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Ittig S, Studerus E, Papmeyer M, Uttinger M, Koranyi S, Ramyead A, Riecher-Rössler A. Sex Differences in Cognitive Functioning in At-Risk Mental State for Psychosis, First Episode Psychosis and Healthy Control Subjects. Eur Psychiatry 2020; 30:242-50. [DOI: 10.1016/j.eurpsy.2014.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/30/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractBackground:Several sex differences in schizophrenia have been reported including differences in cognitive functioning. Studies with schizophrenia patients and healthy controls (HC) indicate that the sex advantage for women in verbal domains is also present in schizophrenia patients. However, findings have been inconsistent. No study focused on sex-related cognitive performance differences in at-risk mental state for psychosis (ARMS) individuals yet. Thus, the aim of the present study was to investigate sex differences in cognitive functioning in ARMS, first episode psychosis (FEP) and HC subjects. We expected a better verbal learning and memory performance of women in all groups.Methods:The neuropsychological data analysed in this study were collected within the prospective Früherkennung von Psychosen (FePsy) study. In total, 118 ARMS, 88 FEP individuals and 86 HC completed a cognitive test battery covering the domains of executive functions, attention, working memory, verbal learning and memory, IQ and speed of processing.Results:Women performed better in verbal learning and memory regardless of diagnostic group. By contrast, men as compared to women showed a shorter reaction time during the working memory task across all groups.Conclusion:The results provide evidence that women generally perform better in verbal learning and memory, independent of diagnostic group (ARMS, FEP, HC). The finding of a shorter reaction time for men in the working memory task could indicate that men have a superior working memory performance since they responded faster during the target trials, while maintaining a comparable overall working memory performance level.
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Beck K, Andreou C, Studerus E, Egloff L, Heitz U, Menghini-Müller S, Ittig S, Leanza L, Uttinger M, Simon A, Borgwardt S, Riecher-Rössler A. Long-term rates of remission and late psychotic transition of individuals at risk for psychosis. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.2105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IntroductionIn the growing research field of early psychosis detection in patients with an at risk mental state (ARMS), most studies focus on the transition to frank psychosis. However, the majority of ARMS patients do not go on to develop frank psychosis and reported transition rates are declining. Little is known about the long-term outcome of these non-transitioned patients (ARMS-NT).ObjectivesTo investigate in preliminary analyses the long-term outcome of ARMS-NT patients with respect to persistence of ARMS signs and symptoms and the rates of late psychotic transition.MethodsThe ongoing study “FePsy-BHS-NT” follows up ARMS-NT without transition during at least the first two years for up to 15 years after their initial assessment. ARMS status is ascertained with the Basel Screening Instrument for Psychosis (BSIP). ARMS remission is defined as the absence of attenuated psychotic symptoms or brief limited intermittent psychotic symptoms for at least 12 consecutive months.ResultsIn this preliminary sample of 51 ARMS-NT, the majority of patients (70.6%) have remitted from their at risk mental state, 13.7% remain at risk and 15.7% have made a late psychotic transition during the course of long-term follow up (median = 5.75, range 4–11 years after initial assessment).ConclusionsThe considerable rates of ARMS persistence and late psychotic transition indicate that longer follow-up durations than commonly recommended should be contemplated in ARMS patients. Potential predictors of favorable long-term clinical outcome, as well as psychosocial, neurocognitive and other outcomes of ARMS-NT patients will be further evaluated in the present study.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Studerus E, Ramyead A, Riecher-Rössler A. Prediction of transition to psychosis in patients with a clinical high risk for psychosis: a systematic review of methodology and reporting. Psychol Med 2017; 47:1163-1178. [PMID: 28091343 DOI: 10.1017/s0033291716003494] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 12/13/2022]
Abstract
BACKGROUND To enhance indicated prevention in patients with a clinical high risk (CHR) for psychosis, recent research efforts have been increasingly directed towards estimating the risk of developing psychosis on an individual level using multivariable clinical prediction models. The aim of this study was to systematically review the methodological quality and reporting of studies developing or validating such models. METHOD A systematic literature search was carried out (up to 14 March 2016) to find all studies that developed or validated a clinical prediction model predicting the transition to psychosis in CHR patients. Data were extracted using a comprehensive item list which was based on current methodological recommendations. RESULTS A total of 91 studies met the inclusion criteria. None of the retrieved studies performed a true external validation of an existing model. Only three studies (3.5%) had an event per variable ratio of at least 10, which is the recommended minimum to avoid overfitting. Internal validation was performed in only 14 studies (15%) and seven of these used biased internal validation strategies. Other frequently observed modeling approaches not recommended by methodologists included univariable screening of candidate predictors, stepwise variable selection, categorization of continuous variables, and poor handling and reporting of missing data. CONCLUSIONS Our systematic review revealed that poor methods and reporting are widespread in prediction of psychosis research. Since most studies relied on small sample sizes, did not perform internal or external cross-validation, and used poor model development strategies, most published models are probably overfitted and their reported predictive accuracy is likely to be overoptimistic.
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Affiliation(s)
- E Studerus
- University of Basel Psychiatric Hospital,Center for Gender Research and Early Detection,Basel,Switzerland
| | - A Ramyead
- Department of Psychiatry,Weill Institute for Neurosciences,University of California (UCSF),San Francisco,CA,USA
| | - A Riecher-Rössler
- University of Basel Psychiatric Hospital,Center for Gender Research and Early Detection,Basel,Switzerland
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Heitz U, Cherbuin J, Menghini-Müller S, Egloff L, Ittig S, Beck K, Andreou C, Studerus E, Riecher-Rössler A. Comorbidities in Patients with an At-risk Mental State and First Episode Psychosis. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2142] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionNon-psychotic axis I diagnoses are highly prevalent in at-risk mental state (ARMS) and first episode psychosis (FEP) patients, the most common being affective and anxiety disorders. Few studies have examined differences between ARMS and FEP patients or gender effects regarding such diagnoses.ObjectiveTo examine current and lifetime comorbidities in ARMS and FEP patients. Furthermore, to examine gender differences, and differences between patients with (ARMS-T) and without later transition to psychosis (ARMS-NT).MethodsThis study was part of the Früherkennung von Psychosen (FePsy) study. Current and lifetime axis I comorbidities were assessed using the Structured Clinical Interview for DSM-IV (SCID-I).ResultsOne hundred and thirty-two ARMS and 98 FEP patients were included. Current comorbidities were present in 53.1% of FEP and 64.4% of ARMS patients, the most common being affective, anxiety and substance use disorders. Current affective disorders were significantly more common in ARMS than FEP. Lifetime comorbidities were diagnosed in 58.2% of FEP and 69.7% of ARMS patients, with significantly more affective and anxiety disorders in ARMS than FEP. Male FEP patients had more current and lifetime substance use disorders (across all substances) compared to female FEP. No differences emerged between ARMS-T and ARMS-NT.ConclusionsAs expected ARMS patients have many comorbidities, while clearly diagnosed FEP have less comorbidities. There were few gender differences in axis I comorbidities. Moreover, no differences between ARMS-T and NT emerged, suggesting that axis I comorbidities do not improve prediction of transition. Nevertheless, the high comorbidity prevalence is relevant for global functioning and clinical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Riecher-Rössler A, Ackermann T, Uttinger M, Ittig S, Koranyi S, Rapp C, Bugra H, Studerus E. Das Basler Interview für Psychosen (BIP): Struktur, Reliabilität und Validität. Fortschr Neurol Psychiatr 2015; 83:99-108. [DOI: 10.1055/s-0034-1398999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. Riecher-Rössler
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
| | - T. Ackermann
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
| | - M. Uttinger
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
| | - S. Ittig
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
| | - S. Koranyi
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena
| | - C. Rapp
- Klinisch Psychologischer Dienst, Psychiatrische Dienste, Solothurn
| | - H. Bugra
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
| | - E. Studerus
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel
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Bugra H, Studerus E, Rapp C, Tamagni C, Aston J, Borgwardt S, Riecher-Rössler A. Cannabis use and cognitive functions in at-risk mental state and first episode psychosis. Psychopharmacology (Berl) 2013; 230:299-308. [PMID: 23756588 DOI: 10.1007/s00213-013-3157-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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] [Received: 12/19/2012] [Accepted: 05/18/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Meta-analyses suggest that schizophrenia patients with a history of cannabis use have less impaired cognitive functioning compared to patients without cannabis use. AIMS The objective of this study was to assess the association between recency and frequency of cannabis use and cognitive functioning in at-risk mental state for psychosis (ARMS) and first episode psychosis (FEP) individuals. METHODS One hundred thirty-six participants completed a cognitive test battery and were assessed for current and past cannabis use. Analyses of covariance models were applied to evaluate the main effects of cannabis use and patient group (ARMS vs. FEP) as well as their interactions on cognitive functioning. RESULTS No differences were observed in cognitive performance between current, former, and never users, and there were no significant interactions between cannabis use and patient group. Furthermore, within the group of current cannabis users, the frequency of cannabis use was not significantly associated with cognitive functioning. CONCLUSION The results of the present study do not support the notion that FEP patients and ARMS individuals with a history of cannabis use have less impaired cognitive functioning compared to those without cannabis use.
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Affiliation(s)
- H Bugra
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, c/o University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
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Riecher-Rössler A, Aston J, Borgwardt S, Bugra H, Fuhr P, Gschwandtner U, Koutsouleris N, Pflueger M, Tamagni C, Radü EW, Rapp C, Smieskova R, Studerus E, Walter A, Zimmermann R. [Prediction of psychosis by stepwise multilevel assessment--the Basel FePsy (Early Recognition of Psychosis)-Project]. Fortschr Neurol Psychiatr 2013; 81:265-75. [PMID: 23695791 DOI: 10.1055/s-0033-1335017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We have conducted various studies in Basel with the aim of improving the methods for the early detection of psychosis (Früherkennung von Psychosen, FePsy). METHODS From 1.3.2000 to 29.2.2004 234 individuals were screened using the Basel Screening Instrument for Psychosis (BSIP). 106 patients were identified as at risk for psychosis; out of these 53 remained in follow-up for up to 7 years (mean 5.4 years). The assessments were done with a specifically developed instrument for history taking, various scales for the psychopathology, assessments of neuropsychology and fine motor functioning, clinical and quantitative EEG, MRI of the brain, laboratory etc. RESULTS Based on the BSIP alone, a relatively reliable prediction was possible: 21 (39.6%) of the individuals identified as at risk developed psychosis within the follow-up time. Post-hoc prediction could be improved to 81% by weighting psychopathology and including neuropsychology. Including the other domains obviously allows further improvements of prediction. CONCLUSIONS The risk for psychosis should be assessed in a stepwise procedure. In a first step, a clinically oriented screening should be conducted. If an at-risk status is found, further assessments in various domains should be done in a specialised centre.
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Affiliation(s)
- A Riecher-Rössler
- Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Schweiz.
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Bugra H, Rapp C, Studerus E, Aston J, Borgwardt S, Riecher-Rössler A. Kann Cannabis das Risiko für schizophrene Psychosen erhöhen? Fortschr Neurol Psychiatr 2012; 80:635-43. [DOI: 10.1055/s-0032-1325415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H. Bugra
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
| | - C. Rapp
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
| | - E. Studerus
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
| | - J. Aston
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
| | - S. Borgwardt
- Zentrum für Diagnostik und Krisenintervention, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
| | - A. Riecher-Rössler
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken, Universitätsspital Basel, Schweiz
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Hasler F, Studerus E, Lindner K, Ludewig S, Vollenweider FX. Investigation of serotonin-1A receptor function in the human psychopharmacology of MDMA. J Psychopharmacol 2009; 23:923-35. [PMID: 18635693 DOI: 10.1177/0269881108094650] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
Serotonin (5-HT) release is the primary pharmacological mechanism of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') action in the primate brain. Dopamine release and direct stimulation of dopamine D2 and serotonin 5-HT2A receptors also contributes to the overall action of MDMA. The role of 5-HT1A receptors in the human psychopharmacology of MDMA, however, has not yet been elucidated. In order to reveal the consequences of manipulation at the 5-HT1A receptor system on cognitive and subjective effects of MDMA, a receptor blocking study using the mixed beta-adrenoreceptor blocker/5-HT1A antagonist pindolol was performed. Using a double-blind, placebo-controlled within-subject design, 15 healthy male subjects were examined under placebo (PL), 20 mg pindolol (PIN), MDMA (1.6 mg/kg b.wt.), MDMA following pre-treatment with pindolol (PIN-MDMA). Tasks from the Cambridge Neuropsychological Test Automated Battery were used for the assessment of cognitive performance. Psychometric questionnaires were applied to measure effects of treatment on core dimensions of Altered States of Consciousness, mood and state anxiety. Compared with PL, MDMA significantly impaired sustained attention and visual-spatial memory, but did not affect executive functions. Pre-treatment with PIN did not significantly alter MDMA-induced impairment of cognitive performance and only exerted a minor modulating effect on two psychometric scales affected by MDMA treatment ('positive derealization' and 'dreaminess'). Our findings suggest that MDMA differentially affects higher cognitive functions, but does not support the hypothesis from animal studies, that some of the MDMA effects are causally mediated through action at the 5-HT1A receptor system.
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Affiliation(s)
- F Hasler
- Department of Clinical Research, Heffter Research Center, University Hospital of Psychiatry, Zürich, Switzerland.
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