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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] [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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Reid S, Bhattacharyya S. Antipsychotic treatment failure in patients with psychosis and co-morbid cannabis use: A systematic review. Psychiatry Res 2019; 280:112523. [PMID: 31450032 DOI: 10.1016/j.psychres.2019.112523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/23/2023]
Abstract
Whilst the effects of cannabis preceding psychosis onset are well established, an effect post-onset is less clear. Emerging evidence suggests that cannabis use is associated with increased relapse outcomes possibly because of determinants, antipsychotic treatment failure and medication adherence, that are not mutually exclusive. Due to the paucity of literature on antipsychotic treatment failure an association with cannabis remains conjectural. This review sought to summarise current evidence regarding the effect of cannabis use on antipsychotic treatment failure among users and non-users with psychosis. Ovid databases (Embase, Journals@Ovid Full Text, OvidMEDLINE® In-Process and Other Non-Indexed Citations and PsycINFO) were searched to identify relevant articles. Seven articles met eligibility criteria. Cannabis use was associated with the following deleterious outcomes increased: odds of non-remission, prescription of unique antipsychotic medications, cumulative prescription of Clozapine and poor treatment trajectories. One study reported similar life-time, but lower past-year, rates of cannabis use in those prescribed Clozapine. Another study reported differences between groups for chlorpromazine equivalent doses for long-term Olanzapine prescription. Improved methodologies are warranted due to a lack of well-designed prospective studies and heterogeneity of key variables. There remains, despite research paucity, the need to encourage early cannabis cessation and higher-quality research to inform clinical practice.
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Affiliation(s)
- Sam Reid
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.
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