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Lappin JM, Heslin M, Lomas B, Jones PB, Doody GA, Reininghaus UA, Croudace T, Craig T, Fearon P, Murray RM, Dazzan P, Morgan C. Early sustained recovery following first episode psychosis: Evidence from the AESOP10 follow-up study. Schizophr Res 2018; 199:341-345. [PMID: 29571751 DOI: 10.1016/j.schres.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/24/2018] [Accepted: 03/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the characteristics of individuals with early sustained recovery following first episode psychosis. METHODS Individuals with a first episode psychosis were followed-up for ten years. Comparisons were made between those with Early Sustained Recovery and those with Other Course types. RESULTS Of 345 individuals, n=43 (12.5%) had Early Sustained Recovery. They were more likely than those with Other Course types to be female (OR=2.45; 95% CI: 1.25-4.81); employed (OR=2.39; 95% CI: 1.22-4.69); in a relationship (OR=2.68; 95% CI: 1.35-5.32); have a short DUP (OR=2.86; 95% CI: 1.37-5.88); and have a diagnosis other than schizophrenia, particularly mania (OR=6.39; 95% CI: 2.52-16.18) or brief psychosis (OR=3.64; 95% CI: 1.10-12.10). CONCLUSIONS Sustained recovery from first episode psychosis occurs in a minority.
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Affiliation(s)
- J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - B Lomas
- Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - P B Jones
- University of Cambridge, Cambridge, UK
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University
| | | | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Demjaha A, Lappin JM, Stahl D, Patel MX, MacCabe JH, Howes OD, Heslin M, Reininghaus UA, Donoghue K, Lomas B, Charalambides M, Onyejiaka A, Fearon P, Jones P, Doody G, Morgan C, Dazzan P, Murray RM. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med 2017; 47:1981-1989. [PMID: 28395674 DOI: 10.1017/s0033291717000435] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors. METHOD The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance. RESULTS From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset. CONCLUSIONS The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.
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Affiliation(s)
- A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J M Lappin
- School of Psychiatry, University of New South Wales, Sydney, NSW,Australia
| | - D Stahl
- Department of Biostatistics,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M X Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - J H MacCabe
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - O D Howes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Heslin
- Health Service and Population Research Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - U A Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - K Donoghue
- Addictions Department,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - B Lomas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - M Charalambides
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Fearon
- Department of Psychiatry,Trinity College,Dublin, Republic ofIreland
| | - P Jones
- Department of Psychiatry,University of Cambridge,Cambridge,UK
| | - G Doody
- Division of Psychiatry,University of Nottingham,Nottingham,UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
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Heslin M, Desai R, Lappin JM, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Dazzan P, Fisher HL, Demjaha A, Craig T, Morgan C. Biological and psychosocial risk factors for psychotic major depression. Soc Psychiatry Psychiatr Epidemiol 2016; 51:233-45. [PMID: 26520449 PMCID: PMC4748002 DOI: 10.1007/s00127-015-1131-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
Abstract
AIMS Few studies have investigated risk factors for psychotic major depression (PMD). We aimed to investigate the biological and psychosocial risk factors associated with PMD compared with other psychotic disorders. METHODS Based on the aetiology and ethnicity in schizophrenia and other psychoses (ÆSOP) study, we used a case-control study to identify and recruit, at baseline and 10-year follow-up, all first episode cases of psychosis, presenting for the first time to specialist mental health services in defined catchment areas in the UK. Population-based controls were recruited from the same areas. Data were collected on: sociodemographics; social isolation; childhood adversity; life events; minor physical anomalies; and neurological soft signs. RESULTS Living alone (aOR = 2.26, CI = 1.21-4.23), basic level qualification (aOR = 2.89, CI = 1.08-7.74), being unemployed (aOR = 2.12, CI = 1.13-3.96), having contact with friends less than monthly (aOR = 4.24, CI = 1.62-11.14), having no close confidants (aOR = 4.71, CI = 2.08-10.68), having experienced childhood adversity (aOR = 2.57, CI = 1.02-6.44), family history of mental illness (aOR = 10.68, CI = 5.06-22.52), family history of psychosis (aOR = 12.85, CI = 5.24-31.51), and having more neurological soft signs (aOR = 1.15, CI = 1.07-1.24) were all associated with a follow-up diagnosis of PMD and schizophrenia. Few variables associated with PMD were also associated with a diagnosis of bipolar disorder. Minor physical anomalies were associated with a follow-up diagnosis of schizophrenia and bipolar disorder, but not PMD. CONCLUSIONS Risk factors associated with PMD appear to overlap with those for schizophrenia, but less so for bipolar disorder. Future work on the differential aetiology of PMD, from other psychoses is needed to find the 'specifier' between PMD and other psychoses. Future research on aetiology in PMD, and perhaps other psychoses, should account for diagnostic change.
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Affiliation(s)
- M Heslin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - R Desai
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - J M Lappin
- University of New South Wales, Sydney, Australia
| | - K Donoghue
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - B Lomas
- University of Nottingham, Nottingham, UK
| | - U Reininghaus
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- Maastricht University, Maastrict, The Netherlands
| | - A Onyejiaka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | | | - P B Jones
- University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - P Fearon
- Trinity College, Dublin, Ireland
| | - G A Doody
- University of Nottingham, Nottingham, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - H L Fisher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - A Demjaha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - T Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
- National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
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Heslin M, Lomas B, Lappin JM, Donoghue K, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Dazzan P, Morgan C, Doody GA. Diagnostic change 10 years after a first episode of psychosis. Psychol Med 2015; 45:2757-2769. [PMID: 25936425 PMCID: PMC4595854 DOI: 10.1017/s0033291715000720] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/19/2015] [Accepted: 03/24/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND A lack of an aetiologically based nosology classification has contributed to instability in psychiatric diagnoses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an incidence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change. METHOD Data were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables associated with change were examined using logistic regression and likelihood ratio tests. RESULTS Slightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years. Many variables were associated with change to schizophrenia but few with overall change in diagnosis. CONCLUSIONS Diagnoses other than schizophrenia should to be regarded as potentially provisional.
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Affiliation(s)
- M. Heslin
- Centre for Economics of Mental and Physical
Health, King's College London,
London, UK
| | - B. Lomas
- Division of Psychiatry,
University of Nottingham, Nottingham,
UK
| | - J. M. Lappin
- Department of Psychiatry,
University of New South Wales, Sydney,
Australia
- Psychosis Studies Department,
King's College London, London,
UK
| | - K. Donoghue
- Addictions Department,
King's College London, London,
UK
| | - U. Reininghaus
- Centre for Epidemiology and Public
Health, King's College London,
London, UK
- Department of Psychiatry and Psychology,
School for Mental Health and Neuroscience, Maastricht
University, Maastricht, The
Netherlands
- NIHR Collaboration for Leadership in Applied
Health Research & Care, Cambridge,
UK
| | - A. Onyejiaka
- Department of Psychology,
King's College London, London,
UK
| | - T. Croudace
- School of Nursing and Midwifery,
College of Medicine, Dentistry and Nursing, University
of Dundee, Dundee, UK
| | - P. B. Jones
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
| | - R. M. Murray
- Psychosis Studies Department,
King's College London, London,
UK
| | - P. Fearon
- Department of Psychiatry,
Trinity College, Dublin,
Republic of Ireland
| | - P. Dazzan
- Psychosis Studies Department,
King's College London, London,
UK
| | - C. Morgan
- Centre for Epidemiology and Public
Health, King's College London,
London, UK
| | - G. A. Doody
- Division of Psychiatry,
University of Nottingham, Nottingham,
UK
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Lappin JM, Morgan C, Chalavi S, Morgan KD, Reinders AATS, Fearon P, Heslin M, Zanelli J, Jones PB, Murray RM, Dazzan P. Bilateral hippocampal increase following first-episode psychosis is associated with good clinical, functional and cognitive outcomes. Psychol Med 2014; 44:1279-1291. [PMID: 23866084 DOI: 10.1017/s0033291713001712] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hippocampal pathology has been proposed to underlie clinical, functional and cognitive impairments in schizophrenia. The hippocampus is a highly plastic brain region; examining change in volume, or change bilaterally, over time, can advance understanding of the substrate of recovery in psychosis. METHOD Magnetic resonance imaging and outcome data were collected at baseline and 6-year follow-up in 42 first-episode psychosis subjects and 32 matched controls, to investigate whether poorer outcomes are associated with loss of global matter and hippocampal volumes. Bilateral hippocampal increase (BHI) over time, as a marker of hippocampal plasticity was hypothesized to be associated with better outcomes. Regression analyses were performed on: (i) clinical and functional outcomes with grey matter volume change and BHI as predictor variables; and (ii) cognitive outcome with BHI as predictor. RESULTS BHI was present in 29% of psychosis participants. There was no significant grey matter loss over time in either patient or control groups. Less severe illness course and lesser symptom severity were associated with BHI, but not with grey matter change. Employment and global function were associated with BHI and with less grey matter loss. Superior delayed verbal recall was also associated with BHI. CONCLUSIONS BHI occurs in a minority of patients following their first psychotic episode and is associated with good outcome across clinical, functional and cognitive domains.
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Affiliation(s)
- J M Lappin
- Institute of Psychiatry, King's College London, London, UK
| | - C Morgan
- Institute of Psychiatry, King's College London, London, UK
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Morgan
- Department of Psychology, University of Westminster, London, UK
| | | | - P Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Republic of Ireland
| | - M Heslin
- Institute of Psychiatry, King's College London, London, UK
| | - J Zanelli
- Institute of Psychiatry, King's College London, London, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R M Murray
- Institute of Psychiatry, King's College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, King's College London, London, UK
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Schaufelberger MS, Lappin JM, Duran FLS, Rosa PGP, Uchida RR, Santos LC, Murray RM, McGuire PK, Scazufca M, Menezes PR, Busatto GF. Lack of progression of brain abnormalities in first-episode psychosis: a longitudinal magnetic resonance imaging study. Psychol Med 2011; 41:1677-1689. [PMID: 21144111 DOI: 10.1017/s0033291710002163] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Some neuroimaging studies have supported the hypothesis of progressive brain changes after a first episode of psychosis. We aimed to determine whether (i) first-episode psychosis patients would exhibit more pronounced brain volumetric changes than controls over time and (ii) illness course/treatment would relate to those changes. METHOD Longitudinal regional grey matter volume and ventricle:brain ratio differences between 39 patients with first-episode psychosis (including schizophrenia and schizophreniform disorder) and 52 non-psychotic controls enrolled in a population-based case-control study. RESULTS While there was no longitudinal difference in ventricle:brain ratios between first-episode psychosis subjects and controls, patients exhibited grey matter volume changes, indicating a reversible course in the superior temporal cortex and hippocampus compared with controls. A remitting course was related to reversal of baseline temporal grey matter deficits. CONCLUSIONS Our findings do not support the hypothesis of brain changes indicating a progressive course in the initial phase of psychosis. Rather, some brain volume abnormalities may be reversible, possibly associated with a better illness course.
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Affiliation(s)
- M S Schaufelberger
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil.
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Kirkbride JB, Lunn DJ, Morgan C, Lappin JM, Dazzan P, Morgan K, Fearon P, Murray RM, Jones PB. Examining evidence for neighbourhood variation in the duration of untreated psychosis. Health Place 2009; 16:219-25. [PMID: 19875323 PMCID: PMC2812704 DOI: 10.1016/j.healthplace.2009.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/24/2009] [Accepted: 09/30/2009] [Indexed: 11/27/2022]
Abstract
Background Family involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important. Methods DUP was estimated for all cases of first-episode psychoses identified over 2 years in 33 Southeast London neighbourhoods (n=329). DUP was positively skewed and transformed to the natural logarithm scale. We fitted various hierarchical models, adopting different assumptions with regard to spatial variability of DUP, to assess whether there was evidence of neighbourhood heterogeneity in DUP, having accounted for a priori individual-level confounders. Results Neighbourhood-level variation in DUP was negligible compared to overall variability. A non-hierarchical model with age, sex and ethnicity covariates, but without area-level random effects, provided the best fit to the data. Discussion Neighbourhood factors do not appear to be associated with DUP, suggesting its predictors lie at individual and family levels. Our results inform mental healthcare planning, suggesting that in one urbanised area of Southeast London, where you live does not affect duration of untreated psychosis.
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Affiliation(s)
- J B Kirkbride
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Ffytche DH, Lappin JM, Philpot M. Visual command hallucinations in a patient with pure alexia. J Neurol Neurosurg Psychiatry 2004; 75:80-6. [PMID: 14707313 PMCID: PMC1757477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Around 25% of patients with visual hallucinations secondary to eye disease report hallucinations of text. The hallucinated text conveys little if any meaning, typically consisting of individual letters, words, or nonsense letter strings (orthographic hallucinations). A patient is described with textual visual hallucinations of a very different linguistic content following bilateral occipito-temporal infarcts. The hallucinations consisted of grammatically correct, meaningful written sentences or phrases, often in the second person and with a threatening and command-like nature (syntacto-semantic visual hallucinations). A detailed phenomenological interview and visual psychophysical testing were undertaken. The patient showed a classical ventral occipito-temporal syndrome with achromatopsia, prosopagnosia, and associative visual agnosia. Of particular significance was the presence of pure alexia. Illusions of colour induced by monochromatic gratings and a novel motion-direction illusion were also observed, both consistent with the residual capacities of the patient's spared visual cortex. The content of orthographic visual hallucinations matches the known specialisations of an area in the left posterior fusiform gyrus--the visual word form area (VWFA)--suggesting the two are related. The VWFA is unlikely to be responsible for the syntacto-semantic hallucinations described here as the patient had a pure alexic syndrome, a known consequence of VWFA lesions. Syntacto-semantic visual hallucinations may represent a separate category of textual hallucinations related to the cortical network implicated in the auditory hallucinations of schizophrenia.
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Affiliation(s)
- D H Ffytche
- Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5, UK.
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