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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sánchez-Gutiérrez T, Rodríguez-Toscano E, Roldán L, Ferraro L, Parellada M, Calvo A, López G, Rapado-Castro M, La Barbera D, La Cascia C, Tripoli G, Di Forti M, Murray RM, Quattrone D, Morgan C, van Os J, García-Portilla P, Al-Halabí S, Bobes J, de Haan L, Bernardo M, Santos JL, Sanjuán J, Arrojo M, Ferchiou A, Szoke A, Rutten BP, Stilo S, D'Andrea G, Tarricone I, Díaz-Caneja CM, Arango C. Tobacco use in first-episode psychosis, a multinational EU-GEI study. Psychol Med 2023; 53:7265-7276. [PMID: 37185055 DOI: 10.1017/s0033291723000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. METHODS The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. RESULTS After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (β = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use. CONCLUSIONS Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.
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Affiliation(s)
- T Sánchez-Gutiérrez
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - E Rodríguez-Toscano
- Grupo de investigación en Psiquiatría, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy at the Complutense University of Madrid, Madrid, Spain
| | - L Roldán
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - L Ferraro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Calvo
- Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - G López
- Faculty of Health Science, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, 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
| | - D La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - C La Cascia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - G Tripoli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy
| | - M Di Forti
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Mental Health Trust, London, UK
| | - R M Murray
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - D Quattrone
- Department of Social Genetics and Developmental Psychiatry, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - C Morgan
- ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - P García-Portilla
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - S Al-Halabí
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - J Bobes
- Department of Medicine-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - L de Haan
- Early Psychosis Department, Amsterdam UMC, University of Amsterdam, Academic Psychiatric Centre, Arkin, Amsterdam, The Netherlands
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERSAM, ISCIII, Barcelona, Spain
| | - J L Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital 'Virgen de la Luz', Cuenca, Spain
| | - J Sanjuán
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, CIBERSAM, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - M Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - A Ferchiou
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - A Szoke
- Fondation FondaMental, Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopitaux Universitaires 'H. Mondor', DMU IMPACT, F-94010 Creteil, France
| | - B P Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Stilo
- Department of Mental Health and Addiction Services, ASP Crotone, Crotone, Italy
| | - G D'Andrea
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - I Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - C Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
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3
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Marques-Feixa L, Moya-Higueras J, Romero S, Santamarina-Pérez P, Martín-Gonzalez NS, Mas A, Rapado-Castro M, Blasco-Fontecilla H, Zorrilla I, Forner-Puntonet M, Anglada E, Ramírez M, Mayoral M, Muñoz MJ, Fañanás L, Palma-Gudiel H, Castro-Quintas Á, Monteserín JL, Marín-Vila M, Lobato MJ, Martín M, Méndez I, Gadea S, Vidal J, Guillen H, Piazza F, Fàbregas A, Rios G. Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes. J Affect Disord 2023; 332:92-104. [PMID: 37004905 DOI: 10.1016/j.jad.2023.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Exposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure. METHODS Exposure to CM and clinical outcomes were evaluated in 187 youths aged 7-17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems. RESULTS Youths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains. LIMITATIONS Small percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed. CONCLUSIONS Gathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.
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Affiliation(s)
- Laia Marques-Feixa
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain
| | - Jorge Moya-Higueras
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Spain
| | - Soledad Romero
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Pilar Santamarina-Pérez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nerea San Martín-Gonzalez
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
| | - Ariadna Mas
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Rapado-Castro
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
| | - Hilario Blasco-Fontecilla
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, ITA Mental Health, Madrid, Spain
| | - Iñaki Zorrilla
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Hospital Santiago Apostol, Department of Psychiatry, Vitoria-Gasteiz, Spain
| | - Mireia Forner-Puntonet
- Department of Mental Health, Hospital Universitari Vall d'Hebron. Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - Maite Ramírez
- Day Hospital for Adolescents OSI Barrualde-Galdakao, Child and Adolescent Mental Health, Galdakao, Spain
| | - María Mayoral
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - María José Muñoz
- Hospital Benito Menni, Adolescent Crisis Unit, Sant Boi de Llobregat, Spain
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain.
| | - Helena Palma-Gudiel
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain; College of Public Health and Health Professions, Department of Epidemiology, University of Florida, United States of America
| | - Águeda Castro-Quintas
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain
| | - José Luís Monteserín
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, ISCIII, Spain
| | - María Marín-Vila
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, ITA Mental Health, Madrid, Spain
| | - María José Lobato
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, ITA Mental Health, Madrid, Spain
| | - María Martín
- Hospital Benito Menni, Adolescent Crisis Unit, Sant Boi de Llobregat, Spain
| | - Iria Méndez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic Barcelona, Barcelona, Spain
| | - Silvia Gadea
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Jorge Vidal
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Hugo Guillen
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic Barcelona, Barcelona, Spain
| | - Flavia Piazza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Fàbregas
- Department of Pediatrics, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Giulana Rios
- Social Work Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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4
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Marques-Feixa L, Palma-Gudiel H, Romero S, Moya-Higueras J, Rapado-Castro M, Castro-Quintas Á, Zorrilla I, José Muñoz M, Ramírez M, Mayoral M, Mas A, José Lobato M, Blasco-Fontecilla H, Fañanás L. Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose-response relationship in children and adolescents. Psychol Med 2023; 53:1060-1073. [PMID: 34269169 PMCID: PMC9976019 DOI: 10.1017/s003329172100249x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/31/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study investigates the impact of childhood maltreatment (CM) on hypothalamic-pituitary-adrenal (HPA)-axis functioning and on anxiety perception. Moreover, the influence of CM severity and frequency was also explored. METHODS In total, 187 participants aged 7-17 were assessed for CM history using validated questionnaires and ad hoc interviews to be classified according to the criteria of the Tool for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV). Psychopathology was ascertained using the K-SADS-PL5. To assess HPA-axis functioning, salivary cortisol samples were collected throughout a normal day and during an acute psychosocial stressor, the Trier Social Stress Test for children (TSST-C). Subjective anxiety was evaluated using STAI/-C. RESULTS Youth with a CM history had higher overall diurnal cortisol levels (p = 0.001), blunted cortisol response to acute psychosocial stress (p = 0.002) and greater perceived anxiety (p = 0.003), than those without CM. Specifically, participants exposed to moderate/severe or often/frequent CM showed the greater diurnal cortisol output (pseverity = 0.002; pfrequency = 0.003), and blunted cortisol response during the TSST-C (pseverity = 0.006; pfrequency = 0.008). Meanwhile, youth with low CM severity/frequency exhibited a similar cortisol response to those without CM. However, perceived anxiety was higher in those exposed to CM (p < 0.001), regardless of its severity/frequency. CONCLUSIONS Disturbances in HPA-axis functioning are already evident early after CM exposure, while psychological and physiological responses to an acute stressor are dissociated in youth exposed to CM. The dose-response relationship described in this paper highlights the need to comprehensively evaluate CM so that vulnerable children can be identified and assigned to proper interventions.
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Affiliation(s)
- Laia Marques-Feixa
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
| | - Helena Palma-Gudiel
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
| | - Soledad Romero
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR88, Barcelona, Spain
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jorge Moya-Higueras
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Spain
| | - Marta Rapado-Castro
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Victoria, Australia
| | - Águeda Castro-Quintas
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
| | - Iñaki Zorrilla
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Psychiatry, Hospital Santiago Apostol, Vitoria-Gasteiz, Spain
| | - María José Muñoz
- Hospital Benito Menni, Adolescent Crisis Unit, Sant Boi de Llobregat, Spain
| | - Maite Ramírez
- Galdakao Mental Health Services, Child and Adolescent Mental Health, Galdakao, Spain
| | - María Mayoral
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Ariadna Mas
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR88, Barcelona, Spain
| | - María José Lobato
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, Autonoma University, ITA Mental Health, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, Autonoma University, ITA Mental Health, Madrid, Spain
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain
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Rapado-Castro M. New Opportunities and Challenges of Early Psychosis. J Clin Med 2022; 11:jcm11216531. [PMID: 36362758 PMCID: PMC9658694 DOI: 10.3390/jcm11216531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, ISCIII, 28009 Madrid, Spain;
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC 3053, Australia
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Salazar de Pablo G, Moreno D, Gonzalez-Pinto A, Paya B, Castro-Fonieles J, Baeza I, Graell M, Arango C, Rapado-Castro M, Moreno C. Affective symptom dimensions in early-onset psychosis over time: a principal component factor analysis of the Young Mania Rating Scale and the Hamilton Depression Rating Scale. Eur Child Adolesc Psychiatry 2022; 31:1715-1728. [PMID: 34052909 DOI: 10.1007/s00787-021-01815-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/23/2021] [Indexed: 12/11/2022]
Abstract
Early-onset psychosis (EOP) is a complex disorder characterized by a wide range of symptoms, including affective symptoms. Our aim was to (1) examine the dimensional structure of affective symptoms in EOP, (2) evaluate the predominance of the clinical dimensions and (3) assess the progression of the clinical dimensions over a 2-year period. STROBE-compliant prospective principal component factor analysis of Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale-21 (HDRS-21) at baseline, 6-months, 1-year and 2-year follow-up. We included 108 EOP individuals (mean age = 15.5 ± 1.8 years, 68.5% male). The factor analysis produced a four-factor model including the following dimensions: mania, depression/anxiety, sleep and psychosis. It explained 47.4% of the total variance at baseline, 60.6% of the total variance at 6-months follow-up, 54.5% of the total variance at 1-year follow-up and 49.5% of the total variance at 2-year follow-up. According to the variance explained, the mania factor was predominant at baseline (17.4%), 6-month follow-up (23.5%) and 2-year follow-up (26.1%), while the depression/anxiety factor was predominant at 1-year follow-up (23.1%). The mania factor was the most stable; 58.3% items that appeared in this factor (with a load > 0.4) at any time point appeared in the same factor at ≥ 3/4 time points. Affective symptoms are frequent and persistent in EOP. Mania seems to be the most predominant and stable affective dimension. However, depression and anxiety may gain predominance with time. A comprehensive evaluation of the dimensional structure and the progression of affective symptoms may offer clinical and therapeutic advantages.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dolores Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Biomedical Research Networking Centre in Mental Health, BioAraba Research Institute, OSI Araba-University Hospital, University of the Basque Country (EHU/UPV), CIBERSAM, Vitoria, Spain
| | - Beatriz Paya
- Department of Child Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Josefina Castro-Fonieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, School of Medicine, Universidad Autónoma, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain. .,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Victoria, Australia.
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43, 28009, Madrid, Spain
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7
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Marques-Feixa L, Castro-Quintas Á, Palma-Gudiel H, Romero S, Morer A, Rapado-Castro M, Martín M, Zorrilla I, Blasco-Fontecilla H, Ramírez M, Mayoral M, Mendez I, San Martín-Gonzalez N, Rodrigo-Yanguas M, Luis Monteserín-García J, Fañanás L. Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment. Brain Behav Immun 2022; 103:122-129. [PMID: 35427757 DOI: 10.1016/j.bbi.2022.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Mucosal secretory immunoglobulin A (s-IgA) is an antibody protein-complex that plays a crucial role in immune first defense against infection. Although different immune biomarkers have been associated with stress-related psychopathology, s-IgA remains poorly studied, especially in youth. OBJECTIVES The present study investigated how s-IgA behaves in front of acute psychosocial stress in children and adolescents, including possible variability associated with developmental stage and history of childhood maltreatment (CM). METHODS 94 children and adolescents from 7 to 17 years (54 with a current psychiatric diagnostic and 40 healthy controls) drawn from a larger Spanish study were explored (EPI-Young Stress Project). To assess biological reactivity, participants provided five saliva samples during an acute laboratory-based psychosocial stressor, the Trier Social Stress Test for Children (TSST-C). Samples were assayed for s-IgA, as well as for cortisol. Pubertal development was ascertained by Tanner stage and CM following TASSCV criteria. RESULTS We observed s-IgA fluctuations throughout the stressor, indicating the validity of TSST-C to stimulate s-IgA secretion (F(4,199) = 6.200, p <.001). Although s-IgA trajectories followed a reactivity and recovery pattern in adolescents, children exhibited no s-IgA response when faced with stress (F(4,197) = 3.406, p =.010). An interaction was found between s-IgA and CM (F(4,203) = 2.643, p =.035). Interestingly, an interaction between developmental stage, CM history and s-IgA reactivity was identified (F(12,343) = 2.036, p =.017); while children non-exposed to maltreatment exhibited no s-IgA changes to acute stress, children with a history of CM showed a similar response to adolescents, increasing their s-IgA levels after the psychosocial stressor. CONCLUSION Acute psychosocial stress stimulates s-IgA secretion, but only after puberty. However, children with a history of maltreatment exhibited a response resembling that of adolescents, suggesting an early maturation of the immune system. Further studies are needed to clarify the validity of s-IgA as an acute stress biomarker, including additional measures during stress exposure.
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Affiliation(s)
- Laia Marques-Feixa
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Águeda Castro-Quintas
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Helena Palma-Gudiel
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; College of Public Health and Health Professions, Department of Epidemiology, University of Florida, USA
| | - Soledad Romero
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Astrid Morer
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Rapado-Castro
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Victoria, Australia
| | - María Martín
- Hospital Benito Menni, Adolescent Crisis Unit, Sant Boi de Llobregat, Spain
| | - Iñaki Zorrilla
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Hospital Santiago Apostol, Department of Psychiatry, Vitoria-Gasteiz, Spain
| | - Hilario Blasco-Fontecilla
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, Autonoma University, ITA Mental Health, Madrid, Spain
| | - Maite Ramírez
- Day Hospital for Adolescents Barrualde-Galdakao, Child and Adolescent Mental Health, Galdakao, Spain
| | - María Mayoral
- Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Iría Mendez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Nerea San Martín-Gonzalez
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain
| | - María Rodrigo-Yanguas
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, Autonoma University, ITA Mental Health, Madrid, Spain
| | - José Luis Monteserín-García
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; Network Centre for Biomedical Research in Mental Health (CIBERSAM), Spain.
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8
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Palma-Gudiel H, Marques Feixa L, Romero S, Rapado-Castro M, Blasco-Fontecilla H, Zorrilla I, Martín M, Castro Quintas Á, Monteserin-Garcia J, Font E, Ramirez M, Moreno D, Marín-Vila M, Moreno N, Binder E, Fañanas L. Children and adolescents exposed to maltreatment already exhibit epigenetic patterns suggestive of heightened low-grade inflammation. Eur Psychiatry 2022. [PMCID: PMC9567149 DOI: 10.1192/j.eurpsy.2022.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Childhood maltreatment (CM) is one of the best described environmental risk factors for developing any psychiatric disorder, while it also confers increased odds for obesity, cardiometabolic disorders and all-cause mortality. Inflammation has been suggested to mediate the widespread clinical effects of CM. Previously, Ligthart et al. (2016) identified a polyepigenetic signature of circulating CRP levels, a measure of chronic low-grade inflammation, that has been reliably associated with a wide array of complex disorders. The study of this biomarker could dilucidate the mechanistic relationship between CM and psychiatric outcomes.
Objectives
Thus, CRP-associated epigenetic modifications were explored regarding proximal exposure to CM.
Methods
Genomic DNA was extracted from peripheral blood mononuclear cells of 157 children and adolescents (7 to 17 years old). Exposure to CM was assessed following the TASSCV criteria. Genome-wide DNA methylation was assessed by means of the EPIC array. Fifty-two out of the 58 original CRP-associated CpG sites surpassed quality control and were included in the analysis. Age, sex, psychopathological status and cell type proportions were included as covariates.
Results
DNA methylation at 12 out of 52 CpG sites (23%) was significantly associated with exposure to CM (p < .05); 8 of these associations survived correction for multiple testing (q < .05).
Conclusions
This is the first study to date to explore the relationship between childhood maltreatment and an epigenetic signature of chronic low-grade inflammation. Our findings underscore the presence of immune dysregulation early after exposure to CM; further studies are needed to assess the long-term clinical implications of this signature in psychiatric patients.
Disclosure
No significant relationships.
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Marques Feixa L, Romero S, Moya-Higueras J, Santamarina-Pérez P, March-Llanes J, Muñoz M, Zorrilla I, Rapado-Castro M, Blasco-Fontecilla H, Anglada E, Ramirez M, Fañanas L. Reinforcing the new diagnosis of Complex Post-Traumatic Stress disorder (CPTSD) of ICD-11: exploring the clinical outcomes in youth exposed to complex trauma. Eur Psychiatry 2022. [PMCID: PMC9566118 DOI: 10.1192/j.eurpsy.2022.1139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Youth exposed to complex trauma (CT) show an increased risk of psychiatric morbidity, including a wide range of psychiatric disorders. However, to date, there is no specific diagnosis in the DSM-5 that capture the clinical complexity of these patients. Properly, the last version of the ICD-11 includes a diagnosis termed Complex Post-Traumatic Stress Disorder (CPTSD), which considers the pattern of post-traumatic stress symptoms, plus life-impairing disturbances in self-organization (emotion dysregulation, negative self-concept and interpersonal problems). Clinical research about CPTSD, especially in younger population, is still limited.
Objectives
To explore the symptomatology of CPTSD in a sample of youth exposed to CT and its association with worse clinical outcomes.
Methods
187 youth aged 7 to 17 years participated in the EPI_young_stress_project (116 with current psychiatric disorder and 71 healthy controls). CT was evaluated following the TASSCV criteria. To identify CPTSD symptomatology, we performed an exploratory factor analysis including CBCL and TEIQue items. The global level of functioning was measured by CGAS.
Results
Preliminary results pointed that youth exposed to CT showed greater internalizing (p<.001) and externalizing (p<.001) symptomatology. Regardless of their current primary diagnosis based on DSM-5, youth exposed to CT reported more CPTSD symptomatology (p<.001). Moreover, youth with CPTSD showed greater use of psychotropic drugs (p<.001), higher and longer hospitalizations (p=.002) and worse overall functioning (p<.001).
Conclusions
The inclusion of the CPTSD in future versions of mental disorders manuals should increase the implementation of early specific trauma interventions, which may improve victims’ lives and reduce the risk of worse clinical outcomes.
Disclosure
No significant relationships.
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10
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Marques-Feixa L, Moya-Higueras J, Romero S, Santamarina-Pérez P, Rapado-Castro M, Zorrilla I, Martín M, Anglada E, Lobato MJ, Ramírez M, Moreno N, Mayoral M, Marín-Vila M, Arias B, Fañanás L. Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events. J Clin Med 2021; 10:jcm10225293. [PMID: 34830576 PMCID: PMC8624661 DOI: 10.3390/jcm10225293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/19/2022] Open
Abstract
Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan’s Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7–17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.
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Affiliation(s)
- Laia Marques-Feixa
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Av Diagonal 643, 2n A, 08028 Barcelona, Spain; (L.M.-F.); (N.M.); (B.A.)
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
| | - Jorge Moya-Higueras
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Department of Psychology, Faculty of Education, Psychology and Social Work, University of Lleida, Av. de I’Estudi General, 4, 25001 Lleida, Spain
| | - Soledad Romero
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, C/Villarroel, 170, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149, 08036 Barcelona, Spain
| | - Pilar Santamarina-Pérez
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neuroscience, Hospital Clínic de Barcelona, C/Villarroel, 170, 08036 Barcelona, Spain;
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149, 08036 Barcelona, Spain
| | - Marta Rapado-Castro
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, C. Dr. Esquerdo, 46, 28007 Madrid, Spain
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, C/Alan Gilbert, 161, Carlton, VIC 3053, Australia
| | - Iñaki Zorrilla
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Department of Psychiatry, Hospital Santiago Apostol, Olagibel Kalea, 29, 01004 Vitoria-Gasteiz, Spain
| | - María Martín
- Adolescent Crisis Unit, Hospital Benito Menni, C/Pablo Picasso, 12, 08830 Sant Boi de Llobregat, Spain;
| | - Eulalia Anglada
- Hospital for Adolescents, Fundació Orienta, c/Sant Lluís, 64, 08850 Gavà, Spain;
| | - María José Lobato
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, C/Joaquín Rodrigo, 1, 28222 Majadahonda, Spain; (M.J.L.); (M.M.-V.)
| | - Maite Ramírez
- Galdakao Mental Health Services, Child and Adolescent Mental Health, C/Ibaizabal, 6, 48960 Galdakao, Spain;
| | - Nerea Moreno
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Av Diagonal 643, 2n A, 08028 Barcelona, Spain; (L.M.-F.); (N.M.); (B.A.)
| | - María Mayoral
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, C. Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - María Marín-Vila
- Department of Psychiatry, Puerta de Hierro University Hospital-Majadahonda, C/Joaquín Rodrigo, 1, 28222 Majadahonda, Spain; (M.J.L.); (M.M.-V.)
| | - Bárbara Arias
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Av Diagonal 643, 2n A, 08028 Barcelona, Spain; (L.M.-F.); (N.M.); (B.A.)
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
| | - Lourdes Fañanás
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Av Diagonal 643, 2n A, 08028 Barcelona, Spain; (L.M.-F.); (N.M.); (B.A.)
- Network Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain; (J.M.-H.); (S.R.); (M.R.-C.); (I.Z.); (M.M.)
- Correspondence:
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Ibáñez-Samaniego L, Rapado-Castro M, Cabrero L, Navarrete C, García-Mulas S, Ahumada A, Marquez L, Pérez MD, Rincon D, Bañares R, Garcia-Martinez R. Hepatitis C eradication improves cognitive function in patients with or without cirrhosis: A prospective real-life study. Eur J Neurol 2021; 29:400-412. [PMID: 34634159 DOI: 10.1111/ene.15138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Hepatitis C virus (HCV) infection is associated with neuropsychiatric disturbances that impact on functioning and health-related quality of life (HRQoL). Reversibility at different liver disease stages is unknown, particularly in cirrhosis. We aimed to evaluate cognition, functioning, and HRQoL following HCV eradication at different liver disease stages. METHODS A random sample (n = 152) of consecutive patients treated with direct-acting antiviral agents (DAAs) between April 2015 and March 2017 were included. A comprehensive neuropsychological assessment, functioning and HRQoL questionnaires were applied at baseline, and 12 and 48 weeks after the end of antivirals. RESULTS One-hundred thirty-five patients who achieved virological response completed the follow-up, of whom 44 had cirrhosis (27% decompensated). Twenty-one percent had cognitive impairment before starting DAAs (34.1% cirrhotic vs. 14.4% noncirrhotic, p < 0.011). Viral eradication was associated with a decrease in cognitive impairment to 23% of cirrhotic and 6% of noncirrhotic patients (p < 0.05). Interestingly, older patients (B = 0.11, 95% confidence interval [CI] = 0.03-0.19) with baseline cognitive impairment (B = 3.58, 95% CI = 1.54-5.62) were those with higher cognitive benefit, regardless of liver disease. Persistent cognitive impairment was associated with having higher cardiovascular risk, cirrhosis, lower education, and higher anxiety and depression scores. Functioning and HRQoL also improved after eradication but remained worse in the cirrhotic group. CONCLUSIONS Viral eradication decreases the prevalence of cognitive impairment and improves functioning and HRQoL. Patients with lower brain reserve (older patients) and baseline cognitive impairment may benefit the most. Identification and treatment of HCV patients through screening programs may reduce the burden of cognitive disturbances beyond the prevention of liver disease progression.
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Affiliation(s)
- Luis Ibáñez-Samaniego
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain.,Gregorio Marañón Institute of Health Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón University General Hospital, Madrid, Spain.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Carlton, Victoria, Australia.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Lucia Cabrero
- Gregorio Marañón Institute of Health Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Navarrete
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Seila García-Mulas
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Adriana Ahumada
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Laura Marquez
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Maria Dolores Pérez
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Diego Rincon
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain.,Gregorio Marañón Institute of Health Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Rafael Bañares
- Hepatology Unit, Department of Digestive Diseases, Gregorio Marañón University General Hospital, Madrid, Spain.,Gregorio Marañón Institute of Health Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Rita Garcia-Martinez
- Gregorio Marañón Institute of Health Research, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Department of Internal Medicine, Gregorio Marañon University General Hospital, Madrid, Spain
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12
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Molina-García M, Fraguas D, del Rey-Mejías Á, Mezquida G, Sánchez-Torres AM, Amoretti S, Lobo A, González-Pinto A, Andreu-Bernabeu Á, Corripio I, Vieta E, Baeza I, Mané A, Cuesta M, de la Serna E, Payá B, Zorrilla I, Arango C, Bernardo M, Rapado-Castro M, Parellada M. The Role of Premorbid IQ and Age of Onset as Useful Predictors of Clinical, Functional Outcomes, and Recovery of Individuals with a First Episode of Psychosis. J Clin Med 2021; 10:2474. [PMID: 34199653 PMCID: PMC8199787 DOI: 10.3390/jcm10112474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND premorbid IQ (pIQ) and age of onset are predictors of clinical severity and long-term functioning after a first episode of psychosis. However, the additive influence of these variables on clinical, functional, and recovery rates outcomes is largely unknown. METHODS we characterized 255 individuals who have experienced a first episode of psychosis in four a priori defined subgroups based on pIQ (low pIQ < 85; average pIQ ≥ 85) and age of onset (early onset < 18 years; adult onset ≥ 18 years). We conducted clinical and functional assessments at baseline and at two-year follow-up. We calculated symptom remission and recovery rates using the Positive and Negative Symptoms of Schizophrenia Schedule (PANSS) and the Global Assessment Functioning (GAF or Children-GAF). We examined clinical and functional changes with pair-wise comparisons and two-way mixed ANOVA. We built hierarchical lineal and logistic regression models to estimate the predictive value of the independent variables over functioning or recovery rates. RESULTS early-onset patients had more severe positive symptoms and poorer functioning than adult-onset patients. At two-year follow-up, only early-onset with low pIQ and adult-onset with average pIQ subgroups differed consistently, with the former having more negative symptoms (d = 0.59), poorer functioning (d = 0.82), lower remission (61% vs. 81.1%), and clinical recovery (34.1% vs. 62.2%). CONCLUSIONS early-onset individuals with low pIQ may present persistent negative symptoms, lower functioning, and less recovery likelihood at two-year follow-up. Intensive cognitive and functional programs for these individuals merit testing to improve long-term recovery rates in this subgroup.
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Affiliation(s)
- Mariola Molina-García
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - David Fraguas
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos (IdISSC), Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain;
| | - Ángel del Rey-Mejías
- Data Science Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, School of Psychology, Complutense University of Madrid (UCM), 28223 Madrid, Spain;
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Ana M. Sánchez-Torres
- Department of Psychiatry, Navarra Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (A.M.S.-T.); (M.C.)
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Ana González-Pinto
- Department of Psychiatry, Bioaraba Health Research Institute, Hospital Universitario de Álava, Research Networking Center for Mental Health Network (CIBERSAM), University of the Basque Country (UPV/EHU), 01009 Vitoria, Spain; (A.G.-P.); (I.Z.)
| | - Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - Iluminada Corripio
- Department of Psychiatry, Institut d’Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Research Networking Center for Mental Health Network (CIBERSAM), Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain;
| | - Eduard Vieta
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Institute of Neurosciences, Hospital Clinic, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain;
| | - Inmaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, SGR-881, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Anna Mané
- Hospital del Mar Medical Research Institute, Research Networking Center for Mental Health Network (CIBERSAM), Autonomous University of Barcelona, 08003 Barcelona, Spain;
| | - Manuel Cuesta
- Department of Psychiatry, Navarra Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (A.M.S.-T.); (M.C.)
| | - Elena de la Serna
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), 08036 Barcelona, Spain;
| | - Beatriz Payá
- IDIVAL, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Iñaki Zorrilla
- Department of Psychiatry, Bioaraba Health Research Institute, Hospital Universitario de Álava, Research Networking Center for Mental Health Network (CIBERSAM), University of the Basque Country (UPV/EHU), 01009 Vitoria, Spain; (A.G.-P.); (I.Z.)
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic of Barcelona, Research Networking Center for Mental Health Network (CIBERSAM), University of Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC 3053, Australia
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain; (Á.A.-B.); (C.A.); (M.R.-C.); (M.P.)
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13
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de Arriba-Enriquez J, Sanz-Casado E, Vieta E, Rapado-Castro M, Arango C. Quality of care in psychiatry is related to research activity. Eur Psychiatry 2021; 64:e53. [PMID: 33658094 PMCID: PMC8446072 DOI: 10.1192/j.eurpsy.2021.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The top biomedical research institutions have traditionally been assumed to provide better medical treatment for their patients. However, this may not necessarily be the case. Low-to-moderate negative associations between research activity and the quality-of-care provided by clinical departments have been described. We aimed to examine this relationship in the psychiatric units of the largest hospitals in Spain. Methods Scientific publications for 50 hospitals were retrieved from the Web of Science (2006–2015), and quality of mental healthcare data were gathered from Spanish National Health System records (2008–2014). Spearman-rank correlation analyses (adjusting for number of beds and population) were used to examine the associations between research data and quality-of-care outcomes in psychiatry. Stepwise regression models were built in order to determine the predictive value of research productivity for healthcare outcomes. Results We found a positive association between research activity indicators (i.e., number of publications, number of citations, cumulative impact factor, and institutional H-index) and better quality-of-care outcomes in psychiatry (i.e., number of readmissions, transfers, and discharges from hospital). In particular, a higher research activity predicted a lower level of readmissions for individuals with psychoses (p = 0.025; R = 0.317), explaining 8.2% of the variance when other factors were accounted for. Conclusions Higher research activity is associated with better quality of mental healthcare in psychiatry. Our results can inform decision-making in clinical and research management settings in order to determine the most appropriate quality measures of the impact of research on the prognosis of individuals with psychiatric conditions.
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Affiliation(s)
- J de Arriba-Enriquez
- CIBERNED, Network Centre for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - E Sanz-Casado
- Research Institute for Higher Education and Science (INAECU), University Carlos III of Madrid and Autonomous University of Madrid, Madrid, Spain
| | - E Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, VI, Australia
| | - C Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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14
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Rodriguez-Toscano E, López G, Mayoral M, Lewis S, Lees J, Drake R, Arango C, Rapado-Castro M. A longitudinal comparison of two neurocognitive test batteries in patients with schizophrenia and healthy volunteers: Time effects on neuropsychological performance and their relation to functional outcome. Schizophr Res 2020; 216:347-356. [PMID: 31813804 DOI: 10.1016/j.schres.2019.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/21/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
Cognitive impairment is a major unmet need in the treatment of schizophrenia. Over the last decade, the MATRICS Consensus Cognitive Battery (MCCB) has been used to assess the effects of novel treatments for cognitive impairment in schizophrenia. However, other cognitive-neuroscience-based cognitive batteries, such as the Cambridge Neuropsychological Test Automated Battery (CANTAB) have been suggested as an alternative to the MCCB. Although both batteries purport to assess cognitive function in psychosis, no previous study has attempted to examine their validity longitudinally and the potential overlap between the two batteries over time. The aim of the current study was to assess the relationship between the MCCB and the CANTAB in the longitudinal assessment of cognitive impairment in schizophrenia. A sample of 39 stable schizophrenia outpatients and 18 controls completed the MCCB and the CANTAB battery at baseline, and at 2, 4 and 8-weeks follow-up. Correlation analyses and a mixed-model repeated measures approach were used. We found no significant effect of time in the MCCB. In contrast, for the CANTAB a significant effect of time consistent with practice effects for the attention domain in the control group and for the visual learning, reasoning and problem-solving, and social cognition domains in patients, with subjects performing better at follow-up. In particular, a significant time ∗ battery interaction was found for those cognitive domains. These findings suggest there are specific differences across cognitive tests to assess cognitive impairments in schizophrenia and that measures derived from the CANTAB appear to be more prone to practice effects in these patients.
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Affiliation(s)
- Elisa Rodriguez-Toscano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Experimental Psychology, Faculty of Psychology, Universidad Complutense Madrid, Spain.
| | - Gonzalo López
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Maria Mayoral
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Shon Lewis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Jane Lees
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Richard Drake
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Greater Manchester Mental Health NHS Trust, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
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15
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Allott K, Fraguas D, Bartholomeusz CF, Díaz-Caneja CM, Wannan C, Parrish EM, Amminger GP, Pantelis C, Arango C, McGorry PD, Rapado-Castro M. Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis. Psychol Med 2018; 48:1592-1607. [PMID: 29173201 DOI: 10.1017/s0033291717003002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). METHOD MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. RESULTS The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. CONCLUSION There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.
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Affiliation(s)
- K Allott
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - D Fraguas
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C F Bartholomeusz
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C M Díaz-Caneja
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - C Wannan
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - E M Parrish
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - G P Amminger
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - C Pantelis
- Department of Psychiatry,Melbourne Neuropsychiatry Centre,The University of Melbourne and Melbourne Health,Parkville,Australia
| | - C Arango
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
| | - P D McGorry
- Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia
| | - M Rapado-Castro
- Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain
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16
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Allott KA, Yuen HP, Bartholomeusz CF, Rapado-Castro M, Phassouliotis C, Butselaar F, Wood SJ, Proffitt TM, Savage G, Phillips LJ, Bendall S, Markulev C, Reniers RLEP, Pantelis C, Baldwin L, McGorry PD, Garner B. Stress hormones and verbal memory in young people over the first 12 weeks of treatment for psychosis. Psychiatry Res 2018; 260:60-66. [PMID: 29175500 DOI: 10.1016/j.psychres.2017.11.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/24/2022]
Abstract
AIMS Memory impairment in psychosis may be mediated through detrimental effects of hypothalamic-pituitary-adrenal (HPA) axis function. This study prospectively investigated the relationship between cortisol, sulphate dehydroepiandrosterone (DHEA(S) and cortisol: DHEA(S) ratio and memory in 35 first-episode psychosis (FEP) patients during the first 12 weeks of treatment and 23 healthy controls (HC). METHODS Morning blood sampling and tests of attention, working memory and verbal memory occurred at baseline and 12-week follow-up. RESULTS FEP and HC groups did not significantly differ in levels of cortisol, DHEA(S) or their ratio at baseline or over 12-weeks. The FEP group performed significantly below HC on all cognitive measures at baseline and over 12-weeks. Cortisol levels were unrelated to cognition in both groups. At baseline, DHEA(S) was positively associated with attention in HCs, but negatively associated with attention in FEP participants. Change in DHEA(S) was negatively associated with change in memory over 12-weeks in both groups. At 12-weeks, there was a negative correlation between the cortisol: DHEA(S) ratio and attention in both groups. CONCLUSIONS These findings are mostly in contrast to findings in chronic schizophrenia. Investigation at different illness phases and over longer-follow-up periods is required to determine the complex relationship between HPA-axis and memory functioning in psychosis.
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Affiliation(s)
- Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Cali F Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia; Child and Adolescent Psychiatry Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Felicity Butselaar
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Tina-Marie Proffitt
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Greg Savage
- ARC Centre of Excellence in Cognition and its Disorders, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate L E P Reniers
- School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Lara Baldwin
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Belinda Garner
- Translational Research Institute, Institute of Health and Biomedical Innovation, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
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Castro-Fornieles J, Bargalló N, Calvo A, Arango C, Baeza I, Gonzalez-Pinto A, Parellada M, Graell M, Moreno C, Otero S, Janssen J, Rapado-Castro M, de la Serna E. Gray matter changes and cognitive predictors of 2-year follow-up abnormalities in early-onset first-episode psychosis. Eur Child Adolesc Psychiatry 2018; 27:113-126. [PMID: 28707138 DOI: 10.1007/s00787-017-1013-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Abstract
This study aims to examine regional gray matter (GM) changes over a period of 2 years in patients diagnosed with early-onset first-episode psychosis (EO-FEP), and to identify baseline predictors of abnormalities at the follow-up. Fifty-nine patients with EO-FEP aged 11-17 years were assessed. Magnetic resonance imaging was carried out at admission and 2 years later. Changes over time were assessed with voxel-based morphometry. Fifty-nine patients (34 schizophrenia-SCZ, 15 bipolar disorder-BP, and 10 other psychotic disorders) and 70 healthy controls were assessed. At baseline no differences were found between the EO-FEP groups and control subjects. Over time, SCZ patients presented a larger GM decrease in the orbitofrontal cortex, anterior midline frontal cortex, cingulate, left caudate, and thalamus. BP patients also had a larger GM decrease in the right putamen, right orbitofrontal cortex, and anterior and midline region of the right superior frontal gyrus and left caudate, but with fewer areas showing significant differences than in the comparison between SCZ and controls. In the cross-sectional analysis, only SCZ patients showed differences with respect to controls in some GM areas. Significant baseline predictors of a 2-year reduction in GM were IQ and working memory. EO-FEP patients did not show differences in GM compared to controls at baseline. Both SCZ and BP patients showed a greater decrease in specific areas during the first 2 years. At follow-up, only SCZ patients differed significantly from controls in specific brain areas. The GM reduction was predicted by baseline cognitive variables.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain.
- Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain.
| | - Nuria Bargalló
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Anna Calvo
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Immaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Hospital Santiago Apóstol, CIBERSAM, EHU/University of the Basque Country, Vitoria, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, CIBERSAM, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Soraya Otero
- Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, CIBERSAM, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Joost Janssen
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Rapado-Castro
- Department of Child and Adolescent Psychiatry, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Neurosciences Institute, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Villarroel, 170, 08036, Barcelona, Spain
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Abstract
BACKGROUND Cognitive deficits are predictors of functional outcome in patients with psychosis. While conventional antipsychotics are relatively effective on positive symptoms, their impact on negative and cognitive symptoms is limited. Recent studies have established a link between oxidative stress and neurocognitive deficits in psychosis. N-acetylcysteine (NAC), a glutathione precursor with glutamatergic properties, has shown efficacy on negative symptoms and functioning in patients with schizophrenia and bipolar disorder, respectively. However, there are few evidence-based approaches for managing cognitive impairment in psychosis. The present study aims to examine the cognitive effects of adjunctive NAC treatment in a pooled subgroup of participants with psychosis who completed neuropsychological assessment in two trials of both schizophrenia and bipolar disorder. METHOD A sample of 58 participants were randomized in a double fashion to receive 2 g/day of NAC (n = 27) or placebo (n = 31) for 24 weeks. Attention, working memory and executive function domains were assessed. Differences between cognitive performance at baseline and end point were examined using Wilcoxon's test. The Mann-Whitney test was used to examine the differences between the NAC and placebo groups at the end point. RESULTS Participants treated with NAC had significantly higher working memory performance at week 24 compared with placebo (U = 98.5, p = 0.027). CONCLUSIONS NAC may have an impact on cognitive performance in psychosis, as a significant improvement in working memory was observed in the NAC-treated group compared with placebo; however, these preliminary data require replication. Glutamatergic compounds such as NAC may constitute a step towards the development of useful therapies for cognitive impairment in psychosis.
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Affiliation(s)
- M Rapado-Castro
- Child and Adolescent Psychiatry Department,Hospital General Universitario Gregorio Marañón,School of Medicine,Universidad Complutense,IiSGM,CIBERSAM,Madrid,Spain
| | - S Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine,Barwon Health,PO Box 291,Geelong,Victoria,Australia
| | - A I Bush
- Department of Psychiatry,University of Melbourne,Level 1 North,Main Block,Royal Melbourne Hospital,Parkville,Victoria,Australia
| | - G S Malhi
- Academic Department of Psychiatry,Kolling Institute,Northern Sydney Local Health District,St Leonards,NSW,Australia
| | - D R Skvarc
- Deakin University, IMPACT Strategic Research Centre, School of Medicine,Barwon Health,PO Box 291,Geelong,Victoria,Australia
| | - Z X On
- Melbourne School of Psychological Sciences,University of Melbourne,Level 12,Redmond Barry Building 115,Parkville,Victoria,Australia
| | - M Berk
- Orygen, The National Centre of Excellence in Youth Mental Health,Victoria,Australia
| | - O M Dean
- Deakin University, IMPACT Strategic Research Centre, School of Medicine,Barwon Health,PO Box 291,Geelong,Victoria,Australia
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Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sánchez-Gutiérrez T, Arango C, Mayoral M. Psychoeducational Group Intervention for Adolescents With Psychosis and Their Families: A Two-Year Follow-Up. J Am Acad Child Adolesc Psychiatry 2015; 54:984-90. [PMID: 26598473 DOI: 10.1016/j.jaac.2015.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/25/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate whether the beneficial effects of a structured, psychoeducational, parallel-group program for adolescents with early-onset psychosis and their families observed immediately after the intervention were maintained 2 years later. METHOD The present study examines the longitudinal efficacy of a randomized controlled trial based on a psychoeducational, problem-solving, structured group intervention for adolescents with early-onset psychosis and their families (PE) and compares it with that of a nonstructured group intervention (NS) after a 2-year follow-up. We analyzed whether the differences between PE and NS found after the intervention persisted 2 years later. Intergroup differences in number and duration of hospitalizations, symptoms, and functioning were also assessed. RESULTS After 2 years of follow-up, we were able to reassess 89% of patients. In the PE group, 13% of patients had visited the emergency department, compared with 50% in the NS group (p = .019). However, no statistically significant differences were found between the groups for negative symptoms or number and duration of hospitalizations. A significant improvement in Positive and Negative Syndrome Scale (PANSS) general symptoms was observed in the PE group. CONCLUSION Our psychoeducational group intervention showed sustained effects by diminishing the number of visits to emergency departments 2 years after the intervention. Our findings indicate that this psychoeducational intervention could provide patients with long-lasting resources to manage crises more effectively. Clinical trial registration information-Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372.
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Affiliation(s)
- Ana Calvo
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid.
| | - Miguel Moreno
- Gipuzkoako Osasun Mentaleko Sarea, Red de Salud Mental de Guipuzcoa, Biodonostia, San Sebastian, Spain
| | - Ana Ruiz-Sancho
- VocAcción Director-Group Processes and Institutional Consulting, Madrid
| | - Marta Rapado-Castro
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid; Melbourne Neuropsychiatry Centre, the University of Melbourne and Melbourne Health, Carlton South, Australia
| | - Carmen Moreno
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Teresa Sánchez-Gutiérrez
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
| | - María Mayoral
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid
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20
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Parellada M, Castro-Fornieles J, Gonzalez-Pinto A, Pina-Camacho L, Moreno D, Rapado-Castro M, Otero S, de la Serna E, Moreno C, Baeza I, Graell M, Arango C. Predictors of functional and clinical outcome in early-onset first-episode psychosis: the child and adolescent first episode of psychosis (CAFEPS) study. J Clin Psychiatry 2015; 76:e1441-8. [PMID: 26580481 DOI: 10.4088/jcp.13m08863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to study baseline clinical and biological predictors of 2-year outcome in a cohort of children and adolescents with a first episode of psychosis. METHOD Standard instruments were used to evaluate symptoms and functioning in 110 children and adolescents (mean age = 15.47 years) with first episode of psychosis at admission (between 2003 and 2005) and after 2-year follow-up. Clinical assessments included diagnostic assessment to yield DSM-IV diagnosis, developmental, premorbid, and past-year data, together with structural neuroimaging and other biological parameters (genetics and oxidative stress). Eighty-three subjects had assessments at baseline (including the Strauss-Carpenter Outcome Scale [SCOS]) and at 2-year follow-up. Association and multistep regression analyses were conducted to show correlates and predictors of primary outcome measures: functional outcome (Children's Global Assessment Scale [CGAS]), improvement (CGAS change), and primary negative symptoms (Proxy for the Deficit Syndrome Scale). RESULTS The SCOS predicted 27.46% (P < .001) of the variance in CGAS score at 2 years. Baseline severity (measured by CGAS) predicted 30.9% (P < .001) of CGAS improvement after 2 years, and SCOS total score predicted an added 24.1% (P < .001). A diagnosis of nonaffective psychosis, primary negative symptoms, and less white matter at baseline predicted more primary negative symptoms at follow-up. The prediction of functional outcome was not increased by genetic, oxidative stress, or neurostructural markers. CONCLUSIONS Baseline clinical assessments have a better predictive value than biological assessments for 2-year follow-up functioning of children and adolescents with a first episode of psychosis. Patients with primary negative symptoms at baseline continue to have negative symptoms 2 years later, and neurostructural markers predict these. Clinicians must still rely on clinical variables to judge the functional prognosis of early-onset first psychotic episodes.
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Affiliation(s)
- Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Ibiza 43, Madrid 28009, Spain
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21
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Rapado-Castro M, Bartholomeusz CF, Castro-Fornieles J, González-Pinto A, Otero S, Baeza I, Moreno C, Graell M, Janssen J, Bargalló N, Pantelis C, Desco M, Arango C. Gender effects on brain changes in early-onset psychosis. Eur Child Adolesc Psychiatry 2015; 24:1193-205. [PMID: 25589436 DOI: 10.1007/s00787-014-0669-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
Progressive loss of cortical gray matter (GM) and increase of cerebrospinal fluid (CSF) have been reported in early-onset psychosis (EOP). EOP typically begins during adolescence, a time when developmental brain trajectories differ by gender. This study aimed to determine gender differences in progression of brain changes in this population. A sample of 61 (21 females) adolescents with a first psychotic episode and a matched sample of 70 (23 females) controls underwent both baseline and 2-year follow-up anatomical brain imaging assessments. Regional GM and CSF volumes were obtained using automated methods based on the Talairach's proportional grid system. At baseline, only male patients showed a clear pattern of alterations in the frontal lobe relative to controls (smaller GM and larger CSF volumes). However, parallel longitudinal changes for male and female patients relative to controls were observed, resulting in a common pattern of brain changes across both genders: rate of left frontal lobe GM volume loss was larger in male (-3.8%) and female patients (-4.2%) than in controls (-0.7% males; -0.4% females). The reverse was found for the CSF volume in the left frontal lobe. While the GM and CSF volumes of females with EOP appear to be within the normal range at initial illness onset, our results point to a similar trajectory of increased/accelerated brain changes in both male and female patients with EOP. The pattern of progression of brain changes in psychosis appears to be independent of gender or structural alterations on appearance of psychotic symptoms.
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Affiliation(s)
- Marta Rapado-Castro
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, 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, VIC, 3053, Australia.
| | - Cali F Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC, 3053, Australia
| | - Josefina Castro-Fornieles
- Child Psychiatry and Psychology Department, Neurosciences Institute, Hospital Clinic de Barcelona, IDIBAPS, SGR-1119, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Ana González-Pinto
- Hospital Santiago Apóstol de Vitoria, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Kronikgune, EHU-UPV, Vitoria, Spain
| | - Soraya Otero
- Child Psychiatry Unit, Hospital Universitario Marqués de Valdecilla, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Santander, Spain
| | - Inmaculada Baeza
- Child Psychiatry and Psychology Department, Neurosciences Institute, Hospital Clinic de Barcelona, IDIBAPS, SGR-1119, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Carmen Moreno
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Montserrat Graell
- Psychiatry and Psychology Department, Hospital Infantil Universitario Niño Jesús, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Joost Janssen
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
- Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Nuria Bargalló
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC, 3053, Australia
| | - Manuel Desco
- Department of Bioengineering and Aerospatial Engineering, University Carlos III de Madrid, Madrid, Spain
- Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
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22
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Rapado-Castro M, McGorry PD, Yung A, Calvo A, Nelson B. Sources of clinical distress in young people at ultra high risk of psychosis. Schizophr Res 2015; 165:15-21. [PMID: 25890793 DOI: 10.1016/j.schres.2015.03.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/25/2015] [Accepted: 03/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic. METHOD Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psychosis was explored. RESULTS Of the total sample, 89.04% fulfilled the APS UHR criteria. APS symptoms were reported to be distressing for 58.5% of this subsample, but social and functioning difficulties (78.1%) and depressive symptoms (58.9%) were the highest sources of distress leading UHR patients to seek help. Intensity of distress associated with APS, anxiety symptoms and substance use was associated with transition to psychosis. CONCLUSIONS APS were reported to be distressing for approximately half of UHR patients. The intensity of distress associated to these symptoms may be associated with increased risk for subsequent transition to full threshold psychotic disorder.
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Affiliation(s)
- Marta Rapado-Castro
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia
| | - Alison Yung
- Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, England, United Kingdom
| | - Ana Calvo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia.
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Waterdrinker A, Berk M, Venugopal K, Rapado-Castro M, Turner A, Dean OM. Effects of N-Acetyl cysteine on suicidal ideation in bipolar depression. J Clin Psychiatry 2015; 76:665. [PMID: 26035204 DOI: 10.4088/jcp.14l09378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Thomson D, Berk M, Dodd S, Rapado-Castro M, Quirk SE, Ellegaard PK, Berk L, Dean OM. Tobacco use in bipolar disorder. Clin Psychopharmacol Neurosci 2015; 13:1-11. [PMID: 25912533 PMCID: PMC4423166 DOI: 10.9758/cpn.2015.13.1.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
Tobacco use in mental health in general and bipolar disorder in particular remains disproportionally common, despite declining smoking rates in the community. Furthermore, interactions between tobacco use and mental health have been shown, indicating the outcomes for those with mental health disorders are impacted by tobacco use. Factors need to be explored and addressed to improve outcomes for those with these disorders and target specific interventions for people with psychiatric illness to cease tobacco smoking. In the context of bipolar disorder, this review explores; the effects of tobacco smoking on symptoms, quality of life, suicidal behavior, the biological interactions between tobacco use and bipolar disorder, the interactions between tobacco smoking and psychiatric medications, rates and factors surrounding tobacco smoking cessation in bipolar disorder and suggests potential directions for research and clinical translation. The importance of this review is to bring together the current understanding of tobacco use in bipolar disorder to highlight the need for specific intervention.
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Affiliation(s)
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Victoria, Australia.,Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Maranon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong
| | - Pernille K Ellegaard
- Research Unit, Mental Health Services, Region of Southern Denmark, Esbjerg, Denmark
| | - Lesley Berk
- Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia
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25
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Pina-Camacho L, Garcia-Prieto J, Parellada M, Castro-Fornieles J, Gonzalez-Pinto AM, Bombin I, Graell M, Paya B, Rapado-Castro M, Janssen J, Baeza I, Del Pozo F, Desco M, Arango C. Predictors of schizophrenia spectrum disorders in early-onset first episodes of psychosis: a support vector machine model. Eur Child Adolesc Psychiatry 2015; 24:427-40. [PMID: 25109600 DOI: 10.1007/s00787-014-0593-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/29/2014] [Indexed: 12/21/2022]
Abstract
Identifying early-onset schizophrenia spectrum disorders (SSD) at a very early stage remains challenging. To assess the diagnostic predictive value of multiple types of data at the emergence of early-onset first-episode psychosis (FEP), various support vector machine (SVM) classifiers were developed. The data were from a 2-year, prospective, longitudinal study of 81 patients (age 9-17 years) with early-onset FEP and a stable diagnosis during follow-up and 42 age- and sex-matched healthy controls (HC). The input was different combinations of baseline clinical, neuropsychological, magnetic resonance imaging brain volumetric and biochemical data, and the output was the diagnosis at follow-up (SSD vs. non-SSD, SSD vs. HC, and non-SSD vs. HC). Enhanced recursive feature elimination was performed for the SSD vs. non-SSD classifier to select and rank the input variables with the highest predictive value for a diagnostic outcome of SSD. After validation with a test set and considering all baseline variables together, the SSD vs. non-SSD, SSD vs. HC and non-SSD vs. HC classifiers achieved an accuracy of 0.81, 0.99 and 0.99, respectively. Regarding the SSD vs. non-SSD classifier, a combination of baseline clinical variables (severity of negative, disorganized symptoms and hallucinations or poor insight) and neuropsychological variables (impaired attention, motor coordination, and global cognition) showed the highest predictive value for a diagnostic outcome of SSD. Neuroimaging and biochemical variables at baseline did not add to the predictive value. Thus, comprehensive clinical/cognitive assessment remains the most reliable approach for differential diagnosis during early-onset FEP. SVMs may constitute promising multivariate tools in the search for predictors of diagnostic outcome in FEP.
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Affiliation(s)
- Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón. School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Ibiza 43, 28009, Madrid, Spain,
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26
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Rapado-Castro M, Berk M, Venugopal K, Bush AI, Dodd S, Dean OM. Towards stage specific treatments: effects of duration of illness on therapeutic response to adjunctive treatment with N-acetyl cysteine in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2015; 57:69-75. [PMID: 25315856 DOI: 10.1016/j.pnpbp.2014.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
Schizophrenia is a chronic and often debilitating disorder in which stage of illness appears to influence course, outcome, prognosis and treatment response. Current evidence suggests roles for oxidative, neuroinflammatory, neurotrophic, apoptotic, mitochondrial and glutamatergic systems in the disorder; all targets of N-acetyl cysteine (NAC). A double blind, placebo controlled trial suggested NAC to be beneficial to those diagnosed with schizophrenia. The current manuscript aims to investigate duration of the illness as a key factor that may be modulating the response to NAC in the participants who took part in the study. A sample of 121 participants were randomised in a double fashion to 24 weeks (placebo=62; NAC=59). Clinical and functional variables were collected over the treatment period. Duration of the illness at baseline was grouped into <10 years, 10-<20 years and >20 years. Mixed Model Repeated Measures Analysis was used to explore the effect of illness duration on response to treatment with NAC. A significant interaction between duration of the illness and response to treatment with NAC was consistently found for positive symptoms and functional variables, but not for negative or general symptoms or for side effect related outcomes. The pattern of changes suggests that this mediator effect of duration of illness in response to treatment is more evident in those participants with 20 years or more of illness duration. Our results suggest a potential advantage of adjunctive NAC over placebo on functioning and positive symptoms reduction in those patients with chronic schizophrenia. This has potential for suggesting stage specific treatments.
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Affiliation(s)
- Marta Rapado-Castro
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Michael Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, Victoria 3053, Australia; IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong 3220, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052 Parkville, Australia.
| | - Kamalesh Venugopal
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong 3220, Australia
| | - Ashley I Bush
- University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville 3052, Australia
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong 3220, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, Deakin University, School of Medicine, Barwon Health, P.O. Box 291, Geelong 3220, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052 Parkville, Australia
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Martínez-Cengotitabengoa M, Micó JA, Arango C, Castro-Fornieles J, Graell M, Payá B, Leza JC, Zorrilla I, Parellada M, López MP, Baeza I, Moreno C, Rapado-Castro M, González-Pinto A. Basal low antioxidant capacity correlates with cognitive deficits in early onset psychosis. A 2-year follow-up study. Schizophr Res 2014; 156:23-9. [PMID: 24768133 DOI: 10.1016/j.schres.2014.03.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/07/2014] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
The objective of the study is to examine the association of baseline total antioxidant status (TAS) and glutathione (GSH) levels with short- and long-term cognitive functioning in patients with early onset first-episode psychosis, comparing affective and non-affective psychoses. We analysed 105 patients with an early onset-first episode psychosis (age 9-17 years) and 97 healthy controls. Blood samples were taken at admission for measurement of TAS and GSH, and cognitive performance was assessed at baseline and at 2years of follow-up. Regression analysis was used to assess the relationship between TAS/GSH levels at baseline and cognitive performance at both time points, controlling for confounders. Baseline TAS and GSH levels were significantly lower in patients than healthy controls. In patients, baseline TAS was positively associated with the global cognition score at baseline (p=0.048) and two years later (p=0.005), while TAS was not associated with cognitive functioning in healthy controls. Further, baseline TAS in patients was specifically associated with the memory domain at baseline and with the memory and attention domains two years later. Stratifying by affective and non-affective psychoses, significant associations were only found between TAS and cognition in the non-affective psychosis group. Baseline GSH levels were not associated with cognitive functioning at either time point in either group. The antioxidant defence capacity in early onset first-episode psychotic patients is directly correlated with global cognition at baseline and at 2years of follow-up, especially in non-affective psychosis.
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Affiliation(s)
- Mónica Martínez-Cengotitabengoa
- Department of Psychiatry, Hospital Universitario de Alava, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; National Distance Education University (UNED)-Centro Asociado de Vitoria, Spain.
| | - Juan Antonio Micó
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, University of Cadiz, Cadiz, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; Medical School, Universidad Complutense, Madrid, Spain
| | - Josefina Castro-Fornieles
- 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, SGR-1119, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain; Department of Psychiatry and Psychobiology, University of Barcelona, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, Madrid, Spain
| | - Beatriz Payá
- Child and Adolescent Psychiatry and Psychology Unit, University Hospital Marques de Valdecilla, Santander, Spain
| | - Juan Carlos Leza
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Department of Pharmacology, Medical School, Universidad Complutense, Madrid, Spain
| | - Iñaki Zorrilla
- Department of Psychiatry, Hospital Universitario de Alava, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - M Purificación López
- Department of Psychiatry, Hospital Universitario de Alava, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; University of the Basque Country, Spain
| | - Inmaculada Baeza
- Department of Psychiatry, Clinic Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Carmen Moreno
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Marta Rapado-Castro
- Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, Vitoria, Spain; Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; University of the Basque Country, Spain
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Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sánchez-Gutiérrez T, Arango C, Mayoral M. Intervention for adolescents with early-onset psychosis and their families: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2014; 53:688-96. [PMID: 24839887 DOI: 10.1016/j.jaac.2014.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families. The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease, to mitigate crises, and to prevent relapses. METHOD We performed a 9-month, randomized, rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents. A psychoeducational problem-solving group intervention (n = 27) was compared with a nonstructured group intervention (n = 28). The primary outcomes were number of hospitalizations, days of hospitalization, and visits to the emergency department. The secondary outcome measures were clinical variables and family environment. RESULTS Assessments were performed before and after the intervention. At the end of the group intervention, 15% of patients in the psychoeducational group and 39% patients in the nonstructured group had visited the emergency department (χ² = 3.62, df = 1, p = .039). The improvement in negative symptoms was more pronounced in the psychoeducational group (12.84 [7.87]) than in the nonstructured group (15.81 [6.37]) (p = .039). CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family, thus reducing the number of visits to the emergency department. Negative symptoms improved in adolescents in the psychoeducational group. Clinical trial registration information--Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372. [corrected].
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Affiliation(s)
- Ana Calvo
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Miguel Moreno
- Gipuzkoako Osasun MentalekoSarea, Red de Salud Mental de Guipuzcoa, San Sebastian, Spain
| | - Ana Ruiz-Sancho
- VocAcción Director-Group Processes and Institutional Consulting, Madrid, Spain
| | - Marta Rapado-Castro
- Hospital General Universitario Gregorio Maranon School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Orygen Youth Health Research Centre, Centre for Youth Mental Health, and Melbourne Neuropsychiatry Centre, the University of Melbourne, and Melbourne Health, Australia
| | - Carmen Moreno
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Teresa Sánchez-Gutiérrez
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - María Mayoral
- Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Pina-Camacho L, Diaz-Caneja C, Garcia-Prieto J, Parellada M, Castro-Fornieles J, Gonzalez-Pinto A, Bombin I, Graell M, Otero S, Rapado-Castro M, Janssen J, Baeza I, Del Pozo F, Desco M, Arango C. EPA-0882 - Prediction of diagnosis of early-onset schizophrenia spectrum disorders using support vector machines. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Torrent C, Bonnin CDM, Martínez-Arán A, Valle J, Amann BL, González-Pinto A, Crespo JM, Ibáñez Á, Garcia-Portilla MP, Tabarés-Seisdedos R, Arango C, Colom F, Solé B, Pacchiarotti I, Rosa AR, Ayuso-Mateos JL, Anaya C, Fernández P, Landín-Romero R, Alonso-Lana S, Ortiz-Gil J, Segura B, Barbeito S, Vega P, Fernández M, Ugarte A, Subirà M, Cerrillo E, Custal N, Menchón JM, Saiz-Ruiz J, Rodao JM, Isella S, Alegría A, Al-Halabi S, Bobes J, Galván G, Saiz PA, Balanzá-Martínez V, Selva G, Fuentes-Durá I, Correa P, Mayoral M, Chiclana G, Merchan-Naranjo J, Rapado-Castro M, Salamero M, Vieta E. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry 2013; 170:852-9. [PMID: 23511717 DOI: 10.1176/appi.ajp.2012.12070971] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.
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Affiliation(s)
- Carla Torrent
- Centers for Biomedical Research Network on Mental Health(CIBERSAM), Barcelona, Madrid, Vitoria, Oviedo, and Valencia, Spain
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Payá B, Rodríguez-Sánchez JM, Otero S, Muñoz P, Castro-Fornieles J, Parellada M, Gonzalez-Pinto A, Soutullo C, Baeza I, Rapado-Castro M, Sáenz-Herrero M, Moreno D, Arango C. Premorbid impairments in early-onset psychosis: differences between patients with schizophrenia and bipolar disorder. Schizophr Res 2013; 146:103-10. [PMID: 23465966 DOI: 10.1016/j.schres.2013.01.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 01/08/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the large body of research on premorbid impairments in schizophrenia, studies comparing different early-onset psychoses are scarce. AIMS To examine premorbid impairments in first episodes of early-onset bipolar and schizophrenia disorders. METHOD We compared premorbid adjustment and other premorbid variables such as IQ and developmental abnormalities in a cohort of children and adolescents (N=69) with bipolar disorder (BP) or schizophrenia (SZ) experiencing their first psychotic episode and in a healthy control group (N=91). RESULTS Schizophrenia patients showed more social impairment in childhood than bipolar patients (p<0.05) and healthy controls (p<0.001) and had higher rates of developmental abnormalities (p<0.05) than healthy controls. Between childhood and early adolescence, schizophrenia and bipolar patients showed a greater decline in academic adjustment than healthy controls, more specifically in adaptation to school (p<0.01). CONCLUSIONS Early-onset schizophrenia patients show more early social impairment than early-onset bipolar patients. Intellectual premorbid abnormalities are less specific and probably more linked to early-onset psychosis.
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Affiliation(s)
- Beatriz Payá
- Child and Adolescent Psychiatry and Psychology Unit, Hospital Universitario Marques de Valdecilla, Santander, Spain.
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Bombin I, Mayoral M, Castro-Fornieles J, Gonzalez-Pinto A, de la Serna E, Rapado-Castro M, Barbeito S, Parellada M, Baeza I, Graell M, Payá B, Arango C. Neuropsychological evidence for abnormal neurodevelopment associated with early-onset psychoses. Psychol Med 2013; 43:757-768. [PMID: 22831788 DOI: 10.1017/s0033291712001535] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The longitudinal neuropsychological study of first-episode early-onset psychosis (EOP) patients, whose brain maturation is still in progress at the time of illness onset, provides a unique opportunity to compare their cognitive development with that of healthy subjects, in search of specific patterns resulting from the interaction between neurodevelopmental processes and the presence of psychotic disorders. Method Seventy-five first-episode EOP patients (schizophrenia n = 35; bipolar disorder n = 17; other forms of psychosis n = 23) with a mean age of 15.53 years were assessed with a neuropsychological battery that included measures of attention, working memory, memory and executive functions within 6 months following the onset of the first psychotic symptom (baseline) and 2 years later. Psychotic symptoms were assessed at both times with the Positive and Negative Symptom Scale (PANSS). Seventy-nine healthy subjects matched for age and education served as controls. RESULTS EOP patients showed significant cognitive impairment at both baseline and the 2-year follow-up, with no significant differences between diagnostic groups at either time. Both healthy controls and EOP patients improved in all cognitive measures, except for patient working memory. Improvement in patient attention lost significance after controlling for psychotic symptom reduction. No significant time/diagnosis interaction was found among patients (p > 0.405). CONCLUSIONS Cognitive impairment in EOP is already present at the first episode, and cognitive development seems to be arrested early in EOP patients compared to their healthy peers, at least for some cognitive functions. These and previous similar results support the neurodevelopmental hypothesis of psychosis.
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Affiliation(s)
- I Bombin
- Department of Psychology, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
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Ruiz-Sancho A, Calvo A, Rapado-Castro M, Moreno M, Moreno C, Sanchez-Gutierrez T, Tapia C, Chiclana G, Rodriguez P, Fernandez P, Arango C, Mayoral M. PIENSA: Development of an Early Intervention Program for Adolescents With Early-Onset Psychosis and Their Families. APS 2012. [DOI: 10.2174/2210676611202030229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fraguas D, Gonzalez-Pinto A, Micó JA, Reig S, Parellada M, Martínez-Cengotitabengoa M, Castro-Fornieles J, Rapado-Castro M, Baeza I, Janssen J, Desco M, Leza JC, Arango C. Decreased glutathione levels predict loss of brain volume in children and adolescents with first-episode psychosis in a two-year longitudinal study. Schizophr Res 2012; 137:58-65. [PMID: 22365149 DOI: 10.1016/j.schres.2012.01.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/28/2012] [Accepted: 01/29/2012] [Indexed: 02/07/2023]
Abstract
Progressive loss of cortical gray matter (GM), as measured by magnetic resonance imaging, has been described early in the course of first-episode psychosis. This study aims to assess the relationship between oxidative balance and progression of cortical GM changes in a multicenter sample of first-episode early-onset psychosis (EOP) patients from baseline to two-year follow-up. A total of 48 patients (13 females, mean age 15.9±1.5 years) and 56 age- and gender-matched healthy controls (19 females, 15.3±1.5 years) were assessed. Magnetic resonance imaging (MRI) scans performed both at the time of the first psychotic episode and 2 years later were used for volumetric measurements of left and right gray matter regions (frontal, parietal, and temporal lobes) and total sulcal cerebrospinal fluid (CSF). Total glutathione (GSH) blood levels were determined at baseline. In patients, after controlling for possible confounding variables, lower baseline GSH levels were significantly associated with greater volume decrease in left frontal (B=0.034, 95% confidence interval (CI): 0.011 to 0.056, r=0.620, p=0.006), parietal (B=0.039, 95% CI: 0.020 to 0.059, r=0.739, p=0.001), temporal (B=0.026, 95% CI: 0.016 to 0.036, r=0.779, p<0.001), and total (B=0.022, 95% CI: 0.014 to 0.031, r=0.803, p<0.001) gray matter, and with greater increase in total CSF (B=-0.560, 95% CI: -0.270 to -0.850, r=-0.722, p=0.001). Controls did not show significant associations between brain volume changes and GSH levels. GSH deficit during the first psychotic episode was related to greater loss of cortical GM two years later in patients with first-episode EOP, suggesting that oxidative damage may contribute to the progressive loss of cortical GM found in patients with first-episode psychosis.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Fraguas D, Correll CU, Merchán-Naranjo J, Rapado-Castro M, Parellada M, Moreno C, Arango C. Efficacy and safety of second-generation antipsychotics in children and adolescents with psychotic and bipolar spectrum disorders: comprehensive review of prospective head-to-head and placebo-controlled comparisons. Eur Neuropsychopharmacol 2011; 21:621-45. [PMID: 20702068 DOI: 10.1016/j.euroneuro.2010.07.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 06/28/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review data on efficacy and safety of second-generation antipsychotics (SGAs) in children and adolescents with psychotic and bipolar spectrum disorders. METHODS Medline/PubMed/Google Scholar search for studies comparing efficacy and/or tolerability: (i) between two or more SGAs; (ii) between SGAs and placebo; and (iii) between at least one SGA and one first-generation antipsychotic (FGA). The review focused on three major side-effect clusters: 1. body weight, body mass index, and cardiometabolic parameters, 2. prolactin levels, and 3. neuromotor side effects. RESULTS In total, 34 studies with 2719 children and adolescents were included. Studies lasted between 3 weeks and 12 months, with most studies (79.4%) lasting 3 months or less. Nine studies (n=788) were conducted in patients with schizophrenia, 6 (n=719) in subjects with bipolar disorder, and 19 (n=1212) in a mixed population. Data on efficacy showed that, except for clozapine being superior for refractory schizophrenia, there were no significant differences between SGAs. By contrast, safety assessments showed relevant differences between SGAs. Mean weight gain ranged from 3.8 kg to 16.2 kg in patients treated with olanzapine (n=353), from 0.9 kg to 9.5 kg in subjects receiving clozapine (n=97), from 1.9 kg to 7.2 kg in those on risperidone (n=571), from 2.3 kg to 6.1 kg among patients taking quetiapine (n=133), and from 0 kg to 4.4 kg in those treated with aripiprazole (n=451). Prolactin levels increased the most in subjects on risperidone (mean change ranging from 8.3 ng/mL to 49.6 ng/mL), followed by olanzapine (-1.5 ng/mL to +13.7 ng/mL). Treatment with aripiprazole was associated with decreased prolactin levels, while clozapine and quetiapine were found to be mostly neutral. With respect to neuromotor side effects, SGAs were associated with less parkinsonism and akathisia than FGAs. Most of the studies comparing neuromotor side effects between SGAs found no significant differences. CONCLUSIONS SGAs do not behave as a homogeneous group in children and adolescents with psychotic and mood disorders. Except for clozapine, the heterogeneity within the SGA group is mainly due to differences in the rates and severity of adverse events, especially regarding weight gain as a proxy for the risk of cardiometabolic disturbances.
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Affiliation(s)
- David Fraguas
- Servicio de Salud Mental, Complejo Hospitalario Universitario de Albacete, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Albacete, Spain
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Merchán-Naranjo J, Mayoral M, Rapado-Castro M, Llorente C, Boada L, Arango C, Parellada M. Estimation of the Intelligence Quotient Using Wechsler Intelligence Scales in Children and Adolescents with Asperger Syndrome. J Autism Dev Disord 2011; 42:116-22. [DOI: 10.1007/s10803-011-1219-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Parellada M, Boada L, Fraguas D, Reig S, Castro-Fornieles J, Moreno D, Gonzalez-Pinto A, Otero S, Rapado-Castro M, Graell M, Baeza I, Arango C. Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a 2-year longitudinal study. Schizophr Bull 2011; 37:38-51. [PMID: 20884756 PMCID: PMC3004178 DOI: 10.1093/schbul/sbq109] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Increasing evidence supports the important role of illness state and individual characteristics in insight. METHODS Insight, as measured with the Scale to Assess Unawareness of Mental Disorder, over the first 2 years of early-onset first-episode psychosis and its correlations with clinical, socio-demographic, cognitive, and structural brain variables are studied. RESULTS (1) insight at 2 years is poorer in schizophrenia spectrum disorders (SSDs) than in subjects with other psychoses; (2) the more severe the psychosis, the worse the insight. In SSD, depressive symptoms, poorer baseline executive functioning, lower IQ, longer duration of untreated psychosis (DUP), and poorer premorbid infancy adjustment are associated with poorer insight; frontal and parietal gray matter (GM) reductions at baseline correlate with worse insight into having psychotic symptoms at 2 years; (3) insight into having a mental disorder (Scale to Assess Unawareness of Mental Disorder [SUMD]1) at 1 year, DUP, and baseline IQ are the most consistent variables explaining different aspects of insight at 2 years in SSD patients. IQ and SUMD1 at 1 year, together with left frontal and parietal GM volumes, explain 80% of the variance of insight into having specific psychotic symptoms in SSD patients (adjusted R(2) = 0.795, F = 15.576, P < .001). CONCLUSION Insight is a complex phenomenon that depends both on severity of psychopathology and also on disease and subject characteristics, such as past adjustment, IQ, DUP, cognitive functioning, frontal and parietal GM volumes, and age, gender, and ethnicity.
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Affiliation(s)
- Mara Parellada
- Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Ibiza 43, Madrid 28009, Spain.
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Rapado-Castro M, Soutullo C, Fraguas D, Arango C, Payá B, Castro-Fornieles J, González-Pinto A, Parellada M, Graell M, Baeza I, Bombin I. Predominance of symptoms over time in early-onset psychosis: a principal component factor analysis of the Positive and Negative Syndrome Scale. J Clin Psychiatry 2010; 71:327-37. [PMID: 20331934 DOI: 10.4088/jcp.08m04845yel] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 06/03/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early-onset psychosis is a symptomatically nonspecific and heterogeneous entity composed of several diagnoses. This study examined the dimensional structure of symptoms and the temporal stability of this structure during a 6-month follow-up. METHOD A principal component factor analysis of the Positive and Negative Syndrome Scale was conducted at baseline, 4 weeks, and 6 months in a sample of 99 first-episode psychotic patients (mean age = 15.5 years). RESULTS The factor analysis produced a 5-dimension solution (Positive, Negative, Depression, Cognitive, Hostility) that explained 62.4% of the variance at baseline, 63.4% at 4 weeks, and 65.1% at 6 months. Negative dimension was the most consistent and stable over time and was predominant at baseline (23.9%) and at 4 weeks (25.7%). Depression was predominant at 6 months (31.1%). CONCLUSIONS There is a stable 5-dimension structure of symptoms in early-onset psychosis with varying predominance of symptoms over time. Negative symptoms are a core feature of psychosis and are thus important diagnostic criteria.
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Affiliation(s)
- Marta Rapado-Castro
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, C/ Ibiza 43, 28009 Madrid, Spain.
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Soutullo CA, Chang KD, Díez-Suárez A, Figueroa-Quintana A, Escamilla-Canales I, Rapado-Castro M, Ortuño F. Bipolar disorder in children and adolescents: international perspective on epidemiology and phenomenology. Bipolar Disord 2005; 7:497-506. [PMID: 16403175 DOI: 10.1111/j.1399-5618.2005.00262.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is considerable skepticism outside the US over the prevalence of pediatric bipolar disorder (BD). We wished to evaluate the epidemiology of BD in children and adolescents in non-US samples. METHOD We reviewed studies on the prevalence of BD in children and adolescents in international samples. We also describe our sample of 27 children with BD at the University of Navarra. RESULTS There are important and frequently overlooked differences in the definition of BD between the International Classification of Diseases 10th edition (ICD-10) and DSM-IV and methodological differences in epidemiological studies that may partially explain international differences in prevalence of pediatric BD. The prevalence of bipolar spectrum disorder in young adults in Switzerland is 11%. In Holland the 6-month prevalence of mania in adolescents was 1.9% and of hypomania 0.9%. Only 1.2% of hospitalized youth (<15 years) in Denmark and 1.7% of adolescents in Finland had BD. In our clinic, the prevalence of DSM-IV BD in children 5-18 years old is 4%, and of any mood disorders 27%. There are also data from Brazil, India and Turkey with varying results. CONCLUSION Relative lack of data, ICD-10 and DSM-IV differences in diagnostic criteria, different levels of recognition of Child and Adolescent Psychiatry as a true specialty in Europe, clinician bias against BD, an overdiagnosis of the disorder in USA and/or a true higher prevalence of pediatric BD in USA may explain these results. US-International differences may be a methodological artifact and research is needed in this field.
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Affiliation(s)
- César A Soutullo
- Child and Adolescent Psychiatry Unit, Department of Psychiatry and Medical Psychology, Clínica Universitaria, University of Navarra, Pamplona, Spain.
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