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Alver M, Kasela S, Haring L, Luitva LB, Fischer K, Möls M, Milani L. Genetic predisposition and antipsychotic treatment effect on metabolic syndrome in schizophrenia: a ten-year follow-up study using the Estonian Biobank. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100914. [PMID: 38707868 PMCID: PMC11066665 DOI: 10.1016/j.lanepe.2024.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/07/2024]
Abstract
Background Schizophrenia (SCZ) patients exhibit 30% higher prevalence of metabolic syndrome (MetS) compared to the general population with its suboptimal management contributing to increased mortality. Large-scale studies providing real-world evidence of the underlying causes remain limited. Methods To address this gap, we used real-world health data from the Estonian Biobank, spanning a median follow-up of ten years, to investigate the impact of genetic predisposition and antipsychotic treatment on the development of MetS in SCZ patients. Specifically, we set out to characterize antipsychotic treatment patterns, genetic predisposition of MetS traits, MetS prognosis, and body mass index (BMI) trajectories, comparing SCZ cases (n = 677) to age- and sex-matched controls (n = 2708). Findings SCZ cases exhibited higher genetic predisposition to SCZ (OR = 1.75, 95% CI 1.58-1.94), but lower polygenic burden for increased BMI (OR = 0.88, 95% CI 0.88-0.96) and C-reactive protein (OR = 0.88, 95% CI 0.81-0.97) compared to controls. While SCZ cases showed worse prognosis of MetS (HR 1.95, 95% CI 1.54-2.46), higher antipsychotic adherence within the first treatment year was associated with reduced long-term MetS incidence. Linear mixed modelling, incorporating multiple BMI timepoints, underscored the significant contribution of both, antipsychotic medication, and genetic predisposition to higher BMI, driving the substantially upward trajectory of BMI in SCZ cases. Interpretation These findings contribute to refining clinical risk prediction and prevention strategies for MetS among SCZ patients and emphasize the significance of incorporating genetic information, long-term patient tracking, and employing diverse perspectives when analyzing real-world health data. Funding EU Horizon 2020, Swedish Research Council, Estonian Research Council, Estonian Ministry of Education and Research, University of Tartu.
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Affiliation(s)
- Maris Alver
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
| | - Silva Kasela
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
| | - Liina Haring
- Department of Psychiatry, Institute of Clinical Medicine, University of Tartu, Raja 31, Tartu, 50417, Estonia
- Psychiatry Clinic of Tartu University Hospital, Raja 31, Tartu, 50417, Estonia
| | - Laura Birgit Luitva
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
| | | | | | - Krista Fischer
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
- Institute of Mathematics and Statistics, University of Tartu, Narva mnt 18, Tartu, 51009, Estonia
| | - Märt Möls
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
- Institute of Mathematics and Statistics, University of Tartu, Narva mnt 18, Tartu, 51009, Estonia
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Riia 23b, Tartu, 51010, Estonia
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Costas-Carrera A, Verdolini N, Garcia-Rizo C, Mezquida G, Janssen J, Valli I, Corripio I, Sanchez-Torres AM, Bioque M, Lobo A, Gonzalez-Pinto A, Rapado-Castro M, Vieta E, De la Serna H, Mane A, Roldan A, Crossley N, Penades R, Cuesta MJ, Parellada M, Bernardo M. Difficulties during delivery, brain ventricle enlargement and cognitive impairment in first episode psychosis. Psychol Med 2024; 54:1339-1349. [PMID: 38014924 DOI: 10.1017/s0033291723003185] [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: 11/29/2023]
Abstract
BACKGROUND Patients with a first episode of psychosis (FEP) display clinical, cognitive, and structural brain abnormalities at illness onset. Ventricular enlargement has been identified in schizophrenia since the initial development of neuroimaging techniques. Obstetric abnormalities have been associated with an increased risk of developing psychosis but also with cognitive impairment and brain structure abnormalities. Difficulties during delivery are associated with a higher risk of birth asphyxia leading to brain structural abnormalities, such as ventriculomegaly, which has been related to cognitive disturbances. METHODS We examined differences in ventricular size between 142 FEP patients and 123 healthy control participants using magnetic resonance imaging. Obstetric complications were evaluated using the Lewis-Murray scale. We examined the impact of obstetric difficulties during delivery on ventricle size as well as the possible relationship between ventricle size and cognitive impairment in both groups. RESULTS FEP patients displayed significantly larger third ventricle size compared with healthy controls. Third ventricle enlargement was associated with diagnosis (higher volume in patients), with difficulties during delivery (higher volume in subjects with difficulties), and was highest in patients with difficulties during delivery. Verbal memory was significantly associated with third ventricle to brain ratio. CONCLUSIONS Our results suggest that difficulties during delivery might be significant contributors to the ventricular enlargement historically described in schizophrenia. Thus, obstetric complications may contribute to the development of psychosis through changes in brain architecture.
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Affiliation(s)
| | - Norma Verdolini
- Department of Mental Health, Umbria 1 Mental Health Center, Perugia, Italy
| | - Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Basic Clinical Practice, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Joost Janssen
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Isabel Valli
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Iluminada Corripio
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana M Sanchez-Torres
- Department of Psychiatry, Navarra University Hospital, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, BIOARABA, Spain
| | - Marta Rapado-Castro
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia
| | - Eduard Vieta
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neurosciences, Barcelona, Spain
| | - Helena De la Serna
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Mane
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Hospital del Mar Medical Research Institute (IMIM), Pompeu Fabra University, Barcelona, Spain
| | - Alexandra Roldan
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nicolas Crossley
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile
- Department of Psychiatry, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rafael Penades
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Garcia-Rizo C, Crespo-Facorro B, Oliveira C, Gómez-Revuelta M, Kirkpatrick B, Son JMV, de la Hoz LC, Garriga M, Garrido-Torres N, Bernardo M, Fernandez-Egea E, Vázquez-Bourgon J. Anthropometry in antipsychotic-naïve first-episode psychosis patients: An exploratory approach to the role of environmental early life events in two independent samples. Schizophr Res 2024; 266:216-226. [PMID: 38428119 DOI: 10.1016/j.schres.2024.02.020] [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: 08/01/2023] [Revised: 11/14/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Patients with schizophrenia exhibit a reduced life expectancy mainly due to medical-related pathologies which might have been initiated due to stressful events during fetal development. Indeed, intra-uterus growth patterns predict anthropometric measures in adulthood, describing risk factors for schizophrenia and metabolic disorders. We aim to evaluate anthropometric values in two cohorts of antipsychotic-naïve first-episode episode psychosis (FEP) and correlated them with surrogate markers of the fetal environment such as birth weight (BW) and season of birth. METHODS BW, season of birth, and anthropometric values from 2 cohorts of FEP patients (Barcelona and Santander) were evaluated. In cohort B, 91 patients, and 110 controls while in cohort S, 644 and 235 were included respectively. RESULTS Patients were shorter, slimmer, and with lower BMI compared with controls. In both cohorts, patients, and female patients born in winter displayed the shortest height. Regarding BW, height was significantly associated with the interaction of diagnosis and BW in the whole sample and the male subsample. CONCLUSIONS Our results confirm reduced anthropometric features in FEP at onset while suggesting the influence of winter birth and BW, highlighting the role of early life events in the later outcome of FEP with sex differences.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; CIBERSAM, ISCIII, Madrid, Spain; Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Benedicto Crespo-Facorro
- CIBERSAM, ISCIII, Madrid, Spain; Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBIS, Sevilla, Spain.
| | | | - Marcos Gómez-Revuelta
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Institute of Biomedical Research Valdecilla (IDIVAL), Santander, Spain
| | | | - Jacqueline Mayoral-van Son
- CIBERSAM, ISCIII, Madrid, Spain; Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBIS, Sevilla, Spain
| | - Laura Cayón de la Hoz
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Institute of Biomedical Research Valdecilla (IDIVAL), Santander, Spain
| | - Marina Garriga
- CIBERSAM, ISCIII, Madrid, Spain; Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain
| | - Nathalia Garrido-Torres
- CIBERSAM, ISCIII, Madrid, Spain; Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBIS, Sevilla, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clínic de Barcelona, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; CIBERSAM, ISCIII, Madrid, Spain; Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, CB2 0QQ Cambridge, UK; Cambridge shire and Peterborough NHS Foundation Trust, Huntingdon PE29 3RJ, UK
| | - Javier Vázquez-Bourgon
- CIBERSAM, ISCIII, Madrid, Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, Institute of Biomedical Research Valdecilla (IDIVAL), Santander, Spain; Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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4
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Mallorquí A, Oliveira C, Rios J, Isla-Pera MP, Gil-Badenes J, Amoretti S, Bernardo M, Vieta E, Parellada E, Garriga M, García-Rizo C. Nurse-led lifestyle intervention in a cohort of schizophrenia patients treated with clozapine. Arch Psychiatr Nurs 2023; 46:51-57. [PMID: 37813503 DOI: 10.1016/j.apnu.2023.06.008] [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: 06/16/2022] [Revised: 06/06/2023] [Accepted: 06/18/2023] [Indexed: 10/17/2023]
Abstract
Patients diagnosed with schizophrenia are characterized by early mortality compared to the general population. The main cause of this premature death reflects medical complications linked to metabolic syndrome (MetS). The use of antipsychotics such as clozapine is associated with weight gain and metabolic disturbances in certain predisposed individuals. Non-pharmacological interventions for weight control have become a key element for secondary prevention in the health of patients diagnosed with schizophrenia. Here, we aim to evaluate the physical health effects of a nurse-led non-pharmacological intervention program in patients with a diagnosis of schizophrenia treated with clozapine. Thirty-one outpatients from the outpatient clinical facility of Hospital Clinic in Barcelona, Spain diagnosed with schizophrenia and other psychotic disorders receiving clozapine treatment were enrolled in a prospective interventional study, comprising an 8-week group program of therapeutic education in a healthy lifestyle. MetS factors, physical activity, diet, and lifestyle were evaluated at baseline, post-intervention (8 weeks), and 3 months after the program. Weight, body mass index, high-density lipoprotein cholesterol, and diet patterns displayed significant differences post-intervention and after 3 months, while only waist, hip perimeter, and lifestyle improved post-intervention. Our results suggest the effectiveness of the lifestyle intervention in patients under clozapine treatment despite its long-time differential effect. Strategies to prevent weight gain and metabolic decline will help prevent premature cardiometabolic disease in this vulnerable population.
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Affiliation(s)
- Andrea Mallorquí
- Neurosciences Institute, Hospital Clinic of Barcelona, Barcelona, Spain; Jaume I University, Castellón, Spain.
| | | | - Jose Rios
- Medical Statistics Core Facility, Hospital Clinic Barcelona, Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Pilar Isla-Pera
- Public Health, Mental Health and Maternal Department, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joaquin Gil-Badenes
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Silvia Amoretti
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Neurosciences Institute, Hospital Clinic Barcelona, Barcelona, Spain; University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit (BCSU), Neurosciences Institute, Hospital Clinic Barcelona, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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5
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Garcia-Rizo C, Cabrera B, Bioque M, Mezquida G, Lobo A, Gonzalez-Pinto A, Diaz-Caneja CM, Corripio I, Vieta E, Baeza I, Garcia-Portilla MP, Gutierrez-Fraile M, Rodriguez-Jimenez R, Garriga M, Fernandez-Egea E, Bernardo M. The effect of early life events on glucose levels in first-episode psychosis. Front Endocrinol (Lausanne) 2022; 13:983792. [PMID: 36545332 PMCID: PMC9762519 DOI: 10.3389/fendo.2022.983792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Clemente Garcia-Rizo,
| | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Servicio de Psiquiatría, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - Covadonga M. Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria Paz Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, University of Oviedo, Oviedo, Spain. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Miguel Gutierrez-Fraile
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
- Neurosciences Department, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Marina Garriga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, United Kingdom
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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