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Dolz M, Tor J, Puig O, de la Serna E, Muñoz-Samons D, Pardo M, Alvarez-Subiela X, Rodriguez-Pascual M, Sugranyes G, Ilzarbe D, Baeza I. Clinical and neurodevelopmental predictors of psychotic disorders in children and adolescents at clinical high risk for psychosis: the CAPRIS study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02436-4. [PMID: 38642116 DOI: 10.1007/s00787-024-02436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND The neurodevelopmental hypothesis of schizophrenia represents the disorder as an expression of an alteration during the brain development process early in life. Neurodevelopmental variables could become a trait marker, and the study of these variables in children and adolescents at clinical high risk for psychosis (CHR) could identify a specific cluster of patients who later developed psychosis. The aim of this study is to describe clinical and neurodevelopment predictors of transition to psychosis in child and adolescent participants at CHR. Naturalistic longitudinal two-center study of 101 CHR and 110 healthy controls (HC) aged 10-17. CHR participants were children and adolescents aged 10-17, meeting one or more of the CHR criteria assessed at baseline and at 18 months' follow-up. Neurodevelopmental variables assessed were obstetric complications, delay in principal development milestones, and presence of a neurodevelopment diagnosis. Pairwise comparisons, linear regressions, and binary logistic regression were performed.A transition rate of 23.3% at 1.5 years was observed. Participants who developed psychosis (CHR-P) showed higher rates of grandiosity and higher proportions of antipsychotic medication intake at baseline compared to participants who did not develop a psychotic disorder (CHR-NP). In terms of neurodevelopment alterations, CHR-P group showed a higher proportion of participants reporting delay in language development than the CHR-NP and HC groups. The odds of psychosis increased by 6.238 CI 95% [1.276-30.492] for a one-unit increase in having a positive score in grandiosity; they increased by 4.257 95% CI [1.293-14.023] for a one-unit increase in taking antipsychotic medication, and by 4.522 95% [1.185-64.180] for showing language development delay. However, the p-values did not reach significance after adjusting for multiple comparisons.A combination of clinical and neurodevelopmental alterations could help predict the transition to psychotic disorder in a CHR child and adolescent sample. Our results suggest the potential utility of collecting information about neurodevelopment and using these variable multifactorial models to predict psychosis disorders.
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Affiliation(s)
- Montserrat Dolz
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Jordina Tor
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain.
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain.
| | - Olga Puig
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM-ISCIII, Madrid, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM-ISCIII, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Barcelona, SGR2021-01319, Spain
| | - Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Marta Pardo
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Xavier Alvarez-Subiela
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Marta Rodriguez-Pascual
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Gisela Sugranyes
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002,Esplugues de Llobregat, Barcelona, 08950, Spain
| | - Daniel Ilzarbe
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM-ISCIII, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Barcelona, SGR2021-01319, Spain
- Fundació Clínic per a la Recerca Biomèdica-IDIBAPS, Barcelona, Spain
- Department of Medicine, Institute of Neurosciences, University of Barcelona, Bellaterra, Spain
| | - Inmaculada Baeza
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain
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Sagué-Vilavella M, Amoretti S, Garriga M, Mezquida G, Williams E, Serra-Navarro M, Forte MF, Varo C, Montejo L, Palacios-Garran R, Madero S, Sparacino G, Anmella G, Fico G, Giménez-Palomo A, Pons-Cabrera MT, Salgado-Pineda P, Montoro Salvatierra I, Sánchez Gistau V, Pomarol-Clotet E, Ramos-Quiroga JA, Undurraga J, Reinares M, Martínez-Arán A, Pacchiarotti I, Valli I, Bernardo M, Garcia-Rizo C, Vieta E, Verdolini N. Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis. J Psychiatr Res 2022; 151:461-468. [PMID: 35609362 DOI: 10.1016/j.jpsychires.2022.05.005] [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: 01/04/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.
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Affiliation(s)
- Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Gisela Mezquida
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Evelyn Williams
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Serra-Navarro
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Florencia Forte
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Roberto Palacios-Garran
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; University Hospital Santa Maria, University of Lleida, Lleida, Spain
| | - Santiago Madero
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giulio Sparacino
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Teresa Pons-Cabrera
- Addictive Behaviours Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Pilar Salgado-Pineda
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Irene Montoro Salvatierra
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Vanessa Sánchez Gistau
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Edith Pomarol-Clotet
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Undurraga
- Department of Neurology and Psychiatry, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Early Intervention Program, Instituto Psiquiátrico Dr. J. Horwitz Barak, Santiago, Chile
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabel Valli
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Clemente Garcia-Rizo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
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Golembo-Smith S, Schiffman J, Kline E, Sørensen HJ, Mortensen EL, Stapleton L, Hayashi K, Michelsen NM, Ekstrøm M, Mednick S. Premorbid multivariate markers of neurodevelopmental instability in the prediction of adult schizophrenia-spectrum disorder: a high-risk prospective investigation. Schizophr Res 2012; 139:129-35. [PMID: 22664169 PMCID: PMC3393829 DOI: 10.1016/j.schres.2012.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/05/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
Abstract
The authors examined whether multiple childhood indicators of neurodevelopmental instability known to relate to schizophrenia-spectrum disorders could predict later schizophrenia-spectrum outcomes. A standardized battery of neurological and intellectual assessments was administered to a sample of 265 Danish children in 1972, when participants were 10-13 years old. Parent psychiatric diagnoses were also obtained in order to evaluate the predictive strength of neurodevelopmental factors in combination with genetic risk. Adult diagnostic information was available for 244 members of the sample. Participants were grouped into three categories indicating level of genetic risk: children with a parent with schizophrenia (n=94); children with a parent with a non-psychotic mental health diagnosis (n=84); and children with a parent with no records of psychiatric hospitalization (n=66). Variables measured included minor physical anomalies (MPAs), coordination, ocular alignment, laterality, and IQ. Adult diagnoses were assessed through psychiatric interviews in 1992, as well as through a scan of the national psychiatric registry through 2007. Through a combination of multiple childhood predictors, the model correctly classified 73% (24 of 33) of the participants who eventually developed a schizophrenia-spectrum outcome in adulthood. Results suggest that, with replication, multivariate premorbid prediction could potentially be a useful complementary approach to identifying individuals at risk for developing a schizophrenia-spectrum disorder. Genetic risk, MPAs, and other markers of neurodevelopmental instability may be useful for comprehensive prediction models.
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Affiliation(s)
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
| | - Emily Kline
- Department of Psychology, University of Maryland, Baltimore County
| | - Holger J. Sørensen
- Department of Psychiatry, Amager Hospital, Capital Region of Denmark, Copenhagen University Hospital, Denmark,Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
| | - Erik L. Mortensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark,Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
| | | | | | - Niels M. Michelsen
- Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
| | - Morten Ekstrøm
- Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
| | - Sarnoff Mednick
- Institute of Preventive Medicine, Copenhagen University Hospital, Denmark
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