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López-Díaz Á, Ayesa-Arriola R, Ortíz-García de la Foz V, Suárez-Pinilla P, Ramírez-Bonilla ML, Vázquez-Bourgon J, Ruiz-Veguilla M, Crespo-Facorro B. Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study. Acta Psychiatr Scand 2021; 144:578-588. [PMID: 34431080 DOI: 10.1111/acps.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Brief psychotic disorder (BPD) is a relatively uncommon and underexplored psychotic condition. Even though BPD has been related to a more favorable outcome than other schizophrenia spectrum disorders (SSD), current knowledge of its predictive factors remains scant. This study aimed to examine its prevalence and find early predictors of BPD diagnostic stability. METHODS SSD diagnosis following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria was explored in a large epidemiological cohort (n = 569) of non-affective first-episode psychosis (FEP) patients enrolled in a three-year longitudinal intervention program (PAFIP). Premorbid, sociodemographic, and clinical information was collected to characterize BPD patients and determine factors predictive of diagnostic stability. Multivariate analysis included predictors selected from clinical knowledge and also those that had achieved marginal significance (p ≤ 0.1) in univariate analysis. RESULTS A total of 59 patients enrolled in the PAFIP program (10.4% of the whole cohort) met DSM-IV criteria for BPD, of whom 40 completed the three-year follow-up. The temporal stability of BPD in our sample was as high as 40% (n = 16). Transition from BPD to schizophrenia occurred in 37% (n = 15) of patients. Fewer hallucinations at baseline and better insight independently significantly predicted BPD diagnostic stability over time. CONCLUSION Our findings confirm that BPD is a clinical condition with moderate-to-low temporal stability and demonstrate that approximately two-thirds of FEP individuals experiencing BPD will develop a long-lasting psychotic disorder during follow-up, mainly schizophrenia.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Ortíz-García de la Foz
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Paula Suárez-Pinilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Luz Ramírez-Bonilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Vázquez-Bourgon
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ruiz-Veguilla
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
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2
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Murphy BP, Brewer WJ. Early intervention in psychosis: strengths and limitations of services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.110.008573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryEarly intervention services were established on the basis of a number of fundamental principles, including the notions that intervening in the early stages of psychosis alters illness trajectory and prognosis, that multicomponent interventions promote psychosocial recovery and reduce iatrogenic damage, and that early targeting of non-responders reduces treatment resistance. There is growing evidence of the benefits of specialised early intervention services. These include improved clinical, social and vocational outcomes, reduced in-patient stays and better engagement. Early intervention services can also significantly reduce the risk of a second episode and are highly valued by service users and carers. Duration of treatment appears to determine long-term outcome and there remains uncertainty about how long such intensive intervention should last and whether all patients need the same length of care. Budgetary constraints are pervasive and are particularly likely to affect prodrome clinics and community awareness programmes.
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Bustamante LHU, Cerqueira RO, Leclerc E, Brietzke E. Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. ACTA ACUST UNITED AC 2017; 40:220-225. [PMID: 29069252 PMCID: PMC6900760 DOI: 10.1590/1516-4446-2017-2290] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. METHODS The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. RESULTS Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. CONCLUSIONS Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.
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Affiliation(s)
- Lineth H U Bustamante
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Raphael O Cerqueira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Emilie Leclerc
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elisa Brietzke
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Zafran H, Mazer B, Tallant B, Chilingaryan G, Gelinas I. Detecting incipient schizophrenia: a validation of the Azima battery in first episode psychosis. Psychiatr Q 2017; 88:585-602. [PMID: 27804008 DOI: 10.1007/s11126-016-9482-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early psychosis intervention aims to accurately detect adolescents and young adults at risk for major mental disorders, particularly schizophrenia, yet early biomedical diagnostic accuracy remains poor. However, phenomenological approaches focusing on eliciting and understanding the subjective experience of help-seeking youth better detect incipient schizophrenia. The Azima Battery is an occupational therapy projective assessment that uses expressive media in a standard setup, in order to phenomenologically elicit and describe the activity performance and narratives of individuals at risk of, or on, the psychotic-spectrum.The purpose of this study was to estimate the predictive validity of the Azima Battery with youth seeking help for a first episode of psychosis, and identify patterns of performance distinctive of a diagnosis of schizophrenia 1-year later. A mixed methods phenomenological approach was used to calculate the predictive validity of the Azima Battery in detecting incipient schizophrenia, and to qualitatively identify patterns of performance. Study results demonstrate that the diagnostic accuracy of the Azima Battery is greater than psychiatric interviewing for a future diagnosis of schizophrenia (N = 62: 88.7 % vs 42 %). Performance elements and patterns statistically distinctive of schizophrenia are described, and relate to the structure of the created objects. Therefore, the Azima Battery is a valid measure for clinical use by occupational therapists working in early intervention for psychosis as a complement to traditional psychiatric interviewing.
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Affiliation(s)
- Hiba Zafran
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada. .,Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, H3T 1E4, Canada.
| | - Barbara Mazer
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital, 3205 Place Alton Goldbloom, Laval, Quebec, H7V 1R2, Canada.,School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Beverlea Tallant
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Gevorg Chilingaryan
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada.,Feil & Oberfeld/ CRIR Research Centre, Centre intégré de santé et de services sociaux de Laval, Hôpital juif de réadaptation, 3205, Place Alton-Goldbloom, Laval, Québec, H7V 1R2, Canada
| | - Isabelle Gelinas
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital, 3205 Place Alton Goldbloom, Laval, Quebec, H7V 1R2, Canada
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Lyne J, Renwick L, O'Donoghue B, Kinsella A, Malone K, Turner N, O'Callaghan E, Clarke M. Negative symptom domain prevalence across diagnostic boundaries: The relevance of diagnostic shifts. Psychiatry Res 2015; 228:347-54. [PMID: 26162655 DOI: 10.1016/j.psychres.2015.05.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/26/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
Negative symptoms are included in diagnostic manuals as part of criteria for schizophrenia spectrum psychoses only, however some studies have found their presence in other diagnoses. This study sought to clarify negative symptom domain prevalence across diagnostic categories, while investigating whether negative symptoms predicted diagnostic shift over time. Scale for the Assessment of Negative Symptoms (SANS) data were collected at first presentation in 197 individuals presenting with first episode psychosis and again at one year follow-up assessment. Negative symptoms were highest among individuals with schizophrenia and among those whose diagnosis shifted from non-schizophrenia spectrum at baseline to schizophrenia spectrum at follow-up. In a non-schizophrenia spectrum group negative symptoms at baseline were not a significant predictor of diagnostic shift to schizophrenia spectrum diagnoses. The study suggests negative symptoms can present among individuals with non-schizophrenia spectrum diagnoses, although this is most relevant for individuals following diagnostic shift from non-schizophrenia spectrum to schizophrenia spectrum diagnoses. The findings support introduction of a negative symptom dimension when describing a range of psychotic illnesses, and indicate that further research investigating the evolution of negative symptoms in non-schizophrenia diagnoses is needed.
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Affiliation(s)
- John Lyne
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; College of Life Sciences, University College Dublin, Belfield, Dublin 4, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Laoise Renwick
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; College of Life Sciences, University College Dublin, Belfield, Dublin 4, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Brian O'Donoghue
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; College of Life Sciences, University College Dublin, Belfield, Dublin 4, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Anthony Kinsella
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kevin Malone
- Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; Department of Psychiatry, Psychotherapy and Mental Health Research, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Elm Park, Dublin 4, Ireland
| | - Niall Turner
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eadbhard O'Callaghan
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; St. John of God Community Services Ltd., Blackrock, Co. Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Services, Blackrock, Co. Dublin, Ireland; Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland; The School of Psychotherapy, St. Vincent's University Hospital/School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; St. John of God Community Services Ltd., Blackrock, Co. Dublin, Ireland
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6
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Corominas-Roso M, Roncero C, Eiroa-Orosa FJ, Ribasés M, Barral C, Daigre C, Martínez-Luna N, Sánchez-Mora C, Ramos-Quiroga JA, Casas M. Serum brain-derived neurotrophic factor levels and cocaine-induced transient psychotic symptoms. Neuropsychobiology 2014; 68:146-55. [PMID: 24051573 DOI: 10.1159/000353259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/27/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cocaine-induced psychosis (CIP) is among the most serious adverse effects of cocaine. Reduced serum brain-derived neurotrophic factor (BDNF) levels have been reported in schizophrenia and psychosis; however, studies assessing the involvement of BDNF in CIP are lacking. METHODS A total of 22 cocaine-dependent patients (aged 33.65 ± 6.85) who had never experienced psychotic symptoms under the influence of cocaine (non-CIP) and 18 patients (aged 34.18 ± 8.54) with a history of CIP completed a 2-week detoxification program in an inpatient facility. Two serum samples were collected from each patient at baseline and at the end of the protocol. Demographic, consumption and clinical data were recorded for all patients. A paired group of healthy controls was also included. RESULTS At the beginning of the detoxification treatment, serum BDNF levels were similar in both the non-CIP and the CIP groups. During early abstinence, the non-CIP group exhibited a significant increase in serum BDNF levels (p = 0.030), whereas the CIP group exhibited a decrease. Improvements in depression (Beck Depression Inventory, BDI, p = 0.003) and withdrawal symptoms (Cocaine Selective Severity Assessment, CSSA, p = 0.013) show a significant positive correlation with serum BDNF levels in the non-CIP group, whereas no correlation between the same variables was found in the CIP group. CONCLUSIONS This study suggests that BDNF plays a role in the transient psychotic symptoms associated with cocaine consumption. In the non-CIP group, the increase in serum BDNF appears to be driven by the effects of chronic cocaine consumption and withdrawal. In contrast, patients with CIP share some of the neurotrophic deficiencies that characterize schizophrenia and psychosis.
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Affiliation(s)
- Margarida Corominas-Roso
- Department of Psychiatry, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Biomedical Network Research Center on Mental Health (CIBERSAM) Barcelona, Barcelona, Spain
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Björkenstam E, Björkenstam C, Hjern A, Reutfors J, Bodén R. A five year diagnostic follow-up of 1,840 patients after a first episode non-schizophrenia and non-affective psychosis. Schizophr Res 2013; 150:205-10. [PMID: 23899998 DOI: 10.1016/j.schres.2013.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/14/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It is not clear which patients with a first psychotic episode will develop schizophrenia. We performed a diagnostic follow-up of patients treated for a first time non-affective, non-schizophrenia psychosis and explored potential predictors of a subsequent schizophrenia or schizoaffective diagnosis. METHODS This register-based cohort study comprises individuals born between 1973 and 1978 in Sweden, with a first hospital-treated psychosis excluding schizophrenia, schizoaffective disorder, bipolar disorder and depressive disorder with psychotic symptoms (n=1840). The patients were followed for five years regarding subsequent diagnoses. Psychiatric, social, family history of psychiatric illness, premorbid intellectual level, head injuries and obstetrical complications were investigated by logistic regression as predictors of schizophrenia or schizoaffective diagnosis. RESULTS During the follow-up, 18% were diagnosed with schizophrenia or schizoaffective disorder, 5% were diagnosed with bipolar disorder, whereas 29% were not re-admitted to a psychiatric clinic. Patients with a first-degree relative hospitalized for schizophrenia and/or bipolar disorder had an increased risk of subsequent diagnosis for schizophrenia or schizoaffective disorder (odds ratio 1.9 and 95% confidence interval 1.1 to 3.0)), whereas previous severe criminality was associated with a decreased risk (odds ratio 0.5, 95% confidence interval 0.3-0.8). CONCLUSION Diagnostic outcome was diverse after a first non-schizophrenia and non-affective psychosis. Family history of severe mental illness and no previous conviction for severe criminality were the strongest risk factors for a future schizophrenia or schizoaffective diagnosis.
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Affiliation(s)
- E Björkenstam
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden
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Bratlien U, Øie M, Lien L, Agartz I, Lie Romm K, Vaskinn A, Ueland T, Andreassen OA, Melle I. Social dysfunction in first-episode psychosis and relations to neurocognition, duration of untreated psychosis and clinical symptoms. Psychiatry Res 2013; 207:33-9. [PMID: 23153893 DOI: 10.1016/j.psychres.2012.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 01/06/2023]
Abstract
Signs of social dysfunction are present early in the course of psychotic disorders. There is a lack of knowledge about how premorbid function, illness history, psychotic symptoms and neurocognitive characteristics are related to social function in patients with first episode psychosis (FEP). The relationship between these factors could provide important information about the psychopathology underlying social dysfunction and have implications for future prevention and treatment efforts. Our objective is to identify early predictors of social functioning in patients with FEP. We examined 166 patients and 166 age- and gender-matched healthy controls (HC). We used a validated and comprehensive measure of social functioning (the Social Functioning Scale), a comprehensive neurocognitive test battery, in addition to measures of psychotic symptoms, duration of untreated psychosis (DUP) and premorbid adjustment (the Premorbid Adjustment Scale). Lower childhood level of social adjustment and lower psychomotor speed had the strongest influence across measures of social functioning while symptoms and DUP had a weaker influence. The main result of the current study is that premorbid social adjustment and psychomotor speed had the strongest association with measures of social functioning in patients with FEP.
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Affiliation(s)
- Unni Bratlien
- Innlandet Hospital Trust, Division of Mental Health, Ottestad, Norway.
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Strobl EV, Eack SM, Swaminathan V, Visweswaran S. Predicting the risk of psychosis onset: advances and prospects. Early Interv Psychiatry 2012; 6:368-79. [PMID: 22776068 PMCID: PMC3470783 DOI: 10.1111/j.1751-7893.2012.00383.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/16/2012] [Indexed: 12/14/2022]
Abstract
AIM To conduct a systematic review of the methods and performance characteristics of models developed for predicting the onset of psychosis. METHODS We performed a comprehensive literature search restricted to English articles and identified using PubMed, Medline and PsychINFO, as well as the reference lists of published studies and reviews. Inclusion criteria included the selection of more than one variable to predict psychosis or schizophrenia onset, and selection of individuals at familial risk or clinical high risk. Eighteen studies met these criteria, and we compared these studies based on the subjects selected, predictor variables used and the choice of statistical or machine learning methods. RESULTS Quality of life and life functioning as well as structural brain imaging emerged as the most promising predictors of psychosis onset, particularly when they were coupled with appropriate dimensionality reduction methods and predictive model algorithms like the support vector machine (SVM). Balanced accuracy ranged from 100% to 78% in four studies using the SVM, and 67% to 81% in 14 studies using general linear models. CONCLUSIONS Performance of the predictive models improves with quality of life measures, life functioning measures, structural brain imaging data, as well as with the use of methods like SVM. Despite these advances, the overall performance of psychosis predictive models is still modest. In the future, performance can potentially be improved by including genetic variant and new functional imaging data in addition to the predictors that are used currently.
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Affiliation(s)
- Eric V Strobl
- Medical Scientist Training Program, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Alonso-Solís A, Corripio I, de Castro-Manglano P, Duran-Sindreu S, Garcia-Garcia M, Proal E, Nuñez-Marín F, Soutullo C, Alvarez E, Gómez-Ansón B, Kelly C, Castellanos FX. Altered default network resting state functional connectivity in patients with a first episode of psychosis. Schizophr Res 2012; 139:13-8. [PMID: 22633527 PMCID: PMC3393844 DOI: 10.1016/j.schres.2012.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Default network (DN) abnormalities have been identified in patients with chronic schizophrenia using "resting state" functional magnetic resonance imaging (R-fMRI). Here, we examined the integrity of the DN in patients experiencing their first episode of psychosis (FEP) compared with sex- and age-matched healthy controls. METHODS We collected R-fMRI data from 19 FEP patients (mean age 24.9 ± 4.8 yrs, 14 males) and 19 healthy controls (26.1 ± 4.8 yrs, 14 males) at 3T. Following standard preprocessing, we examined the functional connectivity (FC) of two DN subsystems and the two DN hubs (P<0.0045, corrected). RESULTS Patients with FEP exhibited abnormal FC that appeared largely restricted to the dorsomedial prefrontal cortex (dMPFC) DN subsystem. Relative to controls, FEP patients exhibited weaker positive FC between dMPFC and posterior cingulate cortex (PCC) and precuneus, extending laterally through the parietal lobe to the posterior angular gyrus. Patients with FEP exhibited weaker negative FC between the lateral temporal cortex and the intracalcarine cortex, bilaterally. The PCC and temporo-parietal junction also exhibited weaker negative FC with the right fusiform gyrus extending to the lingual gyrus and lateral occipital cortex, in FEP patients, compared to controls. By contrast, patients with FEP showed stronger negative FC between the temporal pole and medial motor cortex, anterior precuneus and posterior mid-cingulate cortex. CONCLUSIONS Abnormalities in the dMPFC DN subsystem in patients with a FEP suggest that FC patterns are altered even in the early stages of psychosis.
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Affiliation(s)
- Anna Alonso-Solís
- Servei de Psiquiatria Institut d'Investigació en Biomedicina de Sant Pau (IIB-Sant Pau) Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Universitat Autònoma de Barcelona, Spain.
| | - Iluminada Corripio
- Servei de Psiquiatria Institut d'Investigació en Biomedicina de Sant Pau (IIB-Sant Pau) Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM. Universitat Autònoma de Barcelona, Spain
| | | | - Santiago Duran-Sindreu
- Servei de Psiquiatria Institut d'Investigació en Biomedicina de Sant Pau (IIB-Sant Pau) Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM. Universitat Autònoma de Barcelona, Spain
| | - Manuel Garcia-Garcia
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Langone Medical Center, New York, NY, USA
| | - Erika Proal
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Langone Medical Center, New York, NY, USA,Unitat Recerca en Neurociència Cognitiva, Universitat Autònoma de Barcelona, Spain
| | - Fidel Nuñez-Marín
- Unitat de Neuroradiologia Servei Radiodiagnostic Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas-CIBERNED. Universitat Autònoma de Barcelona, Spain
| | - Cesar Soutullo
- Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain
| | - Enric Alvarez
- Servei de Psiquiatria Institut d'Investigació en Biomedicina de Sant Pau (IIB-Sant Pau) Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM. Universitat Autònoma de Barcelona, Spain
| | - Beatriz Gómez-Ansón
- Unitat de Neuroradiologia Servei Radiodiagnostic Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas-CIBERNED. Universitat Autònoma de Barcelona, Spain
| | - Clare Kelly
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Langone Medical Center, New York, NY, USA
| | - F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Langone Medical Center, New York, NY, USA,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Lyne J, O'Donoghue B, Owens E, Renwick L, Madigan K, Kinsella A, Clarke M, Turner N, O'Callaghan E. Prevalence of item level negative symptoms in first episode psychosis diagnoses. Schizophr Res 2012; 135:128-33. [PMID: 22281102 DOI: 10.1016/j.schres.2012.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/14/2011] [Accepted: 01/04/2012] [Indexed: 11/27/2022]
Abstract
UNLABELLED The relevance of negative symptoms across the diagnostic spectrum of the psychoses remains uncertain. The purpose of this study was to report on prevalence of item and subscale level negative symptoms across the first episode psychosis (FEP) diagnostic spectrum in an epidemiological sample, and to ascertain whether items and subscales were more prevalent in a schizophrenia spectrum diagnoses group compared to an 'all other psychotic diagnoses' group. We measured negative symptoms in 330 patients presenting with FEP using the Scale for Assessment of Negative Symptoms (SANS), and ascertained diagnosis using the Structured Clinical Interview for DSM IV. Prevalence of SANS items and subscales were tabulated across all psychotic diagnoses, and logistic regression analysis determined which items and subscales were predictive of schizophrenia spectrum diagnoses. SANS items were most prevalent in schizophrenia spectrum conditions but frequently presented in other FEP diagnoses, particularly substance induced psychotic disorder and Major Depressive Disorder. Brief psychotic disorder and bipolar disorders had low levels of negative symptoms. SANS items and subscales which significantly predicted schizophrenia spectrum diagnoses, were also frequently present in some of the other psychotic diagnoses. CONCLUSIONS SANS items have high prevalence in FEP, and while commonest in schizophrenia spectrum conditions are not restricted to this diagnostic subgroup.
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Affiliation(s)
- John Lyne
- DETECT Services, Avila House, Block 5 Blackrock Business Park, Blackrock, Co Dublin, Ireland.
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Murphy BP. Beyond the first episode: candidate factors for a risk prediction model of schizophrenia. Int Rev Psychiatry 2010; 22:202-23. [PMID: 20504060 DOI: 10.3109/09540261003661833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many early psychosis services are financially compromised and cannot offer a full tenure of care to all patients. To maintain viability of services it is important that those with schizophrenia are identified early to maximize long-term outcomes, as are those with better prognoses who can be discharged early. The duration of untreated psychosis remains the mainstay in determining those who will benefit from extended care, yet its ability to inform on prognosis is modest in both the short and medium term. There are a number of known or putative genetic and environmental risk factors that have the potential to improve prognostication, though a multivariate risk prediction model combining them with clinical characteristics has yet to be developed. Candidate risk factors for such a model are presented, with an emphasis on environmental risk factors. More work is needed to corroborate many putative factors and to determine which of the established factors are salient and which are merely proxy measures. Future research should help clarify how gene-environment and environment-environment interactions occur and whether risk factors are dose-dependent, or if they act additively or synergistically, or are redundant in the presence (or absence) of other factors.
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Affiliation(s)
- Brendan P Murphy
- Recovery and Prevention of Psychosis Service, Southern Health, Melbourne, Victoria, Australia.
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