RESUMEN
BACKGROUND: Duration of Untreated Psychosis (DUP) is an important measure associated with outcome of psychosis. This first study in the UK compared DUP between adolescent and adult-onset individuals and explored whether the adolescent-onset group showed variations in DUP that could be accounted for by sociodemographic and selected risk factors. METHODS: This naturalistic cohort study included 940 new first-episode psychosis cases aged 14-35years (136 adolescent-onset versus 804 adult-onset psychotic individuals) referred to nine Early Intervention Services for Psychosis in London (2003-2009). Sociodemographic characteristics, age of onset, family history of mental illness, duration of untreated psychosis, suicidality and substance use information were collected at entry to the services. RESULTS: Adolescents presented with significantly greater median DUP (179days) than adults (81days, p=0.005). Large differences in DUP were found amongst adolescent ethnic groups (median DUP: White: 454days; Black: 103days; Asian and mixed: 28.5days). In addition, younger age of onset and higher lifetime cannabis use were associated with longer treatment delay amongst adolescents. CONCLUSIONS: This study of DUP in adolescent-onset psychosis found it to be approximately twice the length of DUP amongst adults. For the adolescent White sub-group, DUP was far greater than the UK Department of Health target (<3months). Both the high rates of lifetime cannabis use and the lower age of onset might explain the long DUP in this ethnic group. Physicians need to be particularly vigilant about identifying and managing early psychosis in adolescents.
Asunto(s)
Edad de Inicio , Trastornos Psicóticos/etnología , Adolescente , Adulto , Análisis de Varianza , Pueblo Asiatico , Población Negra , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/terapia , Población Blanca , Adulto JovenRESUMEN
OBJECTIVE: To examine the hypothesis that the "natural" combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use. METHODS: In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions. RESULTS: Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need. CONCLUSIONS: The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory-delusional syndrome.
Asunto(s)
Deluciones/fisiopatología , Alucinaciones/fisiopatología , Trastornos Psicóticos/fisiopatología , Adolescente , Adulto , Deluciones/epidemiología , Exposición a Riesgos Ambientales , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Alucinaciones/epidemiología , Humanos , Masculino , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/epidemiología , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
The current systematic review and meta-analysis provides an extended and comprehensive overview of the associations between neurocognitive and social cognitive functioning and different types of functional outcome. Literature searches were conducted in MEDLINE and PsycINFO and reference lists from identified articles to retrieve relevant studies on cross-sectional associations between neurocognition, social cognition and functional outcome in individuals with non-affective psychosis. Of 285 studies identified, 52 studies comprising 2692 subjects met all inclusion criteria. Pearson correlations between cognition and outcome, demographic data, sample sizes and potential moderator variables were extracted. Forty-eight independent meta-analyses, on associations between 12 a priori identified neurocognitive and social cognitive domains and 4 domains of functional outcome yielded a number of 25 significant mean correlations. Overall, social cognition was more strongly associated with community functioning than neurocognition, with the strongest associations being between theory of mind and functional outcomes. However, as three-quarters of variance in outcome were left unexplained, cognitive remediation approaches need to be combined with therapies targeting other factors impacting on outcome.
Asunto(s)
Trastornos del Conocimiento/etiología , Esquizofrenia/complicaciones , Psicología del Esquizofrénico , Conducta Social , Trastornos del Conocimiento/psicología , Humanos , Pruebas NeuropsicológicasRESUMEN
Evidence from clinical patient populations indicates that affective dysregulation is strongly associated with reality distortion, suggesting that a process of misassignment of emotional salience may underlie this connection. To examine this in more detail without clinical confounds, affective regulation-reality distortion relationships, and their clinical relevance, were examined in a German prospective cohort community study. A cohort of 2524 adolescents and young adults aged 14-24 years at baseline was examined by experienced psychologists. Presence of psychotic experiences and (hypo)manic and depressive symptoms was assessed at 2 time points (3.5 and up to 10 years after baseline) using the Munich-Composite International Diagnostic Interview. Associations were tested between level of affective dysregulation on the one hand and incidence of psychotic experiences, persistence of these experiences, and psychotic Impairment on the other. Most psychotic experiences occurred in a context of affective dysregulation, and bidirectional dose-response was apparent with greater level of both affective dysregulation and psychotic experiences. Persistence of psychotic experiences was progressively more likely with greater level of (hypo)manic symptoms (odds ratio [OR] trend=1.51, P<.001) and depressive symptoms (OR trend=1.15, P=.012). Similarly, psychotic experiences of clinical relevance were progressively more likely to occur with greater level of affective dysregulation (depressive symptoms: OR trend=1.28, P=.002; (hypo)manic symptoms: OR trend=1.37, P=.036). Correlated genetic liabilities underlying affective and nonaffective psychotic syndromes may be expressed as correlated dimensions in the general population. Also, affective dysregulation may contribute causally to the persistence and clinical relevance of reality distortion, possibly by facilitating a mechanism of aberrant salience attribution.
Asunto(s)
Desarrollo del Adolescente , Síntomas Afectivos/psicología , Trastorno Bipolar/psicología , Depresión/psicología , Distorsión de la Percepción , Adolescente , Síntomas Afectivos/epidemiología , Trastorno Bipolar/epidemiología , Depresión/epidemiología , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Masculino , Estudios Prospectivos , Prueba de Realidad , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: The cognitive and motivational impairments observed in psychotic disorders may reflect early developmental alterations that, when combined with later environmental exposures, may drive the onset of positive psychotic symptoms. The epidemiological predictions of this model were tested. METHOD: A longitudinal prospective cohort study (the Early Developmental Stages of Psychopathology Study) was conducted with a representative general population sample of adolescents and young adults from Munich (N=3,021), who were 14-24 years of age at baseline. Sociodemographic factors, environmental exposures, and measures of psychopathology and associated clinical relevance were assessed across three waves, covering a period of up to 10 years, by clinical psychologists using the Composite International Diagnostic Interview. RESULTS: Both negative/disorganized and positive psychotic symptoms were frequent (5-year cumulative prevalence rates of around 12%) and occurred in combination more often than predicted by chance. Negative/disorganized symptoms revealed a pattern of sociodemographic associations indicative of developmental impairment, whereas the positive symptoms were associated with environmental exposures such as trauma, cannabis use, and urbanicity. Negative/disorganized symptoms predicted positive symptoms over time, and co-occurrence of positive and negative/disorganized symptoms was predictive of clinical relevance in terms of secondary functional impairment and help-seeking behavior. CONCLUSION: The results suggest that the negative/disorganized features associated with psychotic disorder are distributed at the population level and drive the ontogenesis of positive psychotic experiences after exposure to environmental risks, increasing the likelihood of impairment and need for care.
Asunto(s)
Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/psicología , Adolescente , Análisis por Conglomerados , Estudios de Cohortes , Depresión/epidemiología , Depresión/psicología , Progresión de la Enfermedad , Femenino , Alemania/epidemiología , Humanos , Estudios Longitudinales , Masculino , Motivación , Prevalencia , Probabilidad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Trastornos Psicóticos/diagnóstico , Factores de Riesgo , Medio Social , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Auditory verbal hallucinations in schizophrenia have been linked to defective monitoring of one's own verbal thoughts. Previous studies have shown that patients with auditory verbal hallucinations show attenuated activation of brain regions involved with auditory processing during the monitoring of inner speech. However, there are no functional magnetic resonance imaging studies explicitly comparing the perception of external speech with internal speech in the same patients with schizophrenia. The present study investigated the functional neuroanatomy of inner and external speech in both patients with schizophrenia and healthy control subjects. METHODS: Fifteen patients with schizophrenia and 12 healthy control subjects were studied using functional magnetic resonance imaging while listening to sentences or imagining sentences. RESULTS: Significant interactions between group (control subjects vs. patients) and task (listening vs. inner speech) were seen for the left superior temporal gyrus, as well as regions within the cingulate gyrus. CONCLUSIONS: Attenuated deactivation of the left superior temporal gyrus in schizophrenia patients during the processing of inner speech may reflect deficits in the forward models subserving self-monitoring.
Asunto(s)
Corteza Auditiva/irrigación sanguínea , Ilusiones/fisiología , Esquizofrenia/patología , Psicología del Esquizofrénico , Habla/fisiología , Adulto , Corteza Auditiva/fisiopatología , Mapeo Encefálico , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Oxígeno/sangre , Tiempo de Reacción/fisiología , Esquizofrenia/fisiopatologíaRESUMEN
A systematic review (58 studies, 5,009 individuals) is presented of associations between psychopathological dimensions of psychosis and measures of neurocognitive impairment in subjects with a lifetime history of nonaffective psychosis. Results showed that negative and disorganized dimensions were significantly but modestly associated with cognitive deficits (correlations from -.29 to -.12). In contrast, positive and depressive dimensions of psychopathology were not associated with neurocognitive measures. The patterns of association for the 4 psychosis dimensions were stable across neurocognitive domains and were independent of age, gender, and chronicity of illness. In addition, significantly higher correlations were found for the negative dimension in relation to verbal fluency (p = .005) and for the disorganized dimension in relation to reasoning and problem solving (p = .004) and to attention/vigilance (p = .03). Psychotic psychopathology and neurocognition are not entirely orthogonal, as heterogeneity in nonaffective psychosis is weakly but meaningfully associated with measures of neurocognition. This association suggests that differential latent cerebral mechanisms underlie the cluster of disorganized and negative symptoms versus that of positive and affective symptoms.