RESUMEN
BACKGROUND: The long-term outcome of first-episode schizophrenia needs improvement. Here, we evaluate the effectiveness of 5 years sustained specialist treatment (ST), ST including Parent groups (ST + P) or treatment as usual (TAU) on psychotic relapse and social functioning. METHODS: A three condition randomized, parallel assigned, single-blind efficacy trial, in which 198 first-episode psychosis (FEP) patients aged 15-28 years were included. The effect on time to first relapse, first relapse rates, mean number of relapses per patient, and time to the improvement of social functioning were analyzed using Cox regression or ANOVA. RESULTS: We found no significant differences between treatment conditions in the ITT analysis concerning time to first relapse, nor first relapse rate. Mean number of relapses per patient differed at a trend level between ST, ST + P or TAU conditions, respectively: 0.72; 0.62 or 1.02 (p = 0.069). No evidence was found for differential effect of treatment conditions on social functioning. CONCLUSION: Five years sustained ST of FEP nor addition of parent groups increased time to first relapse or reduced first relapse rate, compared to sustained TAU. Indications for favorable effects of parent groups were found on relapses per patient.
Asunto(s)
Antipsicóticos , Trastornos Psicóticos , Esquizofrenia , Humanos , Esquizofrenia/tratamiento farmacológico , Método Simple Ciego , Trastornos Psicóticos/tratamiento farmacológico , Prevención Secundaria , Antipsicóticos/uso terapéutico , RecurrenciaRESUMEN
AIM: Depression and suicidal ideation (SUI) and behaviour are more prevalent in females than males, and common in clinical high-risk (CHR) patients. Childhood adversities and trauma (CAT) are associated with adult depression and SUI. The role of gender as a moderator and depression as a mediator for the effect of CAT on SUI has not been explored in CHR patients. METHODS: In all, 245 young help-seeking CHR patients were assessed for SUI (thoughts of killing themselves) with the Beck Depression Inventory at baseline, 9-month and 18-month follow-ups. At baseline, clinical depression was assessed by the Structured Clinical Interview for DSM-IV (SCID-I), and CAT by the Trauma and Distress Scale (TADS) which includes the five domains of emotional, physical and sexual abuse, emotional and physical neglect. RESULTS: CAT total and all domains except physical neglect predicted SUI over the study period. The effect of CAT on SUI was mediated via clinical depression and concurrent depression symptoms differently for females and males. In females, the effect of emotional abuse and neglect on SUI was mediated via baseline depression. In males, emotional and physical abuse had a direct effect on SUI, and the effect of sexual abuse and emotional neglect was partly mediated via concurrent depression symptoms. CONCLUSIONS: For CHR females, the effect of CAT on adult SUI is mediated via depression, while for males, CAT and its domains have mainly direct effects in maintaining SUI. These gender differences should be taken into account when treating CHR patients with SUI.
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Adultos Sobrevivientes del Maltrato a los Niños/psicología , Experiencias Adversas de la Infancia , Maltrato a los Niños/psicología , Trastorno Depresivo/psicología , Trastornos Psicóticos/psicología , Ideación Suicida , Adolescente , Adulto , Niño , Maltrato a los Niños/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND: The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. METHODS: In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. RESULTS: At baseline, 54.3% of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4%. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. CONCLUSION: Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.
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Trastorno Depresivo/epidemiología , Trastornos Paranoides/diagnóstico , Trastornos Paranoides/epidemiología , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Entrevista Psicológica , Masculino , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
High rates of obsessive-compulsive symptoms (OCS) in schizophrenia require pathogenic explanations. Personality traits may represent risk and resiliency factors for the development of mental disorders and their comorbidities. The aim of the present study was to explore the associations between Five-Factor Model (FFM) personality traits and the liability for OCS in patients with psychotic disorders and in their un-affected siblings. FFM traits, occurrence and severity of OCS and (subclinical) psychotic symptoms were assessed in 208 patients and in 281 siblings. Differences in FFM traits between participants with vs. without comorbid OCS were examined and the predictive value of FFM traits on group categorization was evaluated. Associations between FFM traits and OCS severity were investigated. Patients and siblings with OCS showed significantly higher Neuroticism compared to their counterparts without OCS. Neuroticism was positively associated with higher OCS severity and significantly predicted group assignment in both patients and in siblings. Patients with comorbid OCS presented with lower scores on Extraversion and Conscientiousness. Higher Neuroticism, and to a lesser degree lower Extraversion and Conscientiousness might add to the vulnerability of patients with a psychotic disorder to also develop OCS. Future prospective studies are needed to elucidate proposed personality-psychopathology interrelations and possible mediating factors.
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Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/genética , Inventario de Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/genética , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/psicología , Carácter , Comorbilidad , Femenino , Humanos , Masculino , Neuroticismo , Trastorno Obsesivo Compulsivo/psicología , Fenotipo , Trastornos Psicóticos/psicología , Valores de Referencia , Adulto JovenRESUMEN
Evidence-based decisions on indicated prevention in early psychosis require large-scale studies on the pathways to care in high-risk subjects. EPOS (The European Prediction of Psychosis Study), a prospective multi-center, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), was designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. Our high risk sample (n=233) reported on average 2.9 help-seeking contacts, with an average delay between onset of relevant problems to initial help-seeking contact of 72.6 weeks, and between initial help-seeking contact and reaching specialized high risk care of 110.9 weeks. This resulted in a total estimated duration of an unrecognized risk for psychosis of 3 ½ years. Across EPOS EU regions, about 90% of care pathway contacts were within professional health care sectors. Between EPOS regions, differences in the pathways parameters including early detection and health-care systems were often very pronounced. High-risk participants who later made transition to a full psychotic disorder had significantly longer delays between initial help-seeking and receiving appropriate interventions. Our study underlines the need for regionally adapted implementation of early detection and intervention programs within respective mental health and health care networks, including enhancing public awareness of early psychosis.
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Aceptación de la Atención de Salud/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Adolescente , Adulto , Diagnóstico Precoz , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Aceptación de la Atención de Salud/psicología , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Factores de Riesgo , Adulto JovenRESUMEN
Earlier studies indicated that personality characteristics contribute to symptomatic outcome in patients with psychotic disorders. The aim of the present study was to further explore this connection by examining the relationship between the Five-Factor Model (FFM) personality traits and a dimensional liability for psychosis. FFM traits according to the NEO-FFI and levels of subclinical psychotic symptoms according to the CAPE were assessed in 217 patients with psychotic disorders, 281 of their siblings and 176 healthy controls. Psychotic symptoms according to the PANSS were assessed in the patient group. Patients differed from siblings and controls on four of the five FFM traits, all but Openness. Siblings reported higher levels of Neuroticism than controls, but lower levels than patients. Particularly lower Agreeableness, and to a lesser degree, higher Neuroticism and lower Extraversion were associated with more severe symptoms in patients. Furthermore, higher Neuroticism and higher Openness were associated with higher levels of subclinical psychotic experiences in all three groups. Associations were strongest in patients. Our findings suggest that levels of Neuroticism increase with the level of familial risk for psychosis. Levels of Openness may reflect levels of impairment that distinguish clinical from subclinical symptomatology.
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Modelos Psicológicos , Trastornos de la Personalidad/psicología , Inventario de Personalidad/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Hermanos , Adulto , Trastornos de Ansiedad/psicología , Estudios de Casos y Controles , Extraversión Psicológica , Femenino , Humanos , Masculino , Neuroticismo , Personalidad/genética , Trastornos de la Personalidad/diagnóstico , Fenotipo , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/genética , Trastornos Psicóticos/psicologíaRESUMEN
PURPOSE: In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. METHODS: In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1%) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. RESULTS: Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients' SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. CONCLUSION: The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.
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Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/epidemiología , Calidad de Vida/psicología , Apoyo Social , Adolescente , Adulto , Análisis de Varianza , Femenino , Estudios de Seguimiento , Humanos , Masculino , Análisis Multivariante , Pacientes/psicología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Adulto JovenRESUMEN
We assessed expressed emotion (EE) with an adapted version of the five-minute speech sample in 847 pregnant women. The prevalence of high EE was 6%. High EE was significantly associated with having a first child, low income, maternal childhood trauma and lack of parental emotional warmth during childhood.
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Emoción Expresada , Embarazo/psicología , Adulto , Femenino , Humanos , Relaciones Padres-Hijo , Paridad , Pobreza/psicología , Prevalencia , Estudios Prospectivos , Factores Socioeconómicos , HablaRESUMEN
BACKGROUND: In selected samples, a considerable number of patients at clinical high risk of psychosis (CHR) are found to meet criteria for co-morbid clinical psychiatric disorders. It is not known how clinical diagnoses correspond to or even predict transitions to psychosis (TTP). Our aim was to examine distributions of life-time and current Axis I diagnoses, and their association with TTP in CHR patients. METHODS: In the EPOS (European Prediction of Psychosis Study) project, six European outpatient centres in four countries examined 245 young help-seeking patients, who fulfilled the inclusion criteria for clinical risk of psychosis according to the Structured Interview for Prodromal Syndromes (SIPS 3.0) or the Bonn Scale for the Assessment of Basic Symptoms - Prediction List basic symptoms (BASBS-P). Patients who had experienced a psychotic episode lasting more than one week were excluded. Baseline and life-time diagnoses were assessed by the Structured Clinical Interview for DSM-IV (SCID-I). TTP was defined by continuation of BLIPS for more than seven days and predicted in Cox-regression analysis. RESULTS: Altogether, 71% of the CHR patients had one or more life-time and 62% one or more current SCID-I diagnosis; about a half in each category received a diagnosis of life-time depressive and anxiety disorder. Currently, 34% suffered from depressive and 39% from anxiety disorder. Four percent received a current SCID diagnosis of bipolar, and 6.5% of somatoform disorder. During follow-up, 37 (15.1%) patients had developed full-blown psychosis. In bivariate analyses, current non-psychotic bipolar disorder associated significantly with TTP. In multivariate analyses, current bipolar disorder, somatoform and unipolar depressive disorders associated positively, and anxiety disorders negatively, with TTP. CONCLUSIONS: Both life-time and current mood and anxiety disorders are highly prevalent among clinical help-seeking CHR patients and need to be carefully evaluated. Among CHR patients, occurrence of bipolar, somatoform and depressive disorders seems to predict TTP, while occurrence of anxiety disorder may predict non-transition to psychosis.
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Trastornos de Ansiedad/epidemiología , Trastorno Bipolar/epidemiología , Trastorno Depresivo/epidemiología , Trastornos Psicóticos/epidemiología , Trastornos Somatomorfos/epidemiología , Adolescente , Adulto , Comorbilidad , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: This study examines the ability of the Scale of Prodromal Symptoms (SOPS) to differentiate between negative and depression symptoms in a young help-seeking ultrahigh risk (UHR) group. METHODS: SOPS data of 77 help-seeking patients at UHR for psychosis were analyzed with an exploratory factor analysis. The extracted Depression factor was validated with the Beck Depression Inventory (BDI). The extracted SOPS Negative symptoms factor was validated with the Negative symptoms subscale of the Positive and Negative Syndrome Scale (PANSS). RESULTS: Four factors were extracted from the SOPS: a negative, depression, disorganized and positive factor. The Negative symptom factor consisted of three items (N1: social anhedonia and withdrawal, N3: decreased expression of emotion; N4: decreased experience of emotions and self), and could be validated with the PANSS Negative symptoms subscale. The Depression factor was also made up of three items (G2: dysphoric mood, G4: impaired tolerance to normal stress, and D4: personal hygiene/social attentiveness), and could be validated with the BDI. CONCLUSIONS: Our results suggest that 3 items of the Negative symptoms subscale of the SOPS, 2 items of the General and 1 item of the Disorganization subscale differentiate validly between negative and depression symptoms in an UHR population.
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Afecto , Depresión/diagnóstico , Trastorno Depresivo/diagnóstico , Esquizofrenia/diagnóstico , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Psicometría , Adulto JovenRESUMEN
Early identification of subjects with an increased risk of psychosis is necessary to develop interventions to delay or prevent disease onset. We recently reported that decreased semantic verbal fluency performance in ultra high risk (UHR) subjects predicts the development of psychosis (Becker et al., 2010). The present study investigated whether semantic and verbal fluency scores correlate with grey matter density in UHR subjects. Thirty-seven UHR subjects underwent structural MRI scanning and verbal fluency assessment after which they were followed up for 2 years. Using voxel-based morphometry, we investigated whether grey matter density correlated with verbal fluency scores in 10 UHR subjects who developed psychosis during follow-up and 27 UHR subjects who did not develop psychosis. In UHR subjects developing psychosis, lower semantic fluency scores correlated significantly with reduced grey matter density in the right superior and middle temporal gyrus, the right insula, and the left anterior cingulate cortex. This study shows that a correlation between semantic fluency performance and grey matter density in task-related areas can differentiate between UHR subjects who subsequently will develop psychosis and those who will not. Combining these two measures could improve psychosis prediction in UHR subjects.
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Encéfalo/patología , Trastornos Psicóticos/etiología , Semántica , Trastornos del Habla/complicaciones , Trastornos del Habla/patología , Adolescente , Adulto , Mapeo Encefálico , Progresión de la Enfermedad , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Riesgo , Estadística como Asunto , Estadísticas no Paramétricas , Factores de Tiempo , Adulto JovenRESUMEN
Providers of mental health services need tools to screen for acute psychosis and ultrahigh risk (UHR) for transition to psychosis in help-seeking individuals. In this study, the Eppendorf Schizophrenia Inventory (ESI) was examined as a screening tool and for its ability to correctly predict diagnostic group membership (e.g., help seeking, mild psychiatric complaints, highly symptomatic mood or anxiety disorder, UHR, acute psychosis). Diagnostic evaluation with established instruments was used for diagnosis in 3 research samples. UHR status was assessed with the Structured Interview for Prodromal Symptoms/Scale of Prodromal Symptoms (Miller et al., 1999) and the Bonn Scale for the Assessment of Basic Symptoms Prediction list (Gross, Huber, Klosterkötter, & Linz, 1987; Klosterkötter, Hellmich, Steinmeyer, & Schulze-Lutter, 2001). This study showed that members of different diagnostic groups rate themselves significantly differently on the ESI and its subscales. A new subscale was constructed, the UHR-Psychosis scale, that showed good utility in detecting individuals with interview-diagnosed UHR status and acute psychosis. The scale is also sensitive to the threshold between UHR and acute psychosis. Practical applications of the ESI include use as a diagnostic tool within various settings.
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Comparación Transcultural , Tamizaje Masivo , Inventario de Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Enfermedad Aguda , Adolescente , Adulto , Atención Ambulatoria , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Femenino , Hospitalización , Humanos , Masculino , Trastornos del Humor/diagnóstico , Trastornos del Humor/psicología , Países Bajos , Aceptación de la Atención de Salud/psicología , Psicometría/estadística & datos numéricos , Derivación y Consulta , Reproducibilidad de los Resultados , Medición de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Decline in social functioning occurs in individuals who later develop psychosis. AIMS: To investigate whether baseline differences in disability are present in those who do and those who do not make a transition to psychosis in a group clinically at high risk and whether disability is a risk factor for transition. METHOD: Prospective multicentre, naturalistic field study with an 18-month follow-up period on 245 help-seeking individuals clinically at high risk. Disability was assessed with the Disability Assessment Schedule of the World Health Organization (WHODAS-II). RESULTS: At baseline, the transition group displayed significantly greater difficulties in making new friends (z = -3.40, P = 0.001), maintaining a friendship (z =-3.00, P = 0.003), dealing with people they do not know (z =-2.28, P = 0.023) and joining community activities (z =-2.0, P = 0.05) compared with the non-transition group. In Cox regression, difficulties in getting along with people significantly contributed to the prediction of transition to psychosis in our sample (ß = 0.569, s.e. = 0.184, Wald = 9.548, P = 0.002, hazard ratio (HR) = 1.767, 95% CI 1.238-2.550). CONCLUSIONS: Certain domains of social disability might contribute to the prediction of psychosis in a sample clinically at high risk.
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Actividades Cotidianas/psicología , Personas con Discapacidad/psicología , Relaciones Interpersonales , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Encuestas y Cuestionarios , Adolescente , Adulto , Niño , Progresión de la Enfermedad , Diagnóstico Precoz , Europa (Continente) , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Esquizofrenia/epidemiología , Participación Social/psicología , Adulto JovenRESUMEN
OBJECTIVE: Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger age. METHOD: People referred to the Academic Medical Centre in Amsterdam, the Netherlands, with an ultra-high risk (UHR) for psychosis were interviewed with the Composite International Diagnostic Interview to assess their cannabis consumption. The Interview for the Retrospective Assessment of the Onset of Schizophrenia was used to collect data about age of onset of high-risk or prodromal symptoms. Nine high-risk symptoms were selected and clustered because of their known relation with cannabis use. RESULTS: Among the 68 included participants, 35 had used cannabis (51.5%), of whom 15 had used recently. Twenty-two participants had been cannabis abusers or cannabis-dependent (32.4%) in the past. Younger age at onset of cannabis use was related to younger age of onset of the cluster of symptoms (rho = 0.48, P = 0.003) and also to 6 symptoms individually (rho = 0.47 to 0.90, P < 0.001 to 0.04). Younger age at onset of a cannabis use disorder was related to younger age of onset of the cluster of symptoms (rho = 0.67, P = 0.001) and also to 6 symptoms individually (rho = 0.50 to 0.93, P = 0.007 to 0.03). CONCLUSION: Cannabis use or a cannabis use disorder at a younger age in a group with an UHR for transition to psychosis is related to onset of high-risk symptoms for psychosis at a younger age.
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Cannabis/efectos adversos , Abuso de Marihuana , Esquizofrenia , Adolescente , Adulto , Factores de Edad , Edad de Inicio , Niño , Humanos , Abuso de Marihuana/complicaciones , Abuso de Marihuana/epidemiología , Países Bajos , Estudios Retrospectivos , Factores de Riesgo , Esquizofrenia/epidemiología , Esquizofrenia/etiología , Adulto JovenRESUMEN
CONTEXT: Indicated prevention is currently regarded as the most promising strategy to attenuate, delay, or even avert psychosis. Existing criteria need improvement in terms of specificity and individual risk assessment to allow for better targeted and earlier interventions. OBJECTIVE: To develop a differential predictive clinical model of transition to first-episode psychosis. DESIGN: Prospective multicenter, naturalistic field study with a total follow-up time of 18 months. SETTING: Six early-detection outpatient centers in Germany, Finland, the Netherlands, and England. PARTICIPANTS: Two hundred forty-five help-seeking patients in a putatively prodromal state of psychosis according to either ultra-high-risk (UHR) criteria or the basic symptom-based criterion cognitive disturbances (COGDIS). MAIN OUTCOME MEASURE: Incidence of transition to psychosis. RESULTS: At 18-month follow-up, the incidence rate for transition to psychosis was 19%. Combining UHR and COGDIS yielded the best sensitivity. A prediction model was developed and included positive symptoms, bizarre thinking, sleep disturbances, a schizotypal disorder, level of functioning in the past year, and years of education. With a positive likelihood ratio of 19.9, an area under the curve of 80.8%, and a positive predictive value of 83.3%, diagnostic accuracy was excellent. A 4-level prognostic index further classifying the general risk of the whole sample predicted instantaneous incidence rates of up to 85% and allowed for an estimation of time to transition. CONCLUSIONS: The prediction model identified an increased risk of psychosis with appropriate prognostic accuracy in our sample. A 2-step risk assessment is proposed, with UHR and cognitive disturbance criteria serving as first-step criteria for general risk and the prognostic index as a second-step tool for further risk classification of each patient. This strategy will allow clinicians to target preventive measures and will support efforts to unveil the biological and environmental mechanisms underlying progression to psychosis.
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Trastornos Psicóticos/diagnóstico , Adulto , Atención Ambulatoria , Progresión de la Enfermedad , Diagnóstico Precoz , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Pronóstico , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/prevención & control , Medición de Riesgo , Factores de Riesgo , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The relationship between cannabis use and psychosis has been studied intensively. Few data, however, are available on the relationship between cannabis use, ultra-high risk for developing psychosis and neurocognition. The aim of the present cross-sectional study was therefore to investigate the relationship between cannabis use, ultra-high-risk (UHR) symptoms and cognitive functioning in UHR patients and healthy controls. METHODS: A total of 63 ultra-high-risk patients (34 cannabis users) and 58 control subjects (28 cannabis users) were assessed with clinical measures and a neuropsychological test battery. Patients were eligible for the study if they were between the ages of 12 and 35 years and if they fell into one or more of the following inclusion groups: familial risk and reduced functioning, attenuated psychotic symptoms, brief limited intermittent psychotic symptoms and basic symptoms. Control subjects were eligible for the study if they were between the ages 12 and 35, had no present or past psychiatric illness, no family history of psychiatric illness, no drug use in the non-cannabis-using group, and use of at least four joints per week in the cannabis-using control group. RESULTS: In the UHR and the control group, cannabis users experienced more basic symptoms and UHR symptoms than the non-cannabis users. Moreover, cannabis users in the control group performed at the level of the UHR subjects on a test of verbal memory and verbal fluency. Frequency of cannabis use correlated with severity of several UHR symptoms. CONCLUSIONS: Cannabis-using UHR patients have more basic symptoms than non-using patients. In addition, healthy cannabis users have more subclinical UHR and basic symptoms and more neuropsychological dysfunctions than non-cannabis users. More frequent cannabis use was related to increased severity of certain UHR symptoms.
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Cognición , Abuso de Marihuana/psicología , Desempeño Psicomotor , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Adolescente , Adulto , Atención , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Pruebas Neuropsicológicas , Pronóstico , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
This study assessed with diffusion tensor imaging (DTI) whether ultra-high-risk subjects who later develop a psychotic disorder (UHR-P) show abnormalities in association white matter fiber tracts as compared to UHR subjects who do not convert to psychosis (UHR-NP) and healthy controls. Participants comprised 17 male UHR subjects and 10 male healthy controls, who received baseline DTI scans before clinical follow-up. The uncinate and arcuate fasciculi, anterior and dorsal cingulate, and subdivisions of the corpus callosum were calculated and visualized, and tract-specific measurements were performed. At 24-month follow-up seven UHR subjects had developed a first psychotic episode. Fractional anisotropy in baseline DTI scans, including left-right asymmetry measures, did not differ between the groups. Thus, DTI measures of these association white matter tracts were not biological markers of psychosis in our UHR sample. Abnormalities of these fiber tracts may develop around or after onset of psychosis. However, further DTI studies in UHR subjects are needed in larger samples.
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Encéfalo/patología , Fibras Nerviosas Mielínicas/patología , Trastornos Psicóticos/patología , Anisotropía , Cuerpo Calloso/patología , Imagen de Difusión Tensora , Estudios de Seguimiento , Giro del Cíngulo/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Vías Nerviosas/patología , Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: The aim of the present study was to gain more insight into the positive and negative effects of cannabis in the prodromal phase of schizophrenia and in the ultra-high-risk (UHR) state for psychosis. METHOD: A theory-driven questionnaire was used to examine subjective effects in the prodromal phase in male subjects with a recent onset of schizophrenia or related disorder (n = 52) and in the UHR state in help-seeking male subjects screened for being at UHR for psychosis (n = 17); both groups were compared to cannabis-using controls from the general population (n=52). RESULTS: Recent-onset patients and UHR subjects reported feeling more anxious, depressed and suspicious immediately after cannabis use. Some patients also reported feeling less depressed after cannabis use. Recent-onset patients reported increased visual and acoustic hallucinations, and confusion after cannabis use. Of the recent-onset patients 37% reported that their very first psychotic symptoms occurred during cannabis intoxication. Long-term effects of cannabis reported more often by both patient groups were depression, less control over thoughts and social problems. CONCLUSIONS: These results suggest that schizophrenia patients in the prodromal phase and subjects at UHR for psychosis are more sensitive to some negative effects of cannabis, in particular psychotic effects, compared to cannabis users from the general population. Although limited by the retrospective design in the recent-onset patients, the present study adds qualitative evidence to longitudinal studies that suggest that cannabis is a component cause in the onset of the first psychotic episode. Further studies are needed on the objective and subjective effects of cannabis in UHR subjects.
Asunto(s)
Fumar Marihuana/psicología , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Adulto , Análisis de Varianza , Ansiedad/inducido químicamente , Depresión/inducido químicamente , Progresión de la Enfermedad , Alucinaciones/inducido químicamente , Humanos , Masculino , Pruebas Neuropsicológicas , Selección de Paciente , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Estadísticas no Paramétricas , Encuestas y CuestionariosRESUMEN
Little is known about medication prescription in a naturalistic setting to patients at ultra high risk (UHR) of developing psychosis. Antipsychotic medication prescription to UHR patients is not recommended in clinical practice guidelines based on the current evidence. The aim of this study is to investigate medication prescription to UHR patients in the Netherlands. The frequency of antipsychotic medication prescription to UHR patients (n=72) was compared with the frequency of antipsychotic medication prescription to patients who were diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition psychotic disorder at first diagnostic evaluation (n=90). Within the UHR group, frequency of antipsychotic medication prescription at baseline was compared between UHR patients who did make the transition to psychosis (n=18) and UHR patients who did not (n=54). No significant differences were found in antipsychotic medication prescription to UHR patients and to patients who turned out to have a florid psychosis: 51% in the psychotic group and 58% in the UHR group used no medication. Thirty-four percent in the psychotic group and 21% in the UHR group used antipsychotic medication. There was also no difference in medication prescription between UHR patients who did and did not make the transition to psychosis. More research should be aimed at developing and implementing clinical practice guidelines for the treatment of UHR patients.
Asunto(s)
Antipsicóticos/uso terapéutico , Prescripciones/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/tratamiento farmacológico , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Pautas de la Práctica en Medicina , RiesgoRESUMEN
Atypical antipsychotics interfere with central and peripheral neurotransmitter systems and with hormonal production. In this study we compared the effect of olanzapine and risperidone on hormonal state and sexual function (by using the Questionnaire for Sexual Dysfunction, QSD) in 40 patients with a first episode psychosis. Results were compared to those of 34 healthy controls. Patients using risperidone had significant higher prolactin levels than patients using olanzapine. Patients using olanzapine had significantly higher 17beta-estradiol levels than patients using risperidone. Overall satisfaction with sexuality was less in patients compared to controls, but not different between patients using olanzapine and those using risperidone. Problems with sexual arousal were significantly higher in patients using olanzapine compared to patients using risperidone. A significantly higher frequency of problems with ejaculation and problems with insensibility of genitals were found in patients compared to healthy controls. We found no relation between medication, prolactin and 17beta-estradiol levels, frequency of sexual activity, overall satisfaction with sexuality and any of the 18 sexual dysfunctions we investigated. Our results suggests that sexual dysfunction in patients with first episode psychosis might occur despite normal prolactin levels. Also, sexual dysfunction is highly prevalent in healthy controls. Awareness should be raised of potential sexual problems in young adults.