Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis

Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale

Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.

Six months functional response to early psychosis intervention program best predicts outcome after three years

BACKGROUND

Not all patients respond well to early interventions for their psychosis. The present study's goal was to evaluate whether patients' responses in the first six months of treatment in a specialised three-year programme could predict final outcomes.

METHODS

206 early psychosis patients were assessed at baseline, using a large set of sociodemographic and clinical variables, and then monitored for 36 months. Among those variables, changes in their Global Assessment of Functioning (GAF) scores during the first six months were used to predict outcomes after three years.

RESULTS

Changes in GAF scores during the first six months were the only variables that predicted every symptom of functional outcome. GAF scores were also always the first or second most important predictor for every outcome. This finding held for both high- and low-functioning patients at baseline.

CONCLUSIONS

Predicting poor long-term outcomes after only six months should help clinicians to improve treatments.

Structural Covariance of Cortical Gyrification at Illness Onset in Treatment Resistance: A Longitudinal Study of First-Episode Psychoses

Treatment resistance (TR) in patients with first-episode psychosis (FEP) is a major cause of disability and functional impairment, yet mechanisms underlying this severe disorder are poorly understood. As one view is that TR has neurodevelopmental roots, we investigated whether its emergence relates to disruptions in synchronized cortical maturation quantified using gyrification-based connectomes. Seventy patients with FEP evaluated at their first presentation to psychiatric services were followed up using clinical records for 4 years; of these, 17 (24.3%) met the definition of TR and 53 (75.7%) remained non-TR at 4 years. Structural MRI images were obtained within 5 weeks from first exposure to antipsychotics. Local gyrification indices were computed for 148 contiguous cortical regions using FreeSurfer; each subject's contribution to group-based structural covariance was quantified using a jack-knife procedure, providing a single deviation matrix for each subject. The latter was used to derive topological properties that were compared between TR and non-TR patients using a Functional Data Analysis approach. Compared to the non-TR patients, TR patients showed a significant reduction in small-worldness (Hedges's g = 2.09, P < .001) and a reduced clustering coefficient (Hedges's g = 1.07, P < .001) with increased length (Hedges's g = -2.17, P < .001), indicating a disruption in the organizing principles of cortical folding. The positive symptom burden was higher in patients with more pronounced small-worldness (r = .41, P = .001) across the entire sample. The trajectory of synchronized cortical development inferred from baseline MRI-based structural covariance highlights the possibility of identifying patients at high-risk of TR prospectively, based on individualized gyrification-based connectomes.

Interplay between Socioeconomic Markers and Polygenic Predisposition on Timing of Dementia Diagnosis

OBJECTIVES

Identifying the interplay between socioeconomic markers (education and financial resources) and polygenetic predisposition influencing the time of dementia and the diagnosis of clinical Alzheimer's disease (AD) dementia is of central relevance for preventive strategies.

DESIGN

Prospective cohort design.

SETTING

The English Longitudinal Study of Aging is a household survey data set of a representative sample.

PARTICIPANTS

A total of 7,039 individuals aged 50 years and older participated in the study. Of these, 320 (4.6%) were diagnosed with dementia over the 10-year follow-up.

MEASUREMENTS

Polygenic score (PGS) for Alzheimer's disease (AD-PGS) was calculated using summary statistics from the International Genomics of Alzheimer's Project. An accelerated failure time survival model was used to investigate interactions between AD-PGS and socioeconomic markers on the timing of dementia and clinical AD dementia diagnosis.

RESULTS

A one standard deviation increase in AD-PGS was associated with an accelerated time to dementia diagnosis by 4.8 months. The presence of the apolipoprotein E gene (APOE-ε4) was associated with an earlier dementia onset by approximately 24.9 months, whereas intermediate and low levels of wealth were associated with an accelerated time to dementia diagnosis by 12.0 months and 18.7 months, respectively. A multiplicative interaction between AD-PGS and years of completed schooling in decelerating the time to clinical AD dementia by 3.0 months suggests educational attainment may serve as a protective mechanism against AD diagnosis among older people with a higher polygenic risk. Interaction between AD-PGS and lower wealth accelerated the time to clinical AD dementia diagnosis by 21.1 to 24.1 months.

CONCLUSION

Socioeconomic markers influence the time to dementia and clinical AD dementia diagnosis, particularly in those with a higher polygenic predisposition. J Am Geriatr Soc 68:1529-1536, 2020.

Decreased Serum EGF in First-episode and Chronic Schizophrenia Patients: Negative Correlation with Psychopathology

Previous studies have demonstrated that neurotrophic factors may play a critical role in the severity of clinical symptoms in schizophrenia. However, it remains unknown whether serum levels of epidermal growth factor (EGF) in schizophrenia are similar to those observed in the case of other neurotrophic factors. Therefore, we compared serum EGF concentrations in first-episode drug-naive (FEP) patients and medicated chronic schizophrenic patients with healthy controls in order to explore whether EGF levels are related to psychopathological symptoms. We measured the serum levels of EGF in 78 first-episode medication-naive schizophrenia patients, 76 medicated chronic schizophrenic patients, and 75 healthy controls using the sandwich ELISA method. Disease severity were measured using the positive and negative syndrome scale (PANSS). Serum EGF levels showed a significant decrease in schizophrenia patients in comparison to healthy subjects. Serum EGF levels in FEP patients are indistinguishable from chronic cases. EGF levels were related to PANSS general symptom subscales in both FEP never-medicated and medicated patients. It is interesting that serum EGF levels were negatively correlated with the PANSS cognitive subscales, with the exception of the patients with chronic schizophrenia. Our preliminary results indicated that EGF may play a role in this illness and that it could be used as a potential biomarker of disease severity. Moreover, EGF may be associated with cognitive subscales of PANSS in FEP patients. Future studies should investigate the relationship between EGF and cognitive function as measured using standardized neuropsychological assessments to identify potential biomarkers related with cognition.