Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

BACKGROUND

The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches.

METHODS

This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients' medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population.

DISCUSSION

A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians' and researchers' awareness and serve as the basis to adapted treatments that will better support recovery.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

Clozapine rechallenge or continuation despite neutropenia or agranulocytosis using colony-stimulating factor: A systematic review

OBJECTIVES

Rechallenge/continuation of clozapine in association with colony-stimulating factors (CSFs) following neutropenia/agranulocytosis has been reported, but many questions remain unanswered about efficacy and safety. This systematic review aims to assess the efficacy and safety of rechallenging/continuing clozapine in patients following neutropenia/agranulocytosis using CSFs.

METHODS

MEDLINE, Embase, PsycInfo, and Web of Science databases were searched from inception date to July 31, 2022. Articles screening and data extraction were realized independently by two reviewers, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 systematic review guidance. Included articles had to report on at least one case where clozapine was rechallenged/continued using CSFs despite previous neutropenia/agranulocytosis.

RESULTS

Eight hundred forty articles were retrieved; 34 articles met the inclusion criteria, totaling 59 individual cases. Clozapine was successfully rechallenged/continued in 76% of patients for an average follow-up period of 1.9 years. There was a trend toward better efficacy reported in case reports/series, compared with consecutive case series (overall success rates of 84% and 60%, respectively, p-value = 0.065). Two administration strategies were identified, "as-needed" and prophylactic, both yielding similar success rates (81% and 80%, respectively). Only mild and transient adverse events were documented.

CONCLUSIONS

Although limited by the relatively small number of published cases, factors such as time of onset to first neutropenia and severity of the episode did not seem to impact the outcome of a subsequent clozapine rechallenge using CSFs. While the efficacy of this strategy remains to be further adequately evaluated in more rigorous study designs, its long-term innocuity warrants considering its use more proactively in the management of clozapine hematological adverse events as to maintain this treatment for as many individuals as possible.

Gaming Disorder and Psychotic Disorders: A Scoping Review

BACKGROUND

There is a growing interest in understanding the impact of video games in the clinical field, given that their excessive use could be associated with health issues. Particularly, gaming disorder (GD) is considered as an addictive behavioral disorder. Clinicians widely recognize the comorbidity of gaming and psychotic disorders (PDs). Furthermore, association between addictive (i.e., substance use disorders) and PDs are well recognized by clinicians. It seems of high interest to explore GD among people with PDs. To this day, little is known about the consequences of GD in vulnerable populations.

OBJECTIVES

The aim of this scoping review was to summarize the available research on the comorbidity between GD and PD and to identify the knowledge gaps in this field.

METHODS

We used Levac's six-stage methodology for scoping review. Two-hundred and forty-two articles from seven databases were identified. Eight articles respected our inclusion and exclusion criteria.

RESULTS

No available study has assessed the prevalence or incidence of GD among patients with PDs. The cases reported highlight the possibility that excessive video gameplay or abrupt gaming disruption could trigger psychosis in some patients.

CONCLUSION

The results highlight a significant lack of knowledge concerning PDs associated with GD as only a few reported cases and one empirical study exposed the potential association between those conditions.

77 TRANSCRIPTOME PROFILING IN OOCYTES-EMBRYO AND GRANULOSA CELLS FROM BOVINE

The EmbryoGENE Network (2008–2013) has assembled data from more than 764 DNA arrays covering the entire transcriptome of bovine oocytes, embryos, and somatic cells, such as granulosa and cumulus cells. The data were obtained using the same extraction-amplification-hybridization-analysis protocols enabling normalization and statistical analysis across time, tissues, and experiments. To provide the scientific community with this information in an organised and functional matter, we have created a web application (http:// http://emb-bioinfo.fsaa.ulaval.ca/granulosaIMAGE/) where the information on 40,000 genes products from 4 tissues are currently available: oocytes (mainly at the germinal vesicle stage), blastocysts in different culture conditions (namely in vitro, in vivo, different concentrations of lipids, free radicals and glucose, as well as blastocysts from cloning, vitrification, and different breeds). Also represented is the complete panel of late folliculogenesis from 3 mm upward including growing, plateau, and atretic phase oocytes, as well as their response to LH and several types of ovarian stimulation. In addition, a postpartum panel of dominant follicles (PGF2α synchronized at Day 30, 60, 90, 12) with high or low BHB (beta-hydroxybutyrate) or vitamin treated (B-6 and B-9) is represented. In each of the panels, a red background indicates differential expression for any given gene or isoform (40,000 on the EmbryoGENE array). To complete the information, a RNAseq experiment was performed on each stage from the germinal vesicle oocyte to the blastocyst (including early and late 8 cell) and presented as an absolute expression level, which is a measure of the total number of RNA molecules for the selected family of transcripts. The web application also provides relative expression values, which measure the proportion of the total transcripts represented by the selected family of transcripts. This information is provided as a graphical representation from the germinal vesicle to the blastocyst stage. This source of information may be cited either by referring to the website or by citing each individual analysis (>20 published papers from >20 principal investigators from Canada and abroad, all publicly available) used to assemble the profiles. We anticipate that this site will be useful to all scientists in bovine reproduction. The EmbryoGENE network was supported by NSERC Canada and Semex Canada for the bovine side.