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Díaz-Pons A, Soler-Andrés M, Ortiz-García de la Foz V, Murillo-García N, Yorca-Ruiz A, Magdaleno Herrero R, Castaño-Castaño S, González-Rodríguez A, Setién-Suero E, Ayesa-Arriola R. Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women. Arch Womens Ment Health 2024; 27:693-703. [PMID: 38512467 DOI: 10.1007/s00737-024-01457-x] [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: 10/31/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences. METHODS Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education. RESULTS Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08 months mothers vs. 27.61 months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up. CONCLUSIONS Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.
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Affiliation(s)
- Alexandre Díaz-Pons
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Medicine and Health Sciences, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
| | - Marina Soler-Andrés
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Faculty of Psychology, University of Oviedo (UO), 33003, Oviedo, Spain
| | | | - Nancy Murillo-García
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Angel Yorca-Ruiz
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Rebeca Magdaleno Herrero
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
- Department of Molecular Biology, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain
| | - Sergio Castaño-Castaño
- Department of Psychobiology, Faculty of Psychology, University of Oviedo (UO), 33003, Oviedo, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, University of Barcelona (UB), 08221, Terrassa, Spain
- Biomedical Research Center in Mental Health Network (CIBERSAM), Health Institute Carlos III, 28029, Madrid, Spain
| | - Esther Setién-Suero
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain
- Department of Psychology, Faculty of Health Sciences, European University of the Atlantic (UNEAT), 39011, Santander, Spain
| | - Rosa Ayesa-Arriola
- Mental Illness Research Department, Valdecilla Biomedical Research Institute (IDIVAL), 39011, Santander, Spain.
- Department of Medicine and Health Sciences, Faculty of Medicine, University of Cantabria (UC), 39011, Santander, Spain.
- Faculty of Psychology, National University of Distance Education (UNED), 28015, Madrid, Spain.
- Biomedical Research Center in Mental Health Network (CIBERSAM), Health Institute Carlos III, 28029, Madrid, Spain.
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Murillo-García N, Ortíz-García de la Foz V, Miguel-Corredera M, Vázquez-Bourgon J, Setién-Suero E, Neergaard K, Moya-Higueras J, Crespo-Facorro B, Ayesa-Arriola R. Intelligence quotient changes over 10 years: Diversity of cognitive profiles in first episode of psychosis and healthy controls. Schizophr Res 2023; 254:163-172. [PMID: 36905766 DOI: 10.1016/j.schres.2023.02.025] [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: 04/05/2022] [Revised: 11/24/2022] [Accepted: 02/23/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to analyse whether intelligence quotient (IQ) improves, declines, or remains stable over 10 years among FEP patients and healthy subjects. METHODS A group of FEP patients enrolled in a Program of First Episode Psychosis in Spain called PAFIP, and a sample of Healthy Controls (HC) completed the same neuropsychological battery at baseline and approximately 10 years later, which included the WAIS vocabulary subtest to estimate premorbid IQ and 10-year IQ. Cluster analysis was performed separately in the patient group and the HC group to determine their profiles of intellectual change. RESULTS One hundred and thirty-seven FEP patients were grouped into five clusters: "Improved low IQ" (9.49 % of patients), "Improved average IQ" (14.6 %), "Preserved low IQ" (17.52 %), "Preserved average IQ" (43.06 %), and "Preserved high IQ" (15.33 %). Ninety HC were grouped into three clusters: "Preserved low IQ" (32.22 % of the HC), "Preserved average IQ" (44.44 %), and "Preserved high IQ" (23.33 %). The first two clusters of FEP patients, characterized by a low IQ, earlier age at illness onset, and lower educational attainment, showed a substantial cognitive improvement. The remaining clusters demonstrated cognitive stability. CONCLUSIONS The FEP patients showed intellectual improvement or stability, but no decline post-onset of psychosis. However, their profiles of intellectual change are more heterogeneous than that of HC over 10 years. Particularly, there is a subgroup of FEP patients with a significant potential for long-term cognitive enhancement.
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Affiliation(s)
- Nancy Murillo-García
- Research Group on Mental Illnesses, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain
| | - Víctor Ortíz-García de la Foz
- Research Group on Mental Illnesses, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Center for Biomedical Research Network on Mental Health (CIBERSAM), Spain
| | | | - Javier Vázquez-Bourgon
- Center for Biomedical Research Network on Mental Health (CIBERSAM), Spain; Department of Psychiatry, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Esther Setién-Suero
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Karl Neergaard
- Research Group on Mental Illnesses, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | - Benedicto Crespo-Facorro
- Center for Biomedical Research Network on Mental Health (CIBERSAM), Spain; Department of Psychiatry, University Hospital Virgen del Rocío, University of Seville, Seville, Spain
| | - Rosa Ayesa-Arriola
- Research Group on Mental Illnesses, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain; Center for Biomedical Research Network on Mental Health (CIBERSAM), Spain.
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Casanovas F, Fonseca F, Mané A. Substance use Specificities in Women with Psychosis: A Critical Review. Curr Neuropharmacol 2023; 21:1953-1963. [PMID: 36453494 PMCID: PMC10514534 DOI: 10.2174/1570159x21666221129113942] [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: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years. METHODS We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia. RESULTS Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis. CONCLUSION Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.
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Affiliation(s)
- Francesc Casanovas
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Mané
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
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4
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Gender differences in the association between environment and psychosis. Schizophr Res 2022; 243:120-137. [PMID: 35287098 DOI: 10.1016/j.schres.2022.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 02/07/2023]
Abstract
Various environmental exposures have been associated with psychosis spectrum disorder. However, the role of gender in this association has received little attention. Therefore, we conducted a systematic review to evaluate gender-related differences and identified 47 research articles investigating the associations of psychosis with childhood adversity, substance use, urbanicity, migration, season of birth, and obstetric complication in the PubMed database. The findings suggest that childhood abuse may be more strongly associated with a risk to develop psychosis and an earlier age at onset of illness in women than in men. Furthermore, childhood adversity has been associated with the severity of different symptom dimensions in men and women. Growing up in an urban environment and immigration are more strongly associated with psychosis risk in men than in women. Despite a higher prevalence of substance abuse comorbidity in men diagnosed with psychotic disorders, it appears that the association between substance use and psychosis risk may be stronger in women. These findings should be evaluated with caution considering several methodological limitations, limited number of studies, and lack of consistency across results. Overall, although further investigation is needed, our review shows that gender-related differences in the associations of environmental exposures with psychosis expression may exist.
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Ricci V, Ceci F, Di Carlo F, Lalli A, Ciavoni L, Mosca A, Sepede G, Salone A, Quattrone D, Fraticelli S, Maina G, Martinotti G. Cannabis use disorder and dissociation: A report from a prospective first-episode psychosis study. Drug Alcohol Depend 2021; 229:109118. [PMID: 34688166 DOI: 10.1016/j.drugalcdep.2021.109118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated. AIMS To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis. METHODS Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected. RESULTS FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it. DISCUSSION Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.
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Affiliation(s)
- V Ricci
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy
| | - F Ceci
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy.
| | - F Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Lalli
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - L Ciavoni
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Mosca
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - G Sepede
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Salone
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - D Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Ln, London SE5 8AF, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159 Mannheim, Germany
| | - S Fraticelli
- DSM PIPSM ASL ROMA 1, Via Plinio, 31, 00193 Roma
| | - G Maina
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy; Rita Levi Montalcini Department of Neurosciences, University of Turin, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy; Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
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Madero S, Oliveras C, Pons MT, Sague M, López-Pelayo H, Gual A, Balcells M. Cannabis use the week before admission to psychiatric in-patient service as a marker of severity. J Psychiatr Res 2020; 129:40-46. [PMID: 32563776 DOI: 10.1016/j.jpsychires.2020.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate if cannabis dose recorded as standard joint unit (SJU) consumed before admission and other related factors have an influence on psychiatric inpatient's symptom severity and clinical outcomes. METHODS Cross-sectional study in an acute psychiatric inpatient unit including 106 individuals. Quantity of cannabis was measured as SJU and symptoms severity through the Brief Psychiatric Rating Scale (BPRS). Secondary outcomes (e.g. length of stay) were also assessed. Bivariate analyses and multivariate analyses were performed to determine the effect of SJU consumed before admission on measures of clinical severity. RESULTS Point prevalence of cannabis use before admission was 25.5%. Mean BPRS score was 55.8 (SD = 16.1); and 62.9 (SD = 11.1) among cannabis users. A low degree positive correlation between SJU consumed the week before admission and BPRS score (rs = 0.28, p = 0.03) was found. In the multivariate analyses both main diagnostic group, Schizophrenia and other psychotic disorders vs. others (Bipolar and Unipolar Affective Disorders and Addictive disorders) (B = 8.327; 95% CI 4.976-11.677) and need of PRN ("pre re nata" or when necessary) administration of antipsychotics and benzodiazepines (B = 12.13; 95% CI 6.868-17.393) were significant predictors, both increasing BPRS score. CONCLUSIONS The study did not find a correlation between SJU consumed last week and psychiatric severity. On the other hand, individuals with psychotic disorders reported a higher prevalence of cannabis use the week before admission and displayed higher BPRS scores, which points to the need for the development of tailored interventions for high-risk groups. The SJU is a useful quantification tool suitable for further clinical research.
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Affiliation(s)
- S Madero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
| | - C Oliveras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M T Pons
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - M Sague
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain
| | - H López-Pelayo
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - A Gual
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - M Balcells
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic of Barcelona, Research Group on Addictions, Barcelona, Spain; Addictions Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
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Marino L, Scodes J, Richkin T, Alves-Bradford JM, Nossel I, Wall M, Dixon L. Persistent cannabis use among young adults with early psychosis receiving coordinated specialty care in the United States. Schizophr Res 2020; 222:274-282. [PMID: 32473930 PMCID: PMC8237378 DOI: 10.1016/j.schres.2020.05.035] [Citation(s) in RCA: 12] [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] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
Persistent cannabis use among young adults with first episode psychosis (FEP), even those receiving early intervention services, has been associated with poor outcomes. In the United States (US), Coordinated Specialty Care (CSC) has been shown to be more effective at reducing symptoms, improving quality of life and increasing involvement in work or school, compared to typical care for FEP. However, little is known about the prevalence, course and outcomes for cannabis use in this real-world, clinical setting. This study examined the prevalence, course and outcomes of cannabis use categorized into three groups: no use, reduced use, and persistent use, among a sample of 938 CSC participants enrolled for at least 1 year. Prevalence of cannabis use was 38.8% at admission and 32.8% of the sample had persistent cannabis use at 1 year. At baseline, persistent cannabis users were more likely to be male (p < .001), white, non-Hispanic and black non-Hispanic (p = .001), have worse symptoms as measured by the GAF (p < .001), increased suicidality (p = .024), violent ideation (p = .008), and legal trouble (p = .006) compared with non-users. At 1 year, persistent users maintained worse symptoms compared with non-users (p = .021) while those who reduced use had significant improvement in symptoms compared with persistent users (p = .008). This study suggests that cannabis use is common among young adults enrolled in a CSC program in the US and that persistent cannabis users may have worse outcomes while reducing cannabis use may improve outcomes. These findings highlight the potential impact of secondary prevention in this population through reduction in cannabis use.
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Affiliation(s)
- Leslie Marino
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032.
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Talia Richkin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA
| | - Jean-Marie Alves-Bradford
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Ilana Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
| | - Lisa Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York 10032, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, USA 10032
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Arranz S, Mané A, Bergé D, Monserrat C, Cabezas A, Vilella E, Sanchez-Gistau V. The impact of sex and cannabis on clinical features in first-admitted patients with psychosis. Eur Neuropsychopharmacol 2020; 36:235-243. [PMID: 32291209 DOI: 10.1016/j.euroneuro.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/06/2020] [Indexed: 12/22/2022]
Abstract
There is a scarcity of studies investigating the effect of sex on the clinical and treatment characteristics of first-admitted patients with first-episode psychosis (FEP). The reasons for using cannabis and the effect of cannabis on clinical features have not received enough attention either. We aim therefore, to investigate sex differences in the reasons for cannabis use and to determine the effects of sex, cannabis use and their interaction on clinical variables at admission and at discharge from the inpatient unit. 204 first-admitted FEPs in two inpatient units in Spain were included. The reasons for using cannabis were determined using the Dixon questionnaire. Clinical variables were compared between sexes and between cannabis users and non-users. Cannabis use was more frequent in males, but females were more likely to smoke cannabis to "feel relaxed". There was a main effect of sex on positive psychotic symptoms and antipsychotics dose and an interaction effect of cannabis and sex on global functioning at discharge .Our findings show sex differences in the reasons for cannabis use and in some clinical and treatment characteristics among FEP patients. More studies focusing on gender perspectives are needed to develop more individualized treatments.
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Affiliation(s)
- Sara Arranz
- Parc Sanitari Sant Joan de Dèu, Sant Boi de Llobregat, Barcelona, Spain; Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Anna Mané
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Dani Bergé
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Clara Monserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain
| | - Angel Cabezas
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Vanessa Sanchez-Gistau
- Hospital Universitari Institut Pere Mata of Reus, Medical Research Institute Pere Virgili (IISPV), and Rovira i Virgili University of Tarragona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain.
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9
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Vázquez-Bourgon J, Ortiz-García de la Foz V, Suarez-Pereira I, Iruzubieta P, Arias-Loste MT, Setién-Suero E, Ayesa-Arriola R, Gómez-Revuelta M, Crespo J, Crespo Facorro B. Cannabis consumption and non-alcoholic fatty liver disease. A three years longitudinal study in first episode non-affective psychosis patients. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109677. [PMID: 31228640 DOI: 10.1016/j.pnpbp.2019.109677] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Increased incidence of obesity and excess weight lead to an increased incidence of non-alcoholic fatty liver disease (NAFLD). Recent evidence indicates a protective effect of cannabis consumption on weight gain and related metabolic alterations in psychosis patients. Overall, patients are at greater risk of presenting fatty diseases, such as NAFLD, partly due to lipid and glycemic metabolic disturbances. However, there are no previous studies on the likely effect of cannabis on liver steatosis. We aimed to explore if cannabis consumption had an effect on hepatic steatosis, in a sample of first-episode (FEP) non-affective psychosis. MATERIAL AND METHODS A total of 390 patients were evaluated at baseline and after 3 years of initiating the antipsychotic treatment. Anthropometric measurements and liver, lipid, and glycemic parameters were obtained at both time points. All but 6.7% of patients were drug-naïve at entry, and they self-reported their cannabis use at both time points. Liver steatosis and fibrosis were evaluated through validated clinical scores (Fatty Liver Index [FLI], Fibrosis-4 [FIB-4], and NAFLD). RESULTS At 3-year follow-up, cannabis users presented significantly lower FLI scores than non-users (F = 13.874; p < .001). Moreover, cannabis users less frequently met the criteria for liver steatosis than non-users (X2 = 7.97, p = .019). Longitudinally, patients maintaining cannabis consumption after 3 years presented the smallest increment in FLI over time, which was significantly smaller than the increment in FLI presented by discontinuers (p = .022) and never-users (p = .016). No differences were seen in fibrosis scores associated with cannabis. CONCLUSIONS Cannabis consumption may produce a protective effect against liver steatosis in psychosis, probably through the modulation of antipsychotic-induced weight gain.
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Affiliation(s)
- Javier Vázquez-Bourgon
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
| | - Víctor Ortiz-García de la Foz
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain.
| | - Irene Suarez-Pereira
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Neuropsychopharmacology & Psychobiology Research Group, University of Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Edificio "Andrés Segovia", Cádiz, Spain.
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Unit, University Hospital de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain.
| | - María Teresa Arias-Loste
- Gastroenterology and Hepatology Unit, University Hospital de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain.
| | - Esther Setién-Suero
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain
| | - Javier Crespo
- Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; Gastroenterology and Hepatology Unit, University Hospital de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain.
| | - Benedicto Crespo Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
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Setién-Suero E, Neergaard K, Ortiz-García de la Foz V, Suárez-Pinilla P, Martínez-García O, Crespo-Facorro B, Ayesa-Arriola R. Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort. Acta Psychiatr Scand 2019; 140:349-359. [PMID: 31381129 DOI: 10.1111/acps.13081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2 = 15.583, P ≤ 0.001; SAPS: x2 = 12.386, P = 0.002) and poorer functionality (DAS: x2 = 6.067, P = 0.048; GAF: x2 = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.
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Affiliation(s)
- E Setién-Suero
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - K Neergaard
- Department of Laboratoire Parole et Langage, Aix-Marseille Université, Marseille, France
| | - V Ortiz-García de la Foz
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - P Suárez-Pinilla
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
| | - O Martínez-García
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - B Crespo-Facorro
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain.,Hospital Universitario Virgen del Rocio, IBiS, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain
| | - R Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.,IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
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Vázquez-Bourgon J, Setién-Suero E, Pilar-Cuéllar F, Romero-Jiménez R, Ortiz-García de la Foz V, Castro E, Crespo-Facorro B. Effect of cannabis on weight and metabolism in first-episode non-affective psychosis: Results from a three-year longitudinal study. J Psychopharmacol 2019; 33:284-294. [PMID: 30702972 DOI: 10.1177/0269881118822173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cannabis smoking is highly prevalent among patients with psychotic disorders. Its use has been found to be related to clinical characteristics and the prognosis of the disorder. Recent evidence indicates a protective effect of cannabis on weight gain and related metabolic alterations. However, there are no previous studies on the long-term longitudinal effects of cannabis on first-episode drug-naïve patients, which would thereby avoid the confounding effects of chronicity and previous treatment exposure. We aimed to explore the effect of cannabis smoking on weight and lipid/glycaemic metabolic measures in a sample of first-episode non-affective psychosis patients. METHOD Anthropometric measurements and glycaemic and lipid parameters were obtained at baseline and three years after initiation of treatment. Patients self-reported their cannabis use at both time points. To explore the longitudinal effect of cannabis, patients were divided into three groups: continuers, discontinuers and non-users. RESULTS Cannabis users at baseline presented a lower weight ( F=14.85, p<0.001), body mass index ( F=13.14, p<0.001), total cholesterol ( F=4.85, p=0.028) and low-density lipoprotein-cholesterol ( F=6.26, p=0.013) compared to non-users. These differences were also observed after three years: weight ( F=8.07, p=0.005), body mass index ( F=4.66, p=0.032) and low-density lipoprotein-cholesterol ( F=3.91, p=0.049). Moreover, those patients discontinuing cannabis use presented a higher increase in weight ( F=2.98, p=0.052), body mass index ( F=2.73, p=0.067) and triglyceride-high-density lipoprotein ratio ( F=2.72, p=0.067) than the 'non-users' and 'continuers'. CONCLUSIONS The study suggests that cannabis use may produce a protective effect against weight gain and related metabolic alterations in psychosis. However, these results need to be replicated in a larger sample size.
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Affiliation(s)
- Javier Vázquez-Bourgon
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Esther Setién-Suero
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | - Fuencisla Pilar-Cuéllar
- 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain.,4 Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.,5 Instituto de Biomedicina y Biotecnología de Cantabria, University of Cantabria-Consejo Superior de Investigaciones Científicas (CSIC)-Sociedad para el Desarrollo de Cantabria (SODERCAN), Santander, Spain
| | - Rodrigo Romero-Jiménez
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Víctor Ortiz-García de la Foz
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain
| | - Elena Castro
- 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Santander, Spain.,4 Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain.,5 Instituto de Biomedicina y Biotecnología de Cantabria, University of Cantabria-Consejo Superior de Investigaciones Científicas (CSIC)-Sociedad para el Desarrollo de Cantabria (SODERCAN), Santander, Spain
| | - Benedicto Crespo-Facorro
- 1 Department of Psychiatry, University Hospital Marqués de Valdecilla-Instituto Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.,3 Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
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