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Forte MF, Oliva V, De Prisco M, Garriga M, Bitanihirwe B, Alameda L, González-Segura À, Vieta E, Baeza I, Parellada E, Penadés R, Ramos-Quiroga JA, Amoretti S, Mezquida G, Garcia-Rizo C. Obstetric complications and psychopathology in schizophrenia: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024:105913. [PMID: 39362417 DOI: 10.1016/j.neubiorev.2024.105913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/16/2024] [Accepted: 09/29/2024] [Indexed: 10/05/2024]
Abstract
Schizophrenia (SZ) is a severe mental health condition involving gene-environment interactions, with obstetric complications (OCs) conferring an elevated risk for the disease. Current research suggests that OCs may exacerbate SZ symptoms. This study conducted a systematic review and meta-analysis to comprehensively evaluate differences in psychopathology between individuals with and without exposure to OCs in relation to SZ and related disorders. We systematically searched PubMed, PsycINFO, and SCOPUS to identify eligible studies. A total of 4,091 records were retrieved through systematic and citation searches. 14 studies were included in the review, and 12 met the criteria for meta-analysis, involving 2,992 patients. The analysis revealed that SZ patients who had been exposed to OCs exhibited significantly higher levels of positive symptoms (SMD=0.10, 95%CI=0.01,0.20; p=0.03), general psychopathology (SMD=0.37, 95%CI=0.22,0.52; p<0.001), total clinical symptomatology (SMD=0.44, 95%CI=0.24,0.64; p<0.001) and depressive symptoms (SMD=0.47, 95%CI=0.09,0.84; p=0.01). No significant differences were found in negative symptomatology and functioning. Our results suggest that OCs are not only associated with an increased risk of developing psychosis but with more severe symptomatology.
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Affiliation(s)
- Maria Florencia Forte
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB)
| | - Vincenzo Oliva
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Byron Bitanihirwe
- Department of Psychiatry, University of Nairobi, Kenya; The Science for Africa Foundation, Nairobi, Kenya
| | - Luis Alameda
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, General Psychiatry Service, Treatment and Early Intervention in Psychosis Program, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Departamento de Psiquiatría, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Spain
| | - Àlex González-Segura
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Baeza
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Spain
| | - Eduard Parellada
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Penadés
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - J Antoni Ramos-Quiroga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Deparment of Mental Health. Hospital Universitari Vall d'Hebron. Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Valld'Hebron Research Institute (VHIR); Vall d'Hebron Research Institute (VHIR); Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Hospital Clínic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Group of Psychiatry, Mental Health and Addictions, Valld'Hebron Research Institute (VHIR); Vall d'Hebron Research Institute (VHIR); Barcelona, Catalonia, Spain.
| | - Gisela Mezquida
- Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Serra-Hunter Lecturer Fellow, Department of Basic Clinal Practice, Pharmacology Unit, Universitat de Barcelona (UB), Spain.
| | - Clemente Garcia-Rizo
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Barcelona, Spain; Fundació Clínic-Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona; Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Peralta V, de Jalón EG, Moreno-Izco L, Peralta D, Janda L, Sánchez-Torres AM, Cuesta MJ. Social exclusion as a major outcome domain of psychotic disorders: early predictors, and associations with non-recovery and clinical staging 21 years after a first episode of psychosis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02650-0. [PMID: 38772974 DOI: 10.1007/s00127-024-02650-0] [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: 11/20/2023] [Accepted: 03/03/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE People with psychotic disorders have high levels of social exclusion; however, little is known about its early predictors. We present a long-term observational cohort study aimed at examining early risk factors for later social exclusion. METHODS A total of 243 subjects were assessed at their first psychotic episode for early risk factors including sociodemographic variables, familial risk of major mental disorders, perinatal complications, childhood factors, and adolescent factors and re-assessed after a mean follow-up of 21 years for 12 social exclusion domains: leisure activities, housing, work, income, neighborhood deprivation, educational attainment, physical and mental health, family and social support, legal competence, and discrimination. The ability of risk factors to predict social exclusion was examined using hierarchical linear regression. RESULTS Overall social exclusion was independently predicted by low parental socio-economic status, length of follow-up, familial risk of schizophrenia, obstetric complications, neurodevelopmental delay, poor childhood adjustment, childhood adversity, poor adolescent social networks, poor adolescent adjustment, and low premorbid IQ. The model explained 58.2% of the variance in total social exclusion score. Each social exclusion domain was predicted by a different set of variables, which explained between 17.8 and 57.0% of their variance, although low socio-economic status, familial risk of schizophrenia, obstetric complications, childhood adversity, and poor social networks predicted most of the social exclusion domains. CONCLUSION Early risk factors strongly predicted later social exclusion. A multifaceted approach to preventing later social exclusion is crucial in people with a first episode of psychosis and early risk factors of social exclusion.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Campus de Arrosadia, 31006, Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
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Smit R, Luckhoff HK, Phahladira L, Du Plessis S, Emsley R, Asmal L. Relapse in schizophrenia: The role of factors other than non-adherence to treatment. Early Interv Psychiatry 2024. [PMID: 38320862 DOI: 10.1111/eip.13510] [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: 03/23/2023] [Revised: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
AIM Relapse rates are very high in schizophrenia. However, little is known about the predictors of the time to relapse other than treatment non-adherence. We investigated possible risk factors for the time to relapse in patients with first-episode schizophrenia (n = 107) who received assured treatment by way of long-acting injectable antipsychotic over 24 months and who underwent regular clinical, cognitive, and metabolic assessments. METHODS Using Cox regression analyses we assessed selected premorbid and baseline potential predictors of time to relapse. Relapse was defined using operationally defined relapse criteria. RESULTS In the primary analysis only neurological soft signs total score retained significance, with higher scores predicting shorter time to relapse (HR = 1.05, 95% CI = 1.01-1.10, p = .029). In a more detailed secondary analysis poorer social relationships predicted shorter time to relapse (HR = 0.85, 95% CI = 0.76-0.95, p = .003). CONCLUSION Our predominantly negative findings suggest that many of the previously implicated risk factors for the time to relapse are mediated by non-adherence rather than having a direct effect on relapse-proneness. Neurological soft signs, and perhaps quality of life in social relationships appear to play a role and merit further investigation.
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Affiliation(s)
- R Smit
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - H K Luckhoff
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L Phahladira
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - R Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Valli I, Gonzalez Segura A, Verdolini N, Garcia-Rizo C, Berge D, Baeza I, Cuesta MJ, Gonzalez-Pinto A, Lobo A, Martinez-Aran A, Mezquida G, Pina-Camacho L, Roldan Bejarano A, Mas S, McGuire P, Bernardo M, Vieta E. Obstetric complications and genetic risk for schizophrenia: Differential role of antenatal and perinatal events in first episode psychosis. Acta Psychiatr Scand 2023; 148:81-90. [PMID: 36912272 DOI: 10.1111/acps.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Obstetric complications (OCs) are key contributors to psychosis risk. However, it is unclear whether they increase psychosis vulnerability independently of genetic risk, in interaction with it, or are a manifestation of psychosis proneness. We examined the role of distinct types of OCs in terms of psychosis risk and tested whether they interact differently with genetic vulnerability, whilst accounting for other known environmental risk factors. STUDY DESIGN 405 participants (219 first episode psychosis patients and 186 healthy volunteers) underwent a comprehensive assessment of OCs, measured using the Lewis-Murray scale and divided into complications of pregnancy, abnormalities of foetal growth and development, and complications of delivery. Participants were compared in terms of history of OCs, polygenic risk score for schizophrenia (PRS-SZ) and interactions between these. RESULTS Both complications of pregnancy and abnormalities of foetal growth were significantly associated with case-control status (p = 0.02 and 0.03, respectively), whereas complications of delivery were not. PRS-SZ showed a significant association with psychosis (p = 0.04), but there were no significant interactions between genetic risk for schizophrenia and OCs, either when these were considered globally or separated based on their timeframe. CONCLUSIONS We observed no significant interaction between genetic and obstetric vulnerability, yet distinct types of OCs may have a different impact on psychosis risk, based on their nature and timeframe. Examining their differential role might clarify their relative contributions to this risk.
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Affiliation(s)
- Isabel Valli
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Alex Gonzalez Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Norma Verdolini
- Department of Mental Health, Umbria 1 Mental Health Center, Perugia, Italy
| | - Clemente Garcia-Rizo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
| | - Daniel Berge
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
- Universitat Pompeu Fabra, MELIS Department, Barcelona, Spain
| | - Inmaculada Baeza
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, BIOARABA, Vitoria, 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
| | - Anabel Martinez-Aran
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
- Bipolar and Depressive Unit, Hospital Clinic de Barcelona, Institute of Neurosciences, Barcelona, Spain
| | - Gisela Mezquida
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Laura Pina-Camacho
- 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, Madrid, Spain
- School of Medicine, Complutense University, Madrid, Spain
| | - Alexandra Roldan Bejarano
- 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
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Miquel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
- Bipolar and Depressive Unit, Hospital Clinic de Barcelona, Institute of Neurosciences, Barcelona, Spain
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