar-Vafaie, M., Tavallaie, S. A., and Monirpoor, N.
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PSYCHOSES ,PSYCHOLOGICAL distress ,MEDICAL centers ,STATISTICAL correlation ,REGRESSION analysis ,MULTIVARIATE analysis - Abstract
Introduction: Review of related literature indicates that few studies have addressed the impacts of the duration of untreated psychosis (DUP) on family, and on the family system in particular. The present research investigates the relationship between DUP and family distress among families with a member suffering from first-episode psychosis (FEP). Method: This was a non-experimental correlational study. Using purposeful sampling, a sample of 107 families from three medical centers was recruited. Family distress was measured using the Family Distress Index (FDI), and was completed by the primary caregiver in each family. Also, DUP was measured by administering a semi-structured interview to primary caregivers with select items from the Course of Onset and Relapse Schedule/Topography of Psychotic Episode (CORS/TOPE). Data were analyzed using Pearson correlation coefficient and regression analysis. Results: Results indicated that there is a significant relationship between DUP and family distress, and that DUP is also a predictor of family distress. Conclusion: In sum, these findings suggest that when there is an increase in the delay of seeking family treatment, DUP is prolonged, with an increase in family distress. Thus, prolonged DUP may be an indicator of an increased need for family to seek professional help in order to achieve balance of the family system. [ABSTRACT FROM AUTHOR]
- Published
- 2012
42. Growth in the Aftermath of Psychosis: Characterizing Post-traumatic Growth in Persons With First Episode Psychosis in Singapore.
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Lee YY, Seet V, Chua YC, Verma SK, and Subramaniam M
- Abstract
Experiencing first episode psychosis (FEP) is a highly traumatic life event. However, there is evidence to show that the outcome of psychosis is more nuanced than was conventionally thought. Young persons with FEP can grow from the experience of psychosis. In this study, we aim to characterize post-traumatic growth (PTG) in persons with FEP over 1 year. A total of 99 FEP clients receiving services from an early psychosis intervention team in Singapore were recruited. The PTG Inventory, among other scales, like Questionnaire on the Process of Recovery and Connor-Davidson Resilience Scale, were administered in this population. A total of 52 participants completed the questionnaire at two timepoints (one year apart). The Reliable Change Index was calculated for participants who completed both timepoints. Repeated measures of correlation were performed, which identified personal recovery and resilience to be associated with PTG in this sample. This clinical population exhibited PTG in the aftermath of psychosis. PTG was associated with personal recovery and resilience, but not clinical indicators, like symptoms and functioning. Data from this study suggests that recovery and growth from first episode psychosis is a possibility. Clinical implications, strengths and limitations of this study are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lee, Seet, Chua, Verma and Subramaniam.)
- Published
- 2022
- Full Text
- View/download PDF
43. No alteration of leukocyte telomere length in first episode psychosis.
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Schürhoff, Franck, Corfdir, Cécile, Pignon, Baptiste, Lajnef, Mohamed, Richard, Jean-Romain, Marcos, Elisabeth, Pelissolo, Antoine, Leboyer, Marion, Adnot, Serge, Jamain, Stephane, and Szöke, Andrei
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- *
TELOMERES , *PSYCHOLOGICAL stress , *SOIL erosion , *PSYCHOSES , *LEUCOCYTES - Abstract
• There is no accelerated telomere erosion in subjects suffering from first episode psychosis. • Excessive shortening of telomeres occurs during the course of schizophrenia. • Psycho-social stress /adversities and stressful situations are probably the cause of telomere erosion in schizophrenia. • Inflammatory processes and oxidative stress may be involved in the relationship between chronic stress and telomere erosion. • Telomere alterations may be considered as a biomarker of illness progression. Both shorter telomeres and schizophrenia have been associated with a decrease in life expectancy. Furthermore, several studies found a shorter telomere length (TL) in schizophrenia. Understanding whether or not telomere shortening is directly related to pathophysiology of schizophrenia or is a consequence of a cumulative exposure to chronic stress is of major importance. Comparing the TL of subjects at the very beginning of the disease (FEP) and control subjects could help to decide between these two hypotheses. The aim of the present study was to compare TL between FEP subjects (N=91) and controls (N=137). After accounting for multiple potential confounders, no significant association was observed between FEP and TL. Our result is consistent with the hypothesis that psycho-social stress / adversities and stressful situations in people with schizophrenia affect TL rather than that telomere erosion contributes to the development of this disorder. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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44. Implementation of first episode psychosis intervention in India - A case study in a low-and middle-income country.
- Author
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Vaitheswaran S, Currie G, Dhandapani VR, Mohan G, Rangaswamy T, and Preet Singh S
- Abstract
First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians' local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)
- Published
- 2021
- Full Text
- View/download PDF
45. Prosody abilities in a large sample of affective and non-affective first episode psychosis patients
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Francesca Pileggi, Paolo Brambilla, Alessandro Tavano, Paolo Santonastaso, Cinzia Perlini, Enrico Ceccato, Giuseppe Delvecchio, Angela Andreella, Elisabetta Caletti, Livio Finos, Doriana Cristofalo, Chiara Bonetto, Mirella Ruggeri, Antonio Lasalvia, Marcella Bellani, Dario Lamonaca, and F Mazzi
- Subjects
Adult ,Male ,Psychosis ,impairment ,lcsh:RC435-571 ,Global Assessment of Functioning ,Emotions ,Clinical Psychology ,Psychiatry and Mental Health ,linguistic prosody ,Speech Disorders ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,lcsh:Psychiatry ,Comprehension ,Female ,Humans ,Italy ,Language ,Psychotic Disorders ,aprosodia ,medicine ,Association (psychology) ,Prosody ,First Episode Psychosis (FEP) ,comprehension abilitiy ,emotional prosody ,Settore M-PSI/03 - Psicometria ,medicine.disease ,030227 psychiatry ,Emotional prosody ,Aprosodia ,medicine.symptom ,Psychology ,030217 neurology & neurosurgery ,Clinical psychology ,Psychopathology - Abstract
Objective Prosody comprehension deficits have been reported in major psychoses. It is still not clear whether these deficits occur at early psychosis stages. The aims of our study were to investigate a) linguistic and emotional prosody comprehension abilities in First Episode Psychosis (FEP) patients compared to healthy controls (HC); b) performance differences between non-affective (FEP-NA) and affective (FEP-A) patients, and c) association between symptoms severity and prosodic features. Methods A total of 208 FEP (156 FEP-NA and 52 FEP-A) patients and 77 HC were enrolled and assessed with the Italian version of the "Protocole Montreal d'Evaluation de la Communication” to evaluate linguistic and emotional prosody comprehension. Clinical variables were assessed with a comprehensive set of standardized measures. Results FEP patients displayed significant linguistic and emotional prosody deficits compared to HC, with FEP-NA showing greater impairment than FEP-A. Also, significant correlations between symptom severity and prosodic features in FEP patients were found. Conclusions Our results suggest that prosodic impairments occur at the onset of psychosis being more prominent in FEP-NA and in those with severe psychopathology. These findings further support the hypothesis that aprosodia is a core feature of psychosis.
- Published
- 2018
46. Hyperprolactinaemia in first episode psychosis:A longitudinal assessment
- Author
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Kathryn Greenwood, Marco Colizzi, Fiona Gaughran, Poonam Gardner-Sood, Sara Fraietta, Elena Carra, Zerrin Atakan, Oliver D. Howes, Olesya Ajnakina, John Lally, S Smith, Hugh R J Williams, David Taylor, David Hopkins, Valeria Mondelli, Khalida Ismail, Robin M. Murray, and Brendon Stubbs
- Subjects
Adult ,Male ,medicine.medical_specialty ,Psychosis ,endocrine system ,Time Factors ,Adolescent ,medicine.medical_treatment ,Stress ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,First episode psychosis (FEP) ,medicine ,Antipsychotics ,Hyperprolactinaemia ,Prolactin ,Schizophrenia ,Humans ,Amisulpride ,Longitudinal Studies ,Young adult ,Antipsychotic ,Biological Psychiatry ,Risperidone ,Psychopathology ,Middle Aged ,medicine.disease ,030227 psychiatry ,Antipsychotic Agents ,Female ,Hyperprolactinemia ,Psychotic Disorders ,Psychiatry and Mental health ,Endocrinology ,Psychology ,030217 neurology & neurosurgery ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
Little is known about hyperprolactinaemia (HPL) in first episode psychosis (FEP) patients. We investigated longitudinal changes in serum prolactin in FEP, and the relationship between HPL, and antipsychotic medication and stress. Serum prolactin was recorded in FEP patients at recruitment and again, 3 and 12 months later. HPL was defined as a serum prolactin level > 410 mIU/L (~ 19.3 ng/ml) for males, and a serum prolactin level > 510 mIU/L (~ 24.1 ng/ml) for females. From a total of 174 people with serum prolactin measurements at study recruitment, 43% (n = 74) had HPL, whilst 27% (n = 21/78) and 27% (n = 26/95) had HPL at 3 and 12 months respectively. We observed higher serum prolactin levels in females versus males (p < 0.001), and in antipsychotic treated (n = 68) versus antipsychotic naïve patients (p < 0.0001). Prolactin levels were consistently raised in FEP patients taking risperidone, amisulpride and FGAs compared to other antipsychotics. No significant relationship was observed between perceived stress scores (β = 7.13, t = 0.21, df = 11, p = 0.0.84 95% CI − 72.91–87.16), or objective life stressors (β = − 21.74, t = − 0.31, df = 8, p = 0.77 95% CI − 218.57–175.09) and serum prolactin. Our study found elevated rates of HPL over the course of the first 12 months of illness. We found no evidence to support the notion that stress is related to elevated serum prolactin at the onset of psychosis.
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- 2017
47. Cortical thinning and caudate abnormalities in first episode psychosis and their association with clinical outcome
- Author
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Colm McDonald, Shane McInerney, Joanne Kenney, John McFarland, Srinath Ambati, Brian Hallahan, Cathy Scanlon, Heike Anderson-Schmidt, Anna Fullard, Gareth J. Barker, Mairead Waldron, Peter McCarthy, Dara M. Cannon, Mark A. Elliott, Sam Logan, Liam Kilmartin, and ~
- Subjects
Adult ,Male ,Psychosis ,medicine.medical_specialty ,Caudate ,Middle temporal gyrus ,Cortical thickness ,Superior temporal gyrus ,Lateral ventricles ,First episode psychosis (FEP) ,Internal medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,Gray Matter ,Gyrification ,Biological Psychiatry ,Psychiatric Status Rating Scales ,First episode ,Temporal cortex ,Volume ,Brain ,Shape ,Organ Size ,Sulcus ,medicine.disease ,Magnetic Resonance Imaging ,Psychiatry and Mental health ,medicine.anatomical_structure ,Psychotic Disorders ,Disease Progression ,Cardiology ,Female ,Psychology ,Neuroscience ,Follow-Up Studies ,MRI - Abstract
Journal article First episode psychosis (FEP) has been associated with structural brain changes, largely identified by volumetric analyses. Advances in neuroimaging processing have made it possible to measure geometric properties that may identify subtle structural changes not appreciated by a measure of volume alone. In this study we adopt complementary methods of assessing the structural integrity of grey matter in FEP patients and assess whether these relate to patient clinical and functional outcome at 3year follow-up. 1.5Tesla T1-weighted Magnetic Resonance (MR) images were acquired for 46 patients experiencing their first episode of psychosis and 46 healthy controls. Cerebral cortical thickness and local gyrification index (LGI) were investigated using FreeSurfer software. Volume and shape of the hippocampus, caudate and lateral ventricles were assessed using manual tracing and spherical harmonics applied for shape description. A cluster of cortical thinning was identified in FEP compared to controls; this was located in the right superior temporal gyrus, sulcus, extended into the middle temporal gyrus (lateral temporal cortex - LTC). Bilateral caudate volumes were significantly lower in FEP relative to controls and the right caudate also displayed regions of shape deflation in the FEP group. No significant structural abnormalities were identified in cortical LGI or hippocampal or lateral ventricle volume/shape. Neither LTC nor caudate abnormalities were related to change in symptom severity or global functioning 3years later. LTC and caudate abnormalities are present at the first episode of psychosis but do not appear to directly affect clinical or functional outcome. peer-reviewed
- Published
- 2014
48. UNRUPTURED INTRACRANIAL ANEURYSM AND FIRST EPISODE PSYCHOSIS: THE MYSTERY WAS FINALLY SOLVED
- Author
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E. Tungaraza, Tongeji and Singh, Ranbir
- Subjects
unruptured intracranial aneurysm (UICA) ,MRI scan ,CT scan ,psychosis ,subarachnoid haemorrhage ,first episode psychosis (FEP) - Abstract
Incidental findings on Head MRI and CT scans are common in the general population as well as in patients presenting with first episode of psychosis (FEP). Though unruptured intracranial aneurysms (UICAs) are among the incidental findings, they are rare in those under the age of 30. We present a case of a young man (28) who presented with FEP and unruptured intracranial aneurysm. The implications to treating physicians are discussed given the rareness of the two to be found together in the given age group. Following physical examination and several physical tests including both CT and MRI scans, it was established that in addition to psychosis, the young man had an unruptured intracranial aneurysm on the right anterior communication artery. The psychosis continued despite successful treatment of the aneurysm. It was concluded that the aneurysm was an incidental finding. UICs under the age of 30 in patients presenting with FEP are more likely to be coincidental findings rather than the underlying cause of psychosis. However, clinicians need to remain vigilant by conducting physical examination including neurological examination for patients presenting with FEP. The need for brain CT or MRI scan should be informed by clinical presentation and the findings on physical examination.
- Published
- 2017
49. Quantification of brain networks in healthy and diseased adolescents using neuroimaging processing techniques
- Author
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Barbazán García, Elena, Pascau González-Garzón, Javier, Janssen, Joost, and Universidad Carlos III de Madrid. Departamento de. Bioingeniería e Ingeniería Aeroespacial
- Subjects
Brain networks ,Magnetic resonance ,First Episode Psychosis (FEP) ,Fronto-Parietal network (FPN) ,Default Mode network (DMN) ,Neuroimaging ,Biología y Biomedicina - Abstract
In the last decades, neuroimaging, and particularly functional magnetic resonance, have lead to a high number of findings on brain organization that have helped the scientific community to better understand brain function. Despite these advances, the foundations of neural activity and connectivity are not yet understood, and little is known about its role in the etiology of psychiatric disorders. A vast amount of literature on neuroimaging demonstrates the presence of abnormal and dysfunctional brain patterns of activity, revealed by a wide number of different analytical approaches. However, the establishment of consistent relations between abnormal connectivity patterns and symptoms or diagnoses is still not confirmed. For this reason, the present project studied these relations in young individuals suffering from First Episode Psychosis (FEP) and healthy control participants by implementing a model-dependent atlas-based approach using the publicly available Seven Network Atlas. The statistical analysis of preprocessed images revealed various tendencies consistent with previous results from literature as well as new findings. Youth in psychosis presented hyperconnectivity in most resting-state networks when compared to controls, being significantly enhanced in Fronto-Parietal network (FPN) and Default Mode network (DMN). Also, within patients hyperconnectivity was negatively related to general cognitive performance and positively linked to clinical symptom severity. We estimate that the results of this work will eventually contribute to a better understanding of the early stages of psychosis in children and adolescents, critical for optimizing current interventions and treatments. En los últimos años, la comunidad científica ha hecho grandes avances para alcanzar una mejor comprensión del funcionamiento del cerebro gracias al gran número de descubrimientos relativos a la organización del mismo, llevados a cabo mediante neuroimagen y en particular por medio de resonancia magnética funcional. A pesar de estos avances, todavía se desconocen las bases de la actividad y conectividad neuronal así como su papel en la etiología de los trastornos psicóticos. Una gran cantidad de literatura sobre análisis de neuroimagen mediante diversos métodos demuestra de manera consistente la presencia de patrones de actividad cerebral alterados y disfuncionales; sin embargo, es imposible establecer de manera sólida, a través de diferentes estudios, la relación entre patrones específicos de conectividad funcional alterada con los diferentes síntomas y condiciones de estos trastornos. Por este motivo, el presente proyecto ha estudiado estos vínculos en niños y adolescentes que padecen un primer episodio de psicosis así como en controles sanos mediante un enfoque basado en un atlas público de 7 redes cerebrales. El análisis estadístico de las imágenes preprocesadas reveló varias tendencias coherentes con resultados previos extraídos de la literatura así como nuevos hallazgos. Los jóvenes con psicosis mostraron tener hiperconectividad en la mayoría de las redes en reposo en comparación con los controles, siendo dicha diferencia especialmente significativa en las redes Fronto-Parietal y por Defecto. Además, se observaron patrones de correlación negativa entre la conectividad y los procesos cognitivos, mientas que la relación de la conectividad con la gravedad de los síntomas mostró ser positiva. Los resultados de este trabajo contribuyen a una mejor comprensión de las etapas iniciales de la psicosis en niños y adolescentes, fundamentales para la optimización de los actuales tratamientos e intervenciones. Ingeniería Biomédica
- Published
- 2015
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