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Serra-Arumí C, Golay P, Bonnarel V, Alerci L, Abrahamyan Empson L, Conus P, Alameda L. Risk and protective factors for recovery at 3-year follow-up after first-episode psychosis onset: a multivariate outcome approach. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1255-1267. [PMID: 37861709 PMCID: PMC11178637 DOI: 10.1007/s00127-023-02579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Recovery in people with first-episode psychosis (FEP) remains a major issue. When risk factors are studied in relation to the disorder, potential protective factors should also be considered since they can modulate this relationship. This study is aimed at exploring which premorbid and baseline characteristics are associated with a good and poor global recovery in patients with FEP at 3-year follow-up. METHODS We categorized patients' outcome by using a Latent Class Analysis (LCA) considering a multimodal set of symptomatic and functional outcomes. A Mixed effects Models Repeated Measures analysis of variance (MMRM) was used to highlight group differences over time on symptomatic and functional outcomes assessed during the 3-year follow-up. RESULTS A total of 325 patients with FEP aged between 18 and 35 years were included. Two groups were identified. A total of 187 patients (57.5%) did not achieve recovery, and 138 patients (42.5%) achieved recovery. Recovered patients had generally a better premorbid and baseline profile in comparison with non-recovered patients (as among which shorter duration of untreated psychosis (DUP), higher degree of insight, better functional level and lower illness severity at baseline). The trajectories for the psychopathological and functional outcomes over 36 months differed between the non-recovered and the recovered group of patients. CONCLUSIONS Our results pointed to some variables associated with recovery, acting as potential protective factors. These should be considered for early intervention programs to promote psychological resilience specifically in those with a worse prognosis in order to mitigate the effects of the variables that make them more vulnerable to poorer outcome.
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Affiliation(s)
- Clara Serra-Arumí
- Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT), Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Philippe Golay
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Vincent Bonnarel
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Livia Alerci
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Lilith Abrahamyan Empson
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Place Chauderon, 18, 1003, Lausanne, Switzerland.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.
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2
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Slot MIE, van Hell HH, Rossum IWV, Dazzan P, Maat A, de Haan L, Crespo-Facorro B, Glenthøj B, Lawrie SM, McDonald C, Gruber O, van Amelsvoort T, Arango C, Kircher T, Nelson B, Galderisi S, Weiser M, Sachs G, Maatz A, Bressan RA, Kwon JS, Mizrahi R, McGuire P, Kahn RS. A naturalistic cohort study of first-episode schizophrenia spectrum disorder: A description of the early phase of illness in the PSYSCAN cohort. Schizophr Res 2024; 266:237-248. [PMID: 38431986 DOI: 10.1016/j.schres.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND We examined the course of illness over a 12-month period in a large, international multi-center cohort of people with a first-episode schizophrenia spectrum disorder (FES) in a naturalistic, prospective study (PSYSCAN). METHOD Patients with a first episode of schizophrenia, schizoaffective disorder (depressive type) or schizophreniform disorder were recruited at 16 institutions in Europe, Israel and Australia. Participants (N = 304) received clinical treatment as usual throughout the study. RESULTS The mean age of the cohort was 24.3 years (SD = 5.6), and 67 % were male. At baseline, participants presented with a range of intensities of psychotic symptoms, 80 % were taking antipsychotic medication, 68 % were receiving psychological treatment, with 46.5 % in symptomatic remission. The mean duration of untreated psychosis was 6.2 months (SD = 17.0). After one year, 67 % were in symptomatic remission and 61 % were in functional remission, but 31 % had been readmitted to hospital at some time after baseline. In the cohort as a whole, depressive symptoms remained stable over the follow-up period. In patients with a current depressive episode at baseline, depressive symptoms slightly improved. Alcohol, tobacco and cannabis were the most commonly used substances, with daily users of cannabis ranging between 9 and 11 % throughout the follow-up period. CONCLUSIONS This study provides valuable insight into the early course of a broad range of clinical and functional aspects of illness in FES patients in routine clinical practice.
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Affiliation(s)
- Margot I E Slot
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Hendrika H van Hell
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America.
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark 458 Hill, London SE5 8AF, United Kingdom.
| | - Arija Maat
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Psychiatry, Department Early Psychosis, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychiatry, University of Sevilla. Hospital Universitario Virgen del Rocio, IBiS-CSIC, Sevilla, Spain.
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Dept. of Clinical Medicine, Copenhagen, Denmark.
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Mondriaan Mental Health Centre, Maastricht, the Netherlands.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany.
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville, Victoria, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Silvana Galderisi
- University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.
| | - Anke Maatz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - Rodrigo A Bressan
- Department of Psychiatry, Interdisciplinary Lab for Clinical Neurosciences (LiNC), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, 101 Dahakno, Jongno-gu, Seoul, Republic of Korea.
| | - Romina Mizrahi
- Department of Psychiatry, McGill University, Montreal, Canada.
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
| | - René S Kahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America.
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3
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Engel L, Alvarez-Jimenez M, Cagliarini D, D’Alfonso S, Faller J, Valentine L, Koval P, Bendall S, O’Sullivan S, Rice S, Miles C, Penn DL, Phillips J, Russon P, Lederman R, Killackey E, Lal S, Maree Cotton S, Gonzalez-Blanch C, Herrman H, McGorry PD, Gleeson JFM, Mihalopoulos C. The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial. Schizophr Bull 2024; 50:427-436. [PMID: 37261464 PMCID: PMC10919787 DOI: 10.1093/schbul/sbad071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective. STUDY DESIGN A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted. STUDY RESULTS The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved. CONCLUSIONS The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.
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Affiliation(s)
- Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D’Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Jan Faller
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O’Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Jess Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- School of Communication, University of Technology Sydney, Sydney, NWS, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Deakin Health Economics, Deakin University, Burwood, VIC, Australia
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Cowman M, Godfrey E, Walsh T, Frawley E, Fowler D, Alvarez-Jimenez M, O’Connor K, Wykes T, Birchwood M, Donohoe G. Measures of Social and Occupational Function in Early Psychosis: A Systematic Review and Meta-analysis. Schizophr Bull 2024; 50:266-285. [PMID: 37173277 PMCID: PMC10919778 DOI: 10.1093/schbul/sbad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Deficits in social and occupational function are widely reported in psychosis, yet no one measure of function is currently agreed upon as a gold standard in psychosis research. The aim of this study was to carry out a systematic review and meta-analysis of functioning measures to determine what measures were associated with largest effect sizes when measuring between-group differences, changes over time, or response to treatment. Literature searches were conducted based on PsycINFO and PubMed to identify studies for inclusion. Cross-sectional and longitudinal observational and intervention studies of early psychosis (≤5 years since diagnosis) that included social and occupational functioning as an outcome measure were considered. A series of meta-analyses were conducted to determine effect size differences for between-group differences, changes over time, or response to treatment. Subgroup analyses and meta-regression were carried out to account for variability in study and participant characteristics. One hundred and sixteen studies were included, 46 studies provided data (N = 13 261) relevant to our meta-analysis. Smallest effect sizes for changes in function over time and in response to treatment were observed for global measures, while more specific measures of social and occupational function showed the largest effect sizes. Differences in effect sizes between functioning measures remained significant after variability in study and participant characteristics were accounted for. Findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emmet Godfrey
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Talissa Walsh
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - Emma Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
| | - David Fowler
- School of Psychology, University of Sussex, Falmer, UK
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Karen O’Connor
- RISE Early Intervention in Psychosis Service, South Lee Mental Health Service, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - Til Wykes
- School of Mental Health & Psychological Sciences, King’s College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, University of Galway, Galway, Ireland
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5
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Cheng Z, Huang B, Ma K, Miao Q, Yuan Y, Han X, Yang L, Zeng X, Yang F, Wang C, Lu Z, Deng H, Zhao J, Yu X, Pu C. Trajectories of social function in patients with first-episode schizophrenia: Analysis of data from a 10-year follow-up study. Asian J Psychiatr 2024; 91:103834. [PMID: 37988930 DOI: 10.1016/j.ajp.2023.103834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Patients with schizophrenia may have diverse functional outcomes. However, the long-term functional trajectories of patients with first-episode schizophrenia (FES) are unclear. METHODS We extracted data from the Chinese First-Episode Schizophrenia Trial, a 10-year prospective study of antipsychotic-naïve patients with FES. We applied K means cluster modelling to longitudinal data on the social function of patients with FES and examined associations of the empirically derived trajectories with baseline clinical characteristics of the 10-year follow-up. OUTCOMES Three distinct functional trajectories emerged: improving-favorable (39·3%), improving-poor (17·8%) and improving-stable (42·9%). All three trajectories demonstrated Personal and Social Performance (PSP) score improvement in the first six months. The improving-poor trajectory demonstrated PSP score decline during the second six months and thereafter, while PSP scores in the other two trajectories were mainly stable during the same period. Patients in the improving-favorable trajectory had higher baseline PSP scores than those in the improving-poor trajectory (OR=0·904 [0·852, 0·961], p < 0·05) and the improving-stable trajectory (OR=0·870 [0·825, 0·918], p < 0·001) and were more likely to be female than those in the improving-stable trajectory (OR=2·699 [1·030, 7·074], p < 0·05). CONCLUSIONS Patients with FES demonstrated varied long-term functional recovery profiles. The first year, especially the second half of the first year, is a key period for social function interventions that improve long-term functional outcomes. Male patients and patients with poor baseline function may particularly benefit from such interventions.
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Affiliation(s)
- Zhang Cheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ke Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qi Miao
- Shandong Mental Health Center, Shandong University, Jinan, Shandong 250014, China
| | - Yanbo Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xue Han
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lei Yang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Zeng
- Peking University Clinical Research Institute, Beijing, China
| | - Fude Yang
- Beijing Hui-Long-Guan Hospital, Beijing, China
| | - Chuanyue Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Zheng Lu
- Tongji Hospital of Tongji University, Shanghai, China
| | - Hong Deng
- West China Hospital, Sichuan University, Chengdu, China
| | - Jingping Zhao
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Chengcheng Pu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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6
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Tiles-Sar N, Habtewold TD, Liemburg EJ, van der Meer L, Bruggeman R, Alizadeh BZ. Understanding Lifelong Factors and Prediction Models of Social Functioning After Psychosis Onset Using the Large-Scale GROUP Cohort Study. Schizophr Bull 2023; 49:1447-1459. [PMID: 37104875 PMCID: PMC10686366 DOI: 10.1093/schbul/sbad046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND HYPOTHESIS Current rates of poor social functioning (SF) in people with psychosis history reach 80% worldwide. We aimed to identify a core set of lifelong predictors and build prediction models of SF after psychosis onset. STUDY DESIGN We utilized data of 1119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) longitudinal Dutch cohort. First, we applied group-based trajectory modeling to identify premorbid adjustment trajectories. We further investigated the association between the premorbid adjustment trajectories, six-year-long cognitive deficits, positive, and negative symptoms trajectories, and SF at 3-year and 6-year follow-ups. Next, we checked associations between demographics, clinical, and environmental factors measured at the baseline and SF at follow-up. Finally, we built and internally validated 2 predictive models of SF. STUDY RESULTS We found all trajectories were significantly associated with SF (P < .01), explaining up to 16% of SF variation (R2 0.15 for 3- and 0.16 for 6-year follow-up). Demographics (sex, ethnicity, age, education), clinical parameters (genetic predisposition, illness duration, psychotic episodes, cannabis use), and environment (childhood trauma, number of moves, marriage, employment, urbanicity, unmet needs of social support) were also significantly associated with SF. After validation, final prediction models explained a variance up to 27% (95% CI: 0.23, 0.30) at 3-year and 26% (95% CI: 0.22, 0.31) at 6-year follow-up. CONCLUSIONS We found a core set of lifelong predictors of SF. Yet, the performance of our prediction models was moderate.
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Affiliation(s)
- Natalia Tiles-Sar
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edith J Liemburg
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, Universityof Groningen, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Coutts-Bain D, Sharpe L, Techakesari P, Forrester MA, Hunt C. A mixed-methods review and meta-synthesis of fears of recurrence and progression in people with mental health conditions. Clin Psychol Rev 2023; 105:102342. [PMID: 37804564 DOI: 10.1016/j.cpr.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/23/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
A fear that one's physical illness will recur or worsen has received substantial research attention over the past decade, most notably as fear of cancer recurrence. Indeed, such fear is known to be associated with poorer quality of life, adjustment, and psychopathology. However, fear of a recurrence or progression (FORP) of mental health conditions has received comparatively little study. The present review aimed to, 1) systematically review quantitative research on FORP in mental health regarding its association with age, gender, quality of life, mental health outcomes, and health behaviours, and 2) meta-synthesize qualitative research related to FORP to construct a transdiagnostic model. A qualitative meta-synthesis of 19 studies identified four subthemes underlying FORP (fear of symptoms, loss of progress, fear of death, and traumatic experiences). The three themes related to FORP were: inability to trust oneself, hypervigilance, and a low-risk low-reward lifestyle which was comprised of three subthemes (limiting relationships, limiting life goals, and fear of changing treatment). A quantitative systematic review of 15 studies found that FORP was strongly associated with worse quality of life, and greater depression, anxiety, psychotic symptoms, and medication adherence, but was not associated with age or gender. Hence, FORP can be understood transdiagnostically, and is generally associated with poorer mental health outcomes but may also predict adaptive health behaviours, such as appropriate medication adherence.
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Affiliation(s)
- Daelin Coutts-Bain
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Pirathat Techakesari
- School of Psychology, Faculty of Science, The University of Sydney, Australia; Cancer Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Australia; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Australia
| | | | - Caroline Hunt
- School of Psychology, Faculty of Science, The University of Sydney, Australia
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8
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Agarwal SM, Dissanayake J, Agid O, Bowie C, Brierley N, Chintoh A, De Luca V, Diaconescu A, Gerretsen P, Graff-Guerrero A, Hawco C, Herman Y, Hill S, Hum K, Husain MO, Kennedy JL, Kiang M, Kidd S, Kozloff N, Maslej M, Mueller DJ, Naeem F, Neufeld N, Remington G, Rotenberg M, Selby P, Siddiqui I, Szacun-Shimizu K, Tiwari AK, Thirunavukkarasu S, Wang W, Yu J, Zai CC, Zipursky R, Hahn M, Foussias G. Characterization and prediction of individual functional outcome trajectories in schizophrenia spectrum disorders (PREDICTS study): Study protocol. PLoS One 2023; 18:e0288354. [PMID: 37733693 PMCID: PMC10513234 DOI: 10.1371/journal.pone.0288354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/23/2023] [Indexed: 09/23/2023] Open
Abstract
Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous economic costs linked primarily to lost productivity and premature mortality. Efforts to delineate the contributors to disability in SSDs have highlighted prominent roles for a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. These findings have provided valuable advances in knowledge and helped define broad patterns of illness and outcomes across SSDs. Unsurprisingly, there have also been conflicting findings for many of these determinants that reflect the heterogeneous population of individuals with SSDs and the challenges of conceptualizing and treating SSDs as a unitary categorical construct. Presently it is not possible to identify the functional course on an individual level that would enable a personalized approach to treatment to alter the individual's functional trajectory and mitigate the ensuing disability they would otherwise experience. To address this ongoing challenge, this study aims to conduct a longitudinal multimodal investigation of a large cohort of individuals with SSDs in order to establish discrete trajectories of personal recovery, disability, and community functioning, as well as the antecedents and predictors of these trajectories. This investigation will also provide the foundation for the co-design and testing of personalized interventions that alter these functional trajectories and improve outcomes for people with SSDs.
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Affiliation(s)
- Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Joel Dissanayake
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Christopher Bowie
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Noah Brierley
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Araba Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Vincenzo De Luca
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Andreea Diaconescu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Philip Gerretsen
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ariel Graff-Guerrero
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Colin Hawco
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Yarissa Herman
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Hill
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kathryn Hum
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Muhammad Omair Husain
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - James L. Kennedy
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Michael Kiang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Sean Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicole Kozloff
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Marta Maslej
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Daniel J. Mueller
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Farooq Naeem
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Nicholas Neufeld
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Martin Rotenberg
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Peter Selby
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Ishraq Siddiqui
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Kate Szacun-Shimizu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Arun K. Tiwari
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Wei Wang
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Joanna Yu
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Clement C. Zai
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Robert Zipursky
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Temerty Faculty Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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9
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Prakash J, Saini R, Srivastava K, Chatterjee K, Basannar D, Mohan P. Longitudinal study of the course and outcome of first-episode psychosis. Med J Armed Forces India 2023; 79:539-546. [PMID: 37719902 PMCID: PMC10499655 DOI: 10.1016/j.mjafi.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background Study of first episode psychosis (FEP), an episode of psychotic nature, which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been a matter of research interest in recent years, as this may give more insight to the overall phenomenology and course of psychotic illnesses. Methods A study was undertaken to evaluate course and outcome of first episode psychosis. A total of 100 consecutive inpatients were selected for the study. Informed consent was obtained. Structured Proforma was used for recording psychosocial profiles and relevant medical history. Brief Psychiatric Rating Scale (BPRS) was given to assess the severity of psychopathology; Positive and Negative Symptom Scale (PANSS) to assess the severity of psychosis; Becks Suicidal Ideation Scale (BSI) to assess the extent of suicidality and Global Assessment of Functioning (GAF) to assess global functioning of the individual. The assessment was done at baseline, at six months, and at one year. Results First episode psychosis constituted around a tenth of the caseload. It commonly affected people in the third decade of life. There was an improvement in 92% of the cases over a year of study. Schizophrenia constituted the majority of first episode psychosis. The history of smoking was relatively higher in acute and transient psychotic disorders. Age inversely correlated with the severity of psychopathology. There was no difference in improvement in psychopathology over time in patients of schizophrenia and related disorder vis--vis other psychotic disorders. Conclusion Our study did not find any significantly varied sociodemographic factors in the course and outcome of the illness. It also refuted the schism between various types of psychosis based on the current classificatory system. It draws our attention toward the unitary concept of psychosis and is a call to re-think our strategies in the management of psychosis.
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Affiliation(s)
- Jyoti Prakash
- Professor, Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - R.K. Saini
- Professor (Psychiatry), Command Hospital (Eastern Command), Kolkata, India
| | - Kalpana Srivastava
- Scientist ‘G’ Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - Kaushik. Chatterjee
- Professor & Head, Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - D.R. Basannar
- Scientist ‘F’, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Prafull. Mohan
- Professor, Department of Pharmacology, Armed Forces Medical College, Pune, India
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10
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Kam CTK, Fung VSC, Chang WC, Hui CLM, Chan SKW, Lee EHM, Lui SSY, Chen EYH. Cognitive subgroups and the relationships with symptoms, psychosocial functioning and quality of life in first-episode non-affective psychosis: a cluster-analysis approach. Front Psychiatry 2023; 14:1203655. [PMID: 37575584 PMCID: PMC10412814 DOI: 10.3389/fpsyt.2023.1203655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Prior research examining cognitive heterogeneity in psychotic disorders primarily focused on chronic schizophrenia, with limited data on first-episode psychosis (FEP). We aimed to identify distinct cognitive subgroups in adult FEP patients using data-driven cluster-analytic approach, and examine relationships between cognitive subgroups and a comprehensive array of illness-related variables. Methods Two-hundred-eighty-nine Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing premorbid adjustment, illness-onset profile, symptom severity, psychosocial functioning, subjective quality-of-life, and a battery of cognitive tests were conducted. Hierarchical cluster-analysis was employed, optimized with k-means clustering and internally-validated by discriminant-functional analysis. Cognitive subgroup comparisons in illness-related variables, followed by multivariable multinominal-regression analyzes were performed to identify factors independently predictive of cluster membership. Results Three clusters were identified including patients with globally-impaired (n = 101, 34.9%), intermediately-impaired (n = 112, 38.8%) and relatively-intact (n = 76, 26.3%) cognition (GIC, IIC and RIC subgroups) compared to demographically-matched healthy-controls' performance (n = 50). GIC-subgroup was older, had lower educational attainment, greater positive, negative and disorganization symptom severity, poorer insight and quality-of-life than IIC- and RIC-subgroups, and higher antipsychotic-dose than RIC-subgroup. IIC-subgroup had lower education levels and more severe negative symptoms than RIC-subgroup, which had better psychosocial functioning than two cognitively-impaired subgroups. Educational attainment and disorganization symptoms were found to independently predict cluster membership. Discussion Our results affirmed cognitive heterogeneity in FEP and identified three subgroups, which were differentially associated with demographic and illness-related variables. Further research should clarify longitudinal relationships of cognitive subgroups with clinical and functional outcomes in FEP.
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Affiliation(s)
- Candice Tze Kwan Kam
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian Shi Cheng Fung
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Simon Sai Yu Lui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
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11
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Habtewold TD, Hao J, Liemburg EJ, Baştürk N, Bruggeman R, Alizadeh BZ. Deep Clinical Phenotyping of Schizophrenia Spectrum Disorders Using Data-Driven Methods: Marching towards Precision Psychiatry. J Pers Med 2023; 13:954. [PMID: 37373943 DOI: 10.3390/jpm13060954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Heterogeneity is the main challenge in the traditional classification of mental disorders, including schizophrenia spectrum disorders (SSD). This can be partly attributed to the absence of objective diagnostic criteria and the multidimensional nature of symptoms and their associated factors. This article provides an overview of findings from the Genetic Risk and Outcome of Psychosis (GROUP) cohort study on the deep clinical phenotyping of schizophrenia spectrum disorders targeting positive and negative symptoms, cognitive impairments and psychosocial functioning. Three to four latent subtypes of positive and negative symptoms were identified in patients, siblings and controls, whereas four to six latent cognitive subtypes were identified. Five latent subtypes of psychosocial function-multidimensional social inclusion and premorbid adjustment-were also identified in patients. We discovered that the identified subtypes had mixed profiles and exhibited stable, deteriorating, relapsing and ameliorating longitudinal courses over time. Baseline positive and negative symptoms, premorbid adjustment, psychotic-like experiences, health-related quality of life and PRSSCZ were found to be the strong predictors of the identified subtypes. Our findings are comprehensive, novel and of clinical interest for precisely identifying high-risk population groups, patients with good or poor disease prognosis and the selection of optimal intervention, ultimately fostering precision psychiatry by tackling diagnostic and treatment selection challenges pertaining to heterogeneity.
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Affiliation(s)
- Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Jiasi Hao
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Edith J Liemburg
- Department of Psychiatry, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Nalan Baştürk
- Department of Quantitative Economics, School of Business and Economics, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, University of Groningen, 9700 RB Groningen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioural and Social Sciences, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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12
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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
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13
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The relationship between negative symptoms, social cognition, and social functioning in patients with first episode psychosis. J Psychiatr Res 2022; 155:171-179. [PMID: 36041260 DOI: 10.1016/j.jpsychires.2022.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/18/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Social functioning is severely affected in psychotic disorders. Negative symptoms and social cognition seem to play an important role in social functioning, although the preponderance and relationship between these three domains is not clear. In this study, we sought to assess the interrelation between social cognition, social functioning, and the expressiveness and experiential factors of negative symptoms in first-episode psychosis (FEP). SAMPLE AND METHODS 216 patients, participants in a multicentre study (AGES-CM), comprised our study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas the Positive and Negative Schizophrenia Syndrome Scale (PANSS) was used to measure the severity of negative symptoms, and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) was applied to assess the emotional processing component of social cognition. Network analyses were conducted with the aim of analysing the patterns of relationships between social cognition, social functioning, and the expressiveness and experiential factors of negative symptoms. RESULTS Our findings suggest that there is a direct relationship between social cognition and social functioning (weight = -.077), but also an indirect connection between them, mediated by the experiential (but not the expressiveness) factor of negative symptoms (weight = 0.300). DISCUSSION The importance of the affectation of subdomains of social cognition, as well as the role of negative symptoms, specifically the experiential factor, in the functioning of patients with FEP seems to be relevant. The inclusion of these factors in prevention and treatment programs would thus allow us to reduce their impact on the social functioning of these patients.
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14
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Engen MJ, Vaskinn A, Melle I, Færden A, Lyngstad SH, Flaaten CB, Widing LH, Wold KF, Åsbø G, Haatveit B, Simonsen C, Ueland T. Cognitive and Global Functioning in Patients With First-Episode Psychosis Stratified by Level of Negative Symptoms. A 10-Year Follow-Up Study. Front Psychiatry 2022; 13:841057. [PMID: 35401286 PMCID: PMC8990888 DOI: 10.3389/fpsyt.2022.841057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Negative and cognitive symptoms are core features of schizophrenia that are correlated in cross-sectional designs. To further explore the relationship between these critical symptom dimensions we use a method for stratifying participants based on level and persistence of negative symptoms from absent to sustained levels over a 10-year follow-up period. We investigate associations with cognitive performance and level of global functioning. First-episode psychosis (FEP) participants (n = 102) and healthy controls (n = 116) were assessed at baseline and follow-up. A cognitive battery consisting of 14 tests derived into four domains and a composite score were used in the analyses. FEP participants were stratified based on negative symptom items from the Positive and Negative Syndrome Scale (PANSS-R) into four groups with either no, mild, transitory or sustained symptoms over the 10-year follow-up period. Global functioning was measured with Global Assessment of Functioning Scale-Split version. Multivariate and univariate analyses of variance were used to explore between-group differences in level and course of cognitive performance as global functioning. A multivariate analysis with four cognitive domains as dependent variables, showed significant group differences in performance when including healthy controls and the negative symptom groups. The groups with no and mild negative symptoms outperformed the group with sustained levels of negative symptoms on verbal learning and memory. The group with no negative symptoms also outperformed the group with sustained negative symptoms on the cognitive composite score. Significant improvements on verbal learning and memory, executive functioning and the cognitive composite were detected for the entire sample. No differences in cognitive course were detected. There was a significant improvement in global functioning as measured by the GAF-F over the follow-up period (p < 0.001), without any time x group interactions (p = 0.25). Participants with sustained negative symptoms had a significantly lower level of global functioning at 10-year follow-up with an additional independent effect of the cognitive composite score, compared to all other groups. Individuals with an early illness course characterized by absence of negative symptoms form a group with better cognitive and functional outcomes than the impairments typically associated with schizophrenia. Individuals with sustained levels of negative symptoms on the other hand may require a combined focus on both negative and cognitive symptoms.
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Affiliation(s)
- Magnus Johan Engen
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Ann Færden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Siv Hege Lyngstad
- Division of Mental Health and Addiction, Nydalen DPS, Oslo University Hospital, Oslo, Norway
| | - Camilla Bärthel Flaaten
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Line Hustad Widing
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Kristin Fjelnseth Wold
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gina Åsbø
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Beathe Haatveit
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
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15
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Mustafa SS, Malla A, Joober R, Abadi S, Latimer E, Schmitz N, Jarvis GE, Margolese HC, Casacalenda N, Abdel-Baki A, Iyer SN. Unfinished business: Functional outcomes in a randomized controlled trial of a three-year extension of early intervention versus regular care following two years of early intervention for psychosis. Acta Psychiatr Scand 2022; 145:86-99. [PMID: 34599603 DOI: 10.1111/acps.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/25/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether first-episode psychosis patients receiving extended early intervention had better functional outcomes than those in regular care and to examine the predictors of functional outcomes. METHODS This is a randomized controlled single-blind trial of 220 patients randomized after 2 years of early intervention to receive early intervention or regular care for the subsequent 3 years. Outcomes included cumulative time in functional recovery during the 3-year trial assessed using the Social and Occupational Functioning Assessment Scale (SOFAS); and employment/education at last assessment which were, respectively, analyzed using multiple linear regression and logistic regression, accounting for well-known predictors. Linear mixed and generalized linear models were also used to examine the course of SOFAS and employment/education over the 3-year period. RESULTS The extended early intervention and regular care groups did not differ on time in functional recovery (mean = 50.17 weeks, SD = 46.62 vs. mean = 46.18 weeks, SD = 51.54); percent employed/in school (60.4% vs. 68.8%) or change in SOFAS or employment/education status over time. SOFAS scores were stable between years 2 and 5. Individuals with longer periods of total symptom remission experienced significantly longer periods of functional recovery and were likelier to be employed/in school. Those who had completed high school were nine times likelier to be employed/studying. CONCLUSION Most individuals maintained functional gains accrued from 2 years of early intervention with no further improvement whether in extended early intervention or regular care. There was a gap between symptomatic and functional recovery, and one-third were unemployed/not in school at year 5. The lack of additional progress even in extended early intervention suggests that specific interventions addressing functional roles need to be provided beyond the first 2 years of early intervention. Sustaining symptom remission and high-school completion may be additional avenues for targeting functional recovery.
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Affiliation(s)
- Sally S Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sherezad Abadi
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Eric Latimer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - G Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Jewish General Hospital, Montreal, QC, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Casacalenda
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Jewish General Hospital, Montreal, QC, Canada
| | | | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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16
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Golay P, Ramain J, Jenni R, Klauser P, Mebdouhi N, Conus P, Solida A. Six months functional response to early psychosis intervention program best predicts outcome after three years. Schizophr Res 2021; 238:62-69. [PMID: 34607255 DOI: 10.1016/j.schres.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Philippe Golay
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland; Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Julie Ramain
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Raoul Jenni
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland
| | - Paul Klauser
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland; Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Switzerland
| | - Nadir Mebdouhi
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Alessandra Solida
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
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Prakash J, Chatterjee K, Srivastava K, Chauhan VS. First-episode psychosis: How long does it last? A review of evolution and trajectory. Ind Psychiatry J 2021; 30:198-206. [PMID: 35017801 PMCID: PMC8709526 DOI: 10.4103/ipj.ipj_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
Study of first-episode psychosis (FEP), an episode of psychotic nature which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been study matter of research interest in recent years. A comprehensive review of the literature will help us understand the evolution and trajectory of this concept better. A literature review of available articles addressing the concept, phenomenology, evolution, identification, course, and outcome of FEP was done; the same was subsequently divided into broad topics for better clarity and analyzed. FEP constituted a clinical psychotic phenomenon with underlying significant heterogeneity in diagnosis, stability, course, and outcome. The study has attempted to view FEP both as horizontal spectrum across various diagnoses and longitudinally ranging from asymptomatic individual with unknown risk status to attenuated psychosis to multiple relapses/unremitting illness. Many risk and protective factors have been brought out with varying certainty ranging bio-psycho-social spectrum. Efforts have been made to calculate polygenic risk score based on genes involvement/sharing between various psychotic spectrum disorders; as well as biomarker panels to identify people at risk. FEP may prove to be an important concept to understand psychosis in general; without putting things into the diagnostic rubric. It may help understand multiple risk and protective factors for the course and outcome of psychotic illness and may clear the cloud to sharpen the evidence toward commonality and distinctiveness between various psychotic diagnoses in vogue for more comprehensive concept.
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Affiliation(s)
- Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - K. Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - K. Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - V. S. Chauhan
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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18
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Altered risky decision making in patients with early non-affective psychosis. Eur Arch Psychiatry Clin Neurosci 2021; 271:723-731. [PMID: 30806772 DOI: 10.1007/s00406-019-00994-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
Abnormal risky decision making may represent an important factor contributing to functional impairment in psychotic disorders. Previous research revealed impaired decision making under risk in patients with chronic schizophrenia. However, risky decision making is under-studied in the early course of illness. We examined risky decision making in 33 patients with early non-affective psychosis and 32 demographically matched controls, using two well-validated experimental paradigms, balloon analogue risk task (BART) and Risky-Gains task (RGT), which modeled and assessed actual risk-taking behaviors in deliberative and time-pressured decision-making situations, respectively. Our results showed that patients exhibited suboptimal decision making on the BART and were more risk averse than controls by having fewer average balloon pumps in non-burst trials, lower explosion rate and lower total points gained. On the RGT, patients also behaved more conservatively than controls, with lower overall rate in choosing the risky option. Intriguingly, patients performed comparably to controls in adjusting risk-taking pattern following punished trials, suggesting relatively preserved sensitivity to punishment in early psychosis. Risk-taking measures showed no significant correlations with any symptom dimensions, impulsivity traits, cognitive functions or antipsychotic treatment after correcting for multiple comparisons. This study is the first to investigate risk-taking propensity in early psychosis based on BART/RGT performance, and consistently indicate that patients with early psychosis displayed altered risky decision making with increased risk aversion relative to healthy participants. Further investigation is warranted to clarify the longitudinal course of aberrant risky decision making and its relationship with functional outcome in early psychosis.
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Nuño L, Guilera G, Bell M, Rojo E, Gómez-Benito J, Calderón C, Barrios M. Occupational Therapists’ Perspective on the International Classification of Functioning, Disability and Health Core Sets (ICF–CS) for Schizophrenia. Am J Occup Ther 2021; 75:7502205060p1-7502205060p10. [PMID: 33657348 DOI: 10.5014/ajot.2021.041509] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: The International Classification of Functioning, Disability and Health (ICF) Core Sets (CSs) for schizophrenia are sets of ICF categories that are relevant specifically to the functioning and disability of people with schizophrenia.
Objective: To identify the problems occupational therapists commonly encounter when treating people with schizophrenia and to validate the ICF–CSs for schizophrenia from their perspective.
Design: Three-round Delphi study using online surveys distributed to occupational therapists worldwide. Participants were asked which problems with functioning they considered most relevant when treating people with schizophrenia.
Participants: Occupational therapists experienced in the treatment of people with schizophrenia.
Measures: Responses were linked to the ICF categories by two trained health professionals, and a statistical measure of agreement and κ coefficient were calculated.
Results: Ninety-two occupational therapists from 29 countries in all six World Health Organization regions named 2,527 meaningful concepts. After the linking process, 121 ICF categories and 31 Personal Factors were presented to the expert panel, who reached consensus (agreement of ≥75%) on 97 ICF categories and 27 Personal Factors. Consensus was reached on the 25 categories in the Brief ICF–CS for schizophrenia and 89 of the 97 categories in the Comprehensive ICF–CS for schizophrenia.
Conclusions and Relevance: The ICF Core Sets for schizophrenia were validated from the perspective of occupational therapists and are potentially useful tools for clinical practice because they cover a wide variety of problems that occupational therapists deal with in interventions with people with schizophrenia.
What This Article Adds: The ICF–CSs for schizophrenia are useful guides for describing and classifying functioning, disability, and health to aid occupational therapy intervention with people with schizophrenia. Occupational therapists are essential in the rehabilitation of this client population, and their perspective has contributed to the development and enrichment of the ICF–CSs for schizophrenia.
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Affiliation(s)
- Laura Nuño
- Laura Nuño, PhD, is Clinical Psychologist, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain;
| | - Georgina Guilera
- Georgina Guilera, PhD, is Professor, Institute of Neurosciences and Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | - Morris Bell
- Morris Bell, PhD, is Professor, Connecticut Mental Health Center, Yale School of Medicine, New Haven, CT
| | - Emilio Rojo
- Emilio Rojo, MD, is Medical Director, Hospital Benito Menni Complex Assistencial en Salut Mental, Sisters Hospitallers, Sant Boi de Llobregat, Spain, and Professor, Department of Psychiatry, International University of Catalonia, Barcelona, Spain
| | - Juana Gómez-Benito
- Juana Gómez-Benito, PhD, is Professor, Institute of Neurosciences and Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | - Caterina Calderón
- Caterina Calderón, PhD, is Associate Professor, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Maite Barrios
- Maite Barrios, PhD, is Associate Professor, Institute of Neurosciences and Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
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20
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Salagre E, Grande I, Solé B, Mezquida G, Cuesta MJ, Díaz-Caneja CM, Amoretti S, Lobo A, González-Pinto A, Moreno C, Pina-Camacho L, Corripio I, Baeza I, Bergé D, Verdolini N, Carvalho AF, Vieta E, Bernardo M. Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis. J Clin Med 2020; 10:E73. [PMID: 33379225 PMCID: PMC7796026 DOI: 10.3390/jcm10010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Abstract
Being able to predict functional outcomes after First-Episode Psychosis (FEP) is a major goal in psychiatry. Thus, we aimed to identify trajectories of psychosocial functioning in a FEP cohort followed-up for 2 years in order to find premorbid/baseline predictors for each trajectory. Additionally, we explored diagnosis distribution within the different trajectories. A total of 261 adults with FEP were included. Latent class growth analysis identified four distinct trajectories: Mild impairment-Improving trajectory (Mi-I) (38.31% of the sample), Moderate impairment-Stable trajectory (Mo-S) (18.39%), Severe impairment-Improving trajectory (Se-I) (12.26%), and Severe impairment-Stable trajectory (Se-S) (31.03%). Participants in the Mi-I trajectory were more likely to have higher parental socioeconomic status, less severe baseline depressive and negative symptoms, and better premorbid adjustment than individuals in the Se-S trajectory. Participants in the Se-I trajectory were more likely to have better baseline verbal learning and memory and better premorbid adjustment than those in the Se-S trajectory. Lower baseline positive symptoms predicted a Mo-S trajectory vs. Se-S trajectory. Diagnoses of Bipolar disorder and Other psychoses were more prevalent among individuals falling into Mi-I trajectory. Our findings suggest four distinct trajectories of psychosocial functioning after FEP. We also identified social, clinical, and cognitive factors associated with more resilient trajectories, thus providing insights for early interventions targeting psychosocial functioning.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Manuel J. Cuesta
- Department of Psychiatry, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Covadonga M. Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, 01009 Vitoria, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain
| | - Immaculada Baeza
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Child and Adolescent Psychiatry and Psychology Department, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic of Barcelona, SGR-881, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Daniel Bergé
- Hospital del Mar Medical Research Institute, CIBERSAM, Autonomous University of Barcelona, 08003 Barcelona, Spain;
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - André F. Carvalho
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON M6J 1H4, Canada;
- The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
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Chang WC, Westbrook A, Strauss GP, Chu AOK, Chong CSY, Siu CMW, Chan SKW, Lee EHM, Hui CLM, Suen YM, Lo TL, Chen EYH. Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis. Psychol Med 2020; 50:2599-2609. [PMID: 31576787 DOI: 10.1017/s0033291719002769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP). METHOD Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants' willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored. RESULTS Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits. CONCLUSION This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - A Westbrook
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen 6525 EN, The Netherlands
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, RI02906, USA
| | - G P Strauss
- Department of Psychology, University of Georgia, Athens, GA30602, USA
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - C S Y Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - C M W Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Y M Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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22
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Chang WC, Wong CSM, Or PCF, Chu AOK, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychol Med 2020; 50:2019-2027. [PMID: 31451127 DOI: 10.1017/s0033291719002113] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP. METHOD This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses. RESULTS Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength. CONCLUSION Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - P C F Or
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - E M H Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y N Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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23
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van der Ven E, Scodes J, Basaraba C, Pauselli L, Mascayano F, Nossel I, Bello I, Humensky J, Susser E, Wall M, Dixon L. Trajectories of occupational and social functioning in people with recent-onset non-affective psychosis enrolled in specialized early intervention services across New York state. Schizophr Res 2020; 222:218-226. [PMID: 32513547 PMCID: PMC8273912 DOI: 10.1016/j.schres.2020.05.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/03/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the benefits of early intervention services for the initial stages of psychosis ongoing impairments in functioning are common. AIMS To identify 1-year trajectories of occupational and social functioning in individuals enrolled in OnTrackNY, a statewide program offering early intervention services for recent-onset psychosis in community settings. METHOD We included 937 persons with recent-onset psychosis enrolled at 19 programs across New York State. Demographic, social and clinical data was collected at program entry and at 3, 6, 9 and 12 months. We used growth mixture models to identify occupational and social functioning trajectories and examined the association between trajectory class, baseline factors and symptoms during 1-year follow-up. RESULTS Four distinct trajectory classes of occupational and social functioning were identified. The converging (58.0%) class had disparate levels of functioning at baseline (low occupational, higher social) which eventually converged. The other classes had high-stable (14.8%), moderate-stable (17.8%) and low-improving (9.4%) trajectories. Female gender, educational attainment and private insurance status were significantly associated with the trajectory characterized by higher functioning, while living alone, homelessness, a longer period from psychosis onset to program enrollment, a schizophrenia diagnosis and cannabis use at enrollment were associated with the poorest trajectory. The differences in severity of symptoms by trajectory class diminished over time. CONCLUSIONS Trajectories of occupational and social functioning showed substantial variation, but overall, remained stable or improved during 1-year follow-up. The relationship between symptoms and occupational and social functioning attenuated after the acute treatment phase.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York, NY, USA; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands.
| | - Jennifer Scodes
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Cale Basaraba
- Mental Health Data Science, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Luca Pauselli
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Franco Mascayano
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Ilana Nossel
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research, Columbia University, New York, NY, USA
| | | | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Melanie Wall
- Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, USA,Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University, New York, NY, USA
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24
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McGinty J, Upthegrove R. Depressive symptoms during first episode psychosis and functional outcome: A systematic review and meta-analysis. Schizophr Res 2020; 218:14-27. [PMID: 31964558 DOI: 10.1016/j.schres.2019.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES First episode psychosis (FEP) is associated with functional decline. Existing evidence was synthesised to explore the influence of depressive symptoms during FEP on future social, occupational and global functioning. METHODS Medline, Embase, PsychINFO, Cochrane Library, Open Grey, NICE Evidence and Web of Science were searched from inception to May 2018. Longitudinal studies of FEP patients were included. Study quality was assessed using the Downs and Black instrument. Two meta-analyses were performed using random effect models. The first meta-analysis correlates depressive symptoms during FEP with follow-up Global Assessment of Functioning (GAF) scores. The second meta-analysis shows the odds of long-term functional remission if depressive symptoms are present during FEP. RESULTS 4751 unique abstracts were found. 36 articles were included. The first meta-analysis included 7 studies (932 participants) and showed depressive symptoms during FEP were negatively correlated with follow-up GAF scores (r = -0.16, 95% CI: -0.24 to -0.09, p < 0.001). The second meta-analysis of 9 studies (2265 participants) showed weak evidence of an association between the presence of depressive symptoms in FEP and reduction in functional remission (OR = 0.87, 95% CI: 0.68 to 1.13, p = 0.294). CONCLUSION Depressive symptoms during FEP are associated with poorer long-term global functioning and may be associated with a reduced chance of achieving functional remission. Clinical trials are needed to identify efficacious management of depressive symptoms in early psychosis.
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Affiliation(s)
- Jessica McGinty
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Rachel Upthegrove
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; University of Birmingham, Institute for Mental Health, Birmingham, United Kingdom; Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Birmingham, United Kingdom.
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Hartmann JA, Schmidt SJ, McGorry PD, Berger M, Berger GE, Chen EY, de Haan L, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma SK, Yuen HP, Yung AR, Amminger GP, Nelson B. Trajectories of symptom severity and functioning over a three-year period in a psychosis high-risk sample: A secondary analysis of the Neurapro trial. Behav Res Ther 2020; 124:103527. [DOI: 10.1016/j.brat.2019.103527] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/31/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
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Further Exploration of Personal and Social Functioning: The Role of Interpersonal Violence, Service Engagement, and Social Network. J Nerv Ment Dis 2019; 207:832-837. [PMID: 31365432 DOI: 10.1097/nmd.0000000000001036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Social functioning (SF) has mainly been studied in major psychoses in relation to symptom severity, but other factors may interfere with the achievement of a functional remission. The aim of this study is to explore interpersonal violence (IV), service engagement (SE), and social network (SN), together with demographics, as predictors of SF in a sample of subjects with severe mental illness (SMI). Consecutive adult inpatients were evaluated using self-report and clinician-rated questionnaires. Findings suggest that IV, SE, SN, male sex, and illness duration explained 39.1% of SF variance in people affected by SMI. IV was the strongest predictor, followed by sex and duration of illness. Lifetime expression of violence is a stronger predictor than lifetime exposure to violence. Positive SE and SN were found to predict SF, whereas age was not associated. This study underlines the need of other non-symptom-related variables for the comprehension of SF in mental disorders.
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Hall MH, Holton KM, Öngür D, Montrose D, Keshavan MS. Longitudinal trajectory of early functional recovery in patients with first episode psychosis. Schizophr Res 2019; 209:234-244. [PMID: 30826261 PMCID: PMC7003957 DOI: 10.1016/j.schres.2019.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. METHODS A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). RESULTS In each of the three predictor models, four distinct functional outcome trajectories emerged: "Poor", "Intermediate", High" and "Catch-up". Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. CONCLUSIONS Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.
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Affiliation(s)
- Mei-Hua Hall
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA, USA.
| | | | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA
| | - Debra Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA
| | - Matcheri S. Keshavan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA,,Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, HMS, Boston, MA
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Chang WC, Chu AOK, Treadway MT, Strauss GP, Chan SKW, Lee EHM, Hui CLM, Suen YN, Chen EYH. Effort-based decision-making impairment in patients with clinically-stabilized first-episode psychosis and its relationship with amotivation and psychosocial functioning. Eur Neuropsychopharmacol 2019; 29:629-642. [PMID: 30879927 DOI: 10.1016/j.euroneuro.2019.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/06/2018] [Accepted: 03/02/2019] [Indexed: 12/14/2022]
Abstract
Effort-based decision-making has recently been proposed as a potential mechanism contributing to motivational deficits (amotivation) in psychotic disorder. Previous research has identified altered effort allocation in chronic schizophrenia, but produced mixed results regarding its relationship with amotivation. No study has investigated effort allocation in first-episode psychosis (FEP). We examined effort-based decision-making in 45 clinically-stabilized FEP patients and 45 demographically-matched controls, using Effort-Expenditure for Reward Task (EEfRT) which measures allocation of physical effort for monetary reward at varying magnitude and probability levels. Our results showed that FEP patients did not demonstrate overall reduction in effort expenditure but displayed reduced willingness to expend effort for high-value/high-probability reward as compared to controls. In particular, such selective effort-related impairment was most pronounced in patients with high levels of amotivation. Furthermore, reduced allocation of greater effort for higher probability reward was related to poorer psychosocial functioning. Decreased effort exertion was generally unrelated to other symptom dimensions, self-report anhedonia, antipsychotic dose and cognitive deficits. This study thus provides the first evidence of effort-based decision-making impairment in FEP, and indicates that first-episode patients were not generally effort-averse but exhibited inefficient effort allocation by failing to make high-effort choices to maximize reward receipt. Our findings affirm the critical role of amotivation on aberrant effort allocation, and support the link between laboratory-based effort-cost measures and real-world psychosocial functioning in medicated FEP. Further longitudinal research is required to clarify trajectory of suboptimal effort allocation and its potential utility in predicting amotivation and functional outcomes in the early course of illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong.
| | - Angel On Ki Chu
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong
| | - Michael T Treadway
- Department of Psychology, University of Emory, Atlanta, GA 30322, United States
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA 30602, United States
| | - Sherry Kit Wa Chan
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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Tundo A, De Crescenzo F, Gori D, Cavalieri P. Long-term treatment response to continuous cycling course in bipolar disorders: A meta-analysis. J Affect Disord 2018; 241:367-370. [PMID: 30144720 DOI: 10.1016/j.jad.2018.08.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/19/2018] [Accepted: 08/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE About 30% of patients with bipolar disorders (BD) exhibit a continuous cycling course (CCC). These patients significantly differ from those with non-continuous cycling course (NCCC) on clinical presentation and have a poorer short-term response to antidepressant treatment. Our aim is to conduct a meta-analysis of the studies comparing long-term treatment response in CCC and NCCC bipolar patients. METHOD We conducted a systematic review of studies on patients with a diagnosis of bipolar disorder with CCC. Our primary outcome measure was the response to treatment at the last follow-up visit. The data analysis was based on the success rate difference as the effect size measure. To account for heterogeneity of primary studies, aggregation of results was based on a random-effects model. RESULTS We included six observational studies comprising a total of 671 patients (CCC 29.4%, NCCC 70.6%). Overall, the response rate was 34.0% in the CCC and 49.3% in the NCCC arm. The meta-analysis shows a significant association between cycle pattern and response (success rate difference: -0.17; 95% CI: -0.25, -0.09; p < 0.0001), with low heterogeneity (χ2 (5 )= 5.16; I2 = 3%). CONCLUSION In bipolar disorders, patients with CCC have a poorer response to prophylactic treatment compared with patients with NCCC.
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Affiliation(s)
- Antonio Tundo
- Istituto di Psicopatologia, via Girolamo da Carpi, 1, Rome, Italy.
| | - Franco De Crescenzo
- Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario "A.Gemelli", Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome 00168, Italy
| | - Davide Gori
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, Università di Bologna, Italy
| | - Paola Cavalieri
- Istituto di Psicopatologia, via Girolamo da Carpi, 1, Rome, Italy
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