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Isayeva U, Manchia M, Collu R, Primavera D, Deriu L, Caboni E, Iaselli NM, Sundas D, Tusconi M, Pinna F, Paribello P, Scherma M, Pisanu C, Meloni A, Zai CC, Congiu D, Squassina A, Fratta W, Fadda P, Carpiniello B. Symptomatic remission and recovery in major psychosis: Is there a role for BDNF? A secondary analysis of the LABSP cohort data. Schizophr Res 2024; 266:197-204. [PMID: 38422890 DOI: 10.1016/j.schres.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Remission, relapse prevention, and clinical recovery are crucial areas of interest in schizophrenia (SCZ) research. Although SCZ is a chronic disorder with poor overall outcomes, years of research demonstrated that recovery is possible. There are considerable data linking brain-derived neurotrophic factor (BDNF) to SCZ, however, evidence on the role of BDNF in remission in SCZ is scarce. This secondary analysis of the Longitudinal Assessment of BDNF in Sardinian patients (LABSP) data aimed to investigate the relationship between serum BDNF levels and symptomatic remission, simultaneous clinical and functional remission, and recovery in patients with SCZ. A total of 105 patients with SCZ or schizoaffective disorder were recruited for a longitudinal assessment of BDNF levels over 24 months. Longitudinal data were analyzed using mixed-effects linear regression models. The study found significant associations between use of long acting injectables (χ2 = 7.075, df = 1, p = 0.008), baseline serum BDNF levels (U = 701, z = -2.543, p = 0.011), and "childhood" (U = 475, z = -2.124, p = 0.034) and "general" (U = 55, z = -2.014, p = 0.044) subscales of the Premorbid Adjustment Scale (PAS) with patients maintaining remission and recovery. The diagnosis of SCZ was significantly associated with lower BDNF levels for patients with simultaneous clinical and functional remission (Z = 2.035, p = 0.0419) and recovery (Z = 2.009, p = 0.0445) compared to those without. There were no significant associations between remission in the entire sample and longitudinal serum BDNF levels or genetic variants within the BDNF gene. These findings provide further insight into the complex relationship between BDNF and SCZ.
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Affiliation(s)
- Ulker Isayeva
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Roberto Collu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Diego Primavera
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Deriu
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Edoardo Caboni
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Novella Maria Iaselli
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Davide Sundas
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Massimo Tusconi
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Maria Scherma
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudia Pisanu
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Anna Meloni
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Clement C Zai
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Institute of Medical Science, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donatella Congiu
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Alessio Squassina
- Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Walter Fratta
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Paola Fadda
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Dependence", University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Unit of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
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Sağlam Y, Ermiş Ç, Tunçtürk M, Turan S, Karakuş OB, Alarslan S, Karaçetin G. Neurocognitive and social cognitive impairments in remission and symptomatic states of early-onset schizophrenia spectrum disorders. Eur Child Adolesc Psychiatry 2023; 32:1621-1631. [PMID: 35316416 DOI: 10.1007/s00787-022-01977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Previous studies demonstrated neurocognitive impairments in early-onset schizophrenia (EOS) and other psychotic spectrum disorders (PSD). This study aimed to compare remitted and symptomatic cases in terms of neurocognition and theory of mind (ToM). 50 healthy controls (HC) and 106 patients diagnosed schizophrenia in remission (EOS-R, n = 38), symptomatic schizophrenia (EOS-S, n = 34), and other PSD (n = 34) were included in our study. The Positive and Negative Symptom Scale, Columbia-Suicide Severity Rating Scale, Reactive and Proactive Aggression Questionnaire were used to evaluate psychopathology. A cognitive battery was conducted to measure verbal learning/memory, visual learning/memory, executive functions (EF), inhibition, processing speed (PS), verbal fluency skills. Reading Mind in Eyes Test (RMET) and Faux-Pas tests were implemented to assess ToM. Principal Component Analysis was used to identify cognitive domain scores. Patient groups had poorer performance in cognitive domains than the HC group. The cognitive impairment and psychopathology levels of EOS-R and the PSD groups were comparable for all cognitive domains. The EOS-S group also had poorer scores in Rey verbal learning score (d = 0.87), RMET (d = 0.72), verbal fluency (d = 0.66), PS/EF (d = 0.82) and visual learning/memory (d = 0.83) test scores than the PSD group. Only RMET (d = 0.72) and executive function/processing speed domain (d = 0.63) were significantly impaired in the EOS-S group than the EOS-R group Cognitive impairments seen in remitted psychotic disorders were on the same continuum. Impaired EF/PS and ToM skills could be a cognitive marker for symptomatic illness in youth.
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Affiliation(s)
- Yeşim Sağlam
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Çağatay Ermiş
- Department of Child and Adolescent Psychiatry, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, 16400, Bursa, Turkey.
| | - Oğuz Bilal Karakuş
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
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Laxmi R, Sahoo S, Grover S, Nehra R. Psychological/Personal recovery and its correlates in patients with first episode psychosis. Int J Soc Psychiatry 2023; 69:1354-1368. [PMID: 37128162 DOI: 10.1177/00207640231164526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. AIM To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. METHODOLOGY One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. RESULTS The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. CONCLUSION The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.
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Affiliation(s)
- Raj Laxmi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Petkari E, Martín-María N, Sánchez-Gutiérrez T, Fernández-Castilla B, Calvo A. A meta-analysis of cognitive interventions for patients with recent onset psychosis: are they effective for improving functioning? Psychol Med 2023; 53:3306-3321. [PMID: 37161705 DOI: 10.1017/s0033291723001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.
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Affiliation(s)
- Eleni Petkari
- Faculty of Health Sciences, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Natalia Martín-María
- Department of Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Belén Fernández-Castilla
- Department of Methodology of Behavioral and Health Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ana Calvo
- Department of Personality, Assessment and Clinical Psychology. School of Psychology. Universidad Complutense de Madrid, Madrid, Spain
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Hansen HG, Speyer H, Starzer M, Albert N, Hjorthøj C, Eplov LF, Nordentoft M. Clinical Recovery Among Individuals With a First-Episode Schizophrenia an Updated Systematic Review and Meta-Analysis. Schizophr Bull 2023; 49:297-308. [PMID: 36029094 PMCID: PMC10016416 DOI: 10.1093/schbul/sbac103] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Through decades the clinical recovery outcomes among individuals diagnosed with schizophrenia have been highly inconsistent ranging from 13.5% to 57%. The primary objective of this updated examination was to report the pooled estimate and explore various moderators to improve the understanding of the course of schizophrenia. STUDY DESIGN A systematic literature search was set up on PubMed, PsycInfo, and EMBASE until January 13th, 2022. Both observational and interventional studies among cohorts of individuals with the first episode of schizophrenia reporting on clinical recovery were included. The PRISMA 2020 statement was used and data was extracted for a random-effects meta-analysis, meta-regression, and sensitivity analyses. Risk of bias was assessed using The Newcastle-Ottawa Scale. STUDY RESULTS A 20.8% (95% CI = 17.3 to 24.8) recovery rate was found among 26 unique study samples (mean trial duration, 9.5 years) including 3877 individuals (mean age, 26.4 years). In meta-regression none of the following study characteristics could uncover the diverse reported recovery rates; age at inclusion (P = .84), year of inclusion (P = .93), follow-up time (P = .99), drop-out rate (P = .07), or strictness of the recovery criteria (P = .35). Furthermore, no differences in recovery were found between early intervention services (EIS; 19.5%; 95% CI = 15.0 to 24.8) compared to other interventions (21%; 95% CI = 16.9 to 25.8), P = .65. CONCLUSIONS A clinical recovery rate of approximately 21% was found with minimum impact from various moderators. The rate was not different comparing EIS with other interventions implying that new initiatives are needed to improve the rate of recovery.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Helene Speyer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Center of Psychiatry Amager, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health – CORE, Mental Health Centre Copenhagen, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Caqueo-Urízar A, Ponce-Correa F, Semir-González C, Urzúa A. Latent Profiles of Premorbid Adjustment in Schizophrenia and Their Correlation with Measures of Recovery. J Clin Med 2022; 11:jcm11133840. [PMID: 35807125 PMCID: PMC9267748 DOI: 10.3390/jcm11133840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Premorbid adjustment (PA) has classically been defined as psychosocial functioning in the areas of education, occupation, social and interpersonal relationships prior to evidence of characteristic positive symptomatology. It is a concept which possesses ample evidence regarding its predictive nature for the course of Schizophrenia. The study aimed to analyze the latent profiles of premorbid adjustment and their relationship with symptomatology, functionality, subjective recovery, stigma resistance and years of untreated psychosis. Latent class analysis (LCA) was used to elaborate a solution of three premorbid adjustment profiles in a sample of 217 patients diagnosed with Schizophrenia from Public Mental Health Centers in the city of Arica, Chile. The results show that premorbid adjustment was significantly correlated with recovery indicators and that latent profiles of better premorbid adjustment predict better outcomes in subjective recovery and stigma resistance. The results show that premorbid adjustment not only has implications for the severity of the disorder, but that psychosocial functioning prior to psychosis affects the patient’s subjectivity, the representation of the disorder and the recovery process.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica 1000000, Chile
- Correspondence:
| | - Felipe Ponce-Correa
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, Chile;
| | - Carla Semir-González
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, Chile;
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta 1270709, Chile;
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Wojtalik JA, Flores AT, Keshavan MS, Eack SM. Premorbid Sociality Moderates Social Adjustment Change during Cognitive Enhancement Therapy for Adults with Early Schizophrenia. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:312-322. [PMID: 35044886 PMCID: PMC9177526 DOI: 10.1080/15374416.2022.2025599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Cognitive remediation approaches for early course schizophrenia are promising interventions for improving social adjustment. Premorbid sociality is a potentially important moderator of social adjustment response to cognitive remediation and may serve to personalize such interventions. METHOD Eighty-eight early course schizophrenia outpatients with premorbid sociality scores were included in this preliminary investigation. Secondary data came from a recent 18-month multi-site confirmatory trial of Cognitive Enhancement Therapy (CET) compared to Enriched Supportive Therapy (EST). Intent-to-treat mixed effects models examined the moderating effect of premorbid sociality assessed at baseline on differential social adjustment change between CET and EST assessed at baseline, 9, and 18 months. RESULTS Premorbid sociality significantly moderated the differential effect of CET vs. EST on overall social adjustment change at 18 months, such that CET was particularly effective for patients with high premorbid sociality and EST for low premorbid sociality. This significant group x time x premorbid sociality interaction was also observed for 18-month change in interpersonal anguish, self-care, and sexual relations. Again, CET was largely favorable for higher premorbid sociality patients and EST for lower premorbid sociality for these sub-scales. CONCLUSIONS The results provide initial evidence that premorbid sociality moderates differential social adjustment change during cognitive remediation in early course schizophrenia. In many, but not all cases, better social functioning prior to the development of schizophrenia was associated with a significantly better social adjustment response to CET. Data on social functioning during childhood and adolescence is possibly useful for personalizing treatment planning in the early course of schizophrenia.
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Affiliation(s)
- Jessica A. Wojtalik
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
- Correspondence: Jessica A. Wojtalik, PhD, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106,
| | - Ana T. Flores
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shaun M. Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Murillo-García N, Setién-Suero E, Pardo-de-Santayana G, Murillo-García M, Pelayo-Terán JM, Crespo-Facorro B, Ayesa-Arriola R. Entire duration of active psychosis and neurocognitive performance in first-episode non-affective psychosis. Early Interv Psychiatry 2021; 15:1266-1275. [PMID: 33244853 DOI: 10.1111/eip.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/27/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore if the entire duration of active psychosis (DAP) is related to neurocognitive performance at baseline and at 3-year follow-up in patients with first episode psychosis (FEP). METHODS DAP was estimated for 481 FEP patients. A neuropsychological battery was administered to measure neurocognitive specific domains, and a global indicator of neurocognitive impairment (global deficits score, GDS) was calculated. According to the DAP quartiles, four subgroups were formed, and these were compared. In addition, a logistic regression analysis was carried out to predict neurocognitive impairment at 3-year follow-up. RESULTS FEP patients with the longest DAP (more than 18.36 months) presented a more severe global neurocognitive impairment evidenced in their GDS, both at baseline (F = 5.53; p˂ .01) and at 3-year follow-up (F = 4.16; p˂ .01). Moreover, a subgroup of participants with DAP between 7.40 and 18.36 months showed a specific attentional decline over the 3-year follow-up (F = 3.089; p˂ .05).The logistic regression model showed that sex (Wald = 7.29, p < .010), premorbid adjustment (Wald = 7.24, p < .010), attention (Wald = 12.10, p < .001), verbal memory (Wald = 16.29, p < .001) and visual memory (Wald = 9.41, p < .010) were significant predictors of neurocognitive impairment 3 years after the FEP. The variables composing the DAP were not significant predictors in this model. CONCLUSIONS DAP seems to be related to global neurocognitive impairment in FEP patients. These findings contribute in several ways to our understanding of the effects of active psychosis on the brain, and provide the basis for future research.
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Affiliation(s)
- Nancy Murillo-García
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,Department of Molecular Biology, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | | | - Marisol Murillo-García
- International Education Program, Framingham State University, Framingham, Massachusetts, USA
| | - José María Pelayo-Terán
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Servicio de Salud de Castilla y León, Unidad de Calidad Asistencial y Seguridad del Paciente, Ponferrada, ES, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
| | - Rosa Ayesa-Arriola
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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Cowman M, Holleran L, Lonergan E, O’Connor K, Birchwood M, Donohoe G. Cognitive Predictors of Social and Occupational Functioning in Early Psychosis: A Systematic Review and Meta-analysis of Cross-Sectional and Longitudinal Data. Schizophr Bull 2021; 47:1243-1253. [PMID: 33761534 PMCID: PMC8379554 DOI: 10.1093/schbul/sbab033] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many individuals with early psychosis experience impairments in social and occupational function. Identification of modifiable predictors of function such as cognitive performance has the potential to inform effective treatments. Our aim was to estimate the strength of the relationship between psychosocial function in early psychosis and different domains of cognitive and social cognitive performance. We conducted a systematic review and meta-analysis of peer-reviewed, cross-sectional, and longitudinal studies examining cognitive predictors of psychosocial function. Literature searches were conducted in PsycINFO, PubMed, and reference lists of relevant articles to identify studies for inclusion. Of the 2565 identified, 46 studies comprising 3767 participants met inclusion criteria. Separate meta-analyses were conducted for 9 cognitive domains. Pearson correlation values between cognitive variables and function were extracted. All cognitive domains were related to psychosocial function both cross-sectionally and longitudinally. Importantly, these associations remained significant even after the effects of symptom severity, duration of untreated psychosis, and length of illness were accounted for. Overall, general cognitive ability and social cognition were most strongly associated with both concurrent and long-term function. Associations demonstrated medium effect sizes. These findings suggest that treatments targeting cognitive deficits, in particular those focusing on social cognition, are likely to be important for improving functional outcomes in early psychosis.
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Affiliation(s)
- Megan Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Laurena Holleran
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Edgar Lonergan
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Karen O’Connor
- First Episode Psychosis Service, South Lee Mental Health Service, Cork, Ireland
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gary Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland Galway, Galway, Ireland
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Salagre E, Grande I, Solé B, Mezquida G, Cuesta MJ, Díaz-Caneja CM, Amoretti S, Lobo A, González-Pinto A, Moreno C, Pina-Camacho L, Corripio I, Baeza I, Bergé D, Verdolini N, Carvalho AF, Vieta E, Bernardo M. Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis. J Clin Med 2020; 10:E73. [PMID: 33379225 PMCID: PMC7796026 DOI: 10.3390/jcm10010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Abstract
Being able to predict functional outcomes after First-Episode Psychosis (FEP) is a major goal in psychiatry. Thus, we aimed to identify trajectories of psychosocial functioning in a FEP cohort followed-up for 2 years in order to find premorbid/baseline predictors for each trajectory. Additionally, we explored diagnosis distribution within the different trajectories. A total of 261 adults with FEP were included. Latent class growth analysis identified four distinct trajectories: Mild impairment-Improving trajectory (Mi-I) (38.31% of the sample), Moderate impairment-Stable trajectory (Mo-S) (18.39%), Severe impairment-Improving trajectory (Se-I) (12.26%), and Severe impairment-Stable trajectory (Se-S) (31.03%). Participants in the Mi-I trajectory were more likely to have higher parental socioeconomic status, less severe baseline depressive and negative symptoms, and better premorbid adjustment than individuals in the Se-S trajectory. Participants in the Se-I trajectory were more likely to have better baseline verbal learning and memory and better premorbid adjustment than those in the Se-S trajectory. Lower baseline positive symptoms predicted a Mo-S trajectory vs. Se-S trajectory. Diagnoses of Bipolar disorder and Other psychoses were more prevalent among individuals falling into Mi-I trajectory. Our findings suggest four distinct trajectories of psychosocial functioning after FEP. We also identified social, clinical, and cognitive factors associated with more resilient trajectories, thus providing insights for early interventions targeting psychosocial functioning.
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Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Brisa Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
| | - Manuel J. Cuesta
- Department of Psychiatry, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Covadonga 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, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de 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, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, 01009 Vitoria, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28007 Madrid, Spain; (C.M.D.-C.); (C.M.); (L.P.-C.)
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain;
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain
| | - Immaculada Baeza
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Child and Adolescent Psychiatry and Psychology Department, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic of Barcelona, SGR-881, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Daniel Bergé
- Hospital del Mar Medical Research Institute, CIBERSAM, Autonomous University of Barcelona, 08003 Barcelona, Spain;
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - André F. Carvalho
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON M6J 1H4, Canada;
- The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (E.S.); (B.S.); (N.V.)
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Department of Medicine, Institut de Neurociències, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (G.M.); (S.A.); (M.B.)
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11
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Ayesa-Arriola R, de la Foz VOG, Setién-Suero E, Ramírez-Bonilla ML, Suárez-Pinilla P, Son JMV, Vázquez-Bourgon J, Juncal-Ruiz M, Gómez-Revuelta M, Tordesillas-Gutiérrez D, Crespo-Facorro B. Understanding sex differences in long-term outcomes after a first episode of psychosis. NPJ SCHIZOPHRENIA 2020; 6:33. [PMID: 33219222 PMCID: PMC7679369 DOI: 10.1038/s41537-020-00120-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022]
Abstract
While sex differences in schizophrenia have long been reported and discussed, long-term sex differences in outcomes among first episode of psychosis (FEP) patients in terms of the efficacy of Early Intervention Services (EIS) has been an under-explored area. A total of 209 FEP patients (95 females and 114 males) were reassessed after a time window ranging from 8 to 16 years after their first contact with an EIS program (PAFIP) that we will call the 10-year PAFIP cohort. Multiple clinical, cognitive, functioning, premorbid, and sociodemographic variables were explored at 1-year, 3-year and 10-year follow-ups. At first contact, females were older at illness onset, had higher premorbid adjustment and IQ, and were more frequently employed, living independently, and accompanied by a partner and/or children. Existence of a schizophrenia diagnosis, and cannabis and alcohol consumption were more probable among men. During the first 3 years, women showed a significantly better response to minimal antipsychotic dosages and higher rates of recovery than men (50% vs. 30.8%). Ten years later, more females continued living independently and had partners, while schizophrenia diagnoses and cannabis consumption continued to be more frequent among men. Females also presented a lower severity of negative symptoms; however, functionality and recovery differences did not show significant differences (46.7% vs. 34.4%). Between the 3- and 10-year follow-up sessions, an increase in dosage of antipsychotics was observed. These results suggest that the better outcomes seen among women during the first 3 years (while they were treated in an EIS) were in the presence of more favourable premorbid and baseline characteristics. After an average period of 10 years, with the only difference being in negative symptoms course, outcomes for women approximated those of men, drawing particular attention to the increase in dosage of antipsychotic medication once FEP patients were discharged from the EIS program towards community-based services. These findings help to pose the question of whether it is advisable to target sexes and lengthen EIS interventions.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain. .,CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain.
| | - Víctor Ortíz-García de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain.,CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain
| | - Esther Setién-Suero
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - María Luz Ramírez-Bonilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Paula Suárez-Pinilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain.,CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain
| | - Jacqueline Mayoral-van Son
- CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
| | - Javier Vázquez-Bourgon
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain.,CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain
| | - María Juncal-Ruiz
- Sierrallana Hospital, Department of Psychiatry, IDIVAL, School of Medicine, University of Cantabria, Torrelavega, Spain
| | - Marcos Gómez-Revuelta
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain
| | - Diana Tordesillas-Gutiérrez
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, Santander, Spain.,CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro InvestigaciónBiomédicaen Red Salud Mental, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
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12
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Relapse rates following antipsychotic discontinuation in the maintenance phase after first-episode of schizophrenia: Results of a long-term follow-up study. Schizophr Res 2020; 225:31-38. [PMID: 31653578 DOI: 10.1016/j.schres.2019.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND When the antipsychotic treatment should be discontinued after first-episode of schizophrenia (FES) in patients who had a good response to initial treatment is still controversial. The aim of this naturalistic follow-up study was to determine the rate of antipsychotic discontinuation in the maintenance phase and its consequences, after FES. METHODS FES patients (n = 105) were followed-up for at least 24 months and up to 22 years (mean = 99.1 months). After minimum one-year antipsychotic treatment without relapse, some patients' antipsychotics were discontinued by psychiatrist. We compared the clinical characteristics of this group to those who stopped their medication themselves and analyzed the predictors of being relapse-free after discontinuation. RESULTS Seventeen (16.2%) of the patients' antipsychotic was discontinued by their psychiatrist. Using the same antipsychotic during the first year was the predictor of discontinuation by the psychiatrist in logistic regression analysis. Ten (58.8%) of them relapsed. Thirty-nine patients (37.1%) discontinued their antipsychotic themselves, relapse rate was 76.9% (n = 30). There was no clinical difference between these two groups. Overall, the patients who had no relapse after discontinuation had better role and global functioning at baseline, were more likely to meet remission criteria, and their antipsychotic was discontinued by psychiatrist and use same antipsychotic during the first year. CONCLUSION Our findings suggest that antipsychotic discontinuation by psychiatrist was possible for only small portion of the FES patients, and relapse rates are high after discontinuation even in these selected patients.
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13
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Neurocognitive functioning in patients with first-episode schizophrenia: results of a prospective 15-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2020; 270:689-698. [PMID: 31214763 DOI: 10.1007/s00406-019-01030-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/03/2019] [Indexed: 02/04/2023]
Abstract
To evaluate the course of neuropsychological impairment, patients with first-episode schizophrenia and healthy controls were assessed with a comprehensive test battery at the time of index treatment and after a 5- and 15-year follow-up period. Summary scores for verbal intelligence (VBI), spatial organization, verbal fluency, verbal learning, semantic memory, visual memory, delay/retention rate, short-term memory, visual-motor processing and attention (VSM) and abstraction/flexibility were constructed. Our results show that neurocognitive functioning is impaired already at the onset of schizophrenia and remains stable over the 15-year follow-up period with an improvement in VBI. With regard to the presence of a deficit syndrome, it became apparent that the group with a deficit syndrome showed a deterioration of neurocognitive functions during the follow-up period, most pronounced in VSM. On the other hand, the group without a deficit syndrome showed an improvement in neurocognitive functions at the 15-year follow-up, which exceeded the learning effects of healthy control subjects. Neurocognitive performance at index assessment strongly predicted the performance at the 15-year follow-up. Most likely due to the small sample size, there were only weak associations between treatment with different types of neuroleptics and neurocognitive performance.
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14
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Duration of active psychosis during early phases of the illness and functional outcome: The PAFIP 10-year follow-up study. Schizophr Res 2020; 220:240-247. [PMID: 32276867 DOI: 10.1016/j.schres.2020.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Longer duration of active psychosis (presence of positive psychotic symptoms) has been associated to worsening of functional and symptomatic outcome in patients with a first-episode of psychosis. There could be a "critical period" of increased brain vulnerability in the early phases of the illness when the effect of active psychosis would be exceptionally pernicious. OBJECTIVES We aim to explore the impact of lengthy periods of active psychosis during early phases of illness on long-term functional outcome. METHODS This is a prospective clinical study. We assessed the effect of the duration active psychosis in patients with a first-episode of nonaffective psychosis on long-term social functioning and functional recovery. The study consisted of a 3-year clinical follow-up and a functional evaluation performed after a 10-year period. RESULTS The sample consisted of 169 patients with a first-episode of non-affective psychosis. The duration of active psychosis after treatment (DAT) during the 3-year clinical follow-up acted as predictor of social functioning at the 10-year functional evaluation (Wald: 10.705; p = .001), but not of functional recovery. The duration of untreated psychosis (DUP) did not act as a predictor of any of the two long-term measures of functional outcome. CONCLUSIONS Active psychosis in early phases of the illness seems to be correlated to worst long-term functionality. In this study the duration of active psychosis after treatment (DAT) was a better predictor of long-term outcome than the duration of untreated psychosis (DUP). Reducing DAT should be considered an important objective for early intervention programs.
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McGinty J, Upthegrove R. Depressive symptoms during first episode psychosis and functional outcome: A systematic review and meta-analysis. Schizophr Res 2020; 218:14-27. [PMID: 31964558 DOI: 10.1016/j.schres.2019.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES First episode psychosis (FEP) is associated with functional decline. Existing evidence was synthesised to explore the influence of depressive symptoms during FEP on future social, occupational and global functioning. METHODS Medline, Embase, PsychINFO, Cochrane Library, Open Grey, NICE Evidence and Web of Science were searched from inception to May 2018. Longitudinal studies of FEP patients were included. Study quality was assessed using the Downs and Black instrument. Two meta-analyses were performed using random effect models. The first meta-analysis correlates depressive symptoms during FEP with follow-up Global Assessment of Functioning (GAF) scores. The second meta-analysis shows the odds of long-term functional remission if depressive symptoms are present during FEP. RESULTS 4751 unique abstracts were found. 36 articles were included. The first meta-analysis included 7 studies (932 participants) and showed depressive symptoms during FEP were negatively correlated with follow-up GAF scores (r = -0.16, 95% CI: -0.24 to -0.09, p < 0.001). The second meta-analysis of 9 studies (2265 participants) showed weak evidence of an association between the presence of depressive symptoms in FEP and reduction in functional remission (OR = 0.87, 95% CI: 0.68 to 1.13, p = 0.294). CONCLUSION Depressive symptoms during FEP are associated with poorer long-term global functioning and may be associated with a reduced chance of achieving functional remission. Clinical trials are needed to identify efficacious management of depressive symptoms in early psychosis.
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Affiliation(s)
- Jessica McGinty
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Rachel Upthegrove
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; University of Birmingham, Institute for Mental Health, Birmingham, United Kingdom; Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Birmingham, United Kingdom.
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Ayesa-Arriola R, Pelayo Terán JM, Setién-Suero E, Neergaard K, Ochoa S, Ramírez-Bonilla M, Pérez-Iglesias R, Crespo-Facorro B. Patterns of recovery course in early intervention for FIRST episode non-affective psychosis patients: The role of timing. Schizophr Res 2019; 209:245-254. [PMID: 30772066 DOI: 10.1016/j.schres.2019.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prevention of symptom relapse and promotion of functional recovery are the two main goals of early intervention following a first episode of non-affective psychosis (FEP). The identification of patterns of recovery is important in developing and implementing recovery focused interventions at set time interval. METHOD Patterns of recovery course, in terms of symptomatic and functional remission, were explored at 1 and 3-year follow-up in a sample of 373 consecutive FEP patients. Relapses during this period were considered. RESULTS Four patterns of recovery course were defined: good stable (26%), good unstable (21%), poor unstable (10%), poor stable (43%). Those who met criteria for good stable recovery were more likely have less severe baseline negative symptoms (OR = 2.092; 95% CI = 0.99-4.419) and to not be diagnosed with schizophrenia (OR = 2.242; 95% CI = 1.015-4.954). Short DUP (OR = 2.152; 95% CI = 0.879-5.27) and low premorbid IQ (OR = 2.281; 95% CI = 0.954-5.457) increased the likelihood of good unstable recovery. Less severe baseline negative symptoms (OR = 3.851; 95% CI = 1.422-10.435) and single status (OR = 4.307; 95% CI = 1.014-18.293) increased the likelihood of a poor unstable recovery. Poor unstable pattern was significantly associated with a high relapse rate (73%). CONCLUSIONS Our results shed light on identifying different recovery patterns in FEP. Despite evidence for early intervention effectiveness, we should explore ways to prevent relapse and improve long-term recovery, particularly in reference to the role of timing in the design of interventions.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain.
| | - Jose María Pelayo Terán
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Unidad de Gestión Clínica de Psiquiatría y Salud Mental, Gerencia de Asistencia Sanitaria de El Bierzo, Servicio de Salud de Castilla y Leon (SACYL), Ponferrada, León, Spain
| | - Esther Setién-Suero
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
| | - Karl Neergaard
- Laboratoire Parole et Langage, Aix-Marseille University, Aix-en-Provence, France
| | - Susana Ochoa
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Mariluz Ramírez-Bonilla
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Rocío Pérez-Iglesias
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Spain
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Hofer A, Post F, Pardeller S, Frajo-Apor B, Hoertnagl CM, Kemmler G, Fleischhacker WW. Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Res 2019; 271:396-401. [PMID: 30530057 DOI: 10.1016/j.psychres.2018.12.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Self-stigma is regarded as a barrier to recovery from schizophrenia and the identification of factors protecting from its development may help identify vulnerable patients and subsequently, implement effective preventive and therapeutic interventions. Hence, this study aimed to assess whether resilience, premorbid adjustment, and psychopathology might differently impact self-stigma and stigma resistance among 54 regular attendees of a specialized outpatient clinic. There was no significant association between sociodemographic variables and self-stigma/stigma resistance, while resilience was negatively correlated with self-stigma and positively correlated with stigma resistance. In addition, we detected a negative correlation between self-stigma and both academic and social functioning during late adolescence. Most residual symptoms correlated with self-stigma, while no association was found between stigma resistance and psychopathology, except for depressed symptoms. These data provide evidence that future self-stigma reduction interventions may consider to focus on the improvement of resilience in order to promote schizophrenia patients' stigma resistance. In addition, the improvement of depressive symptoms as well as interventions focusing on the strengthening of social adjustment during the prodromal phase may be effective in preventing self-stigma.
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Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Fabienne Post
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Christine M Hoertnagl
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
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