Introduction
Family studies provide a suitable approach to analyzing candidate endophenotypes of schizophrenia, including cognitive features.
Objective
To characterize different neurocognitive ...functions in a group of patients with first episode of psychosis (FEP), their first‐degree relatives (parents and siblings), and healthy controls (HC), in order to identify potential endophenotypes for schizophrenia spectrum disorders (SSD).
Methods
Participants were assessed in the context of a national project in Spain called PAFIP‐FAMILIAS. They completed the same neuropsychological battery, which included tests of verbal memory, visual memory, processing speed, working memory, executive functions, motor dexterity, attention, and theory of mind. Group comparisons were performed using one‐way ANOVA, followed by tests of multiple comparisons when appropriate.
Results
One hundred thirty‐three FEP patients were included, as well as 244 of their first‐degree relatives (146 parents and 98 siblings) and 202 HC. In general, relatives showed an intermediate performance between the HC and the FEP patients in all neurocognitive domains. However, the domains of executive functions and attention stood out, as relatives (especially parents) showed similar performance to FEP patients. This was replicated when selecting patients subsequently diagnosed with schizophrenia and their relatives.
Conclusion
These findings suggest that executive and attention dysfunctions might have a family aggregation and could be relevant cognitive endophenotypes for psychotic disorders. The study shows the potential of exploring intra‐family neuropsychological performance supporting neurobiological and genetic research in SSD.
Introduction
Brief psychotic disorder (BPD) is a relatively uncommon and underexplored psychotic condition. Even though BPD has been related to a more favorable outcome than other schizophrenia ...spectrum disorders (SSD), current knowledge of its predictive factors remains scant. This study aimed to examine its prevalence and find early predictors of BPD diagnostic stability.
Methods
SSD diagnosis following Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria was explored in a large epidemiological cohort (n = 569) of non‐affective first‐episode psychosis (FEP) patients enrolled in a three‐year longitudinal intervention program (PAFIP). Premorbid, sociodemographic, and clinical information was collected to characterize BPD patients and determine factors predictive of diagnostic stability. Multivariate analysis included predictors selected from clinical knowledge and also those that had achieved marginal significance (p ≤ 0.1) in univariate analysis.
Results
A total of 59 patients enrolled in the PAFIP program (10.4% of the whole cohort) met DSM‐IV criteria for BPD, of whom 40 completed the three‐year follow‐up. The temporal stability of BPD in our sample was as high as 40% (n = 16). Transition from BPD to schizophrenia occurred in 37% (n = 15) of patients. Fewer hallucinations at baseline and better insight independently significantly predicted BPD diagnostic stability over time.
Conclusion
Our findings confirm that BPD is a clinical condition with moderate‐to‐low temporal stability and demonstrate that approximately two‐thirds of FEP individuals experiencing BPD will develop a long‐lasting psychotic disorder during follow‐up, mainly schizophrenia.
Objective
To evaluate the 10‐year stability of schizophrenia diagnosis in a cohort of first‐episode psychosis (FEP) patients and the factors associated with it.
Methods
Changes in diagnosis of 209 ...FEP patients were described during 10 years of follow‐up. Related factors with maintenance or change of schizophrenia diagnosis were evaluated in prospective and retrospective approaches through binary logistic regressions, ROC and survival curves.
Results
Out of the 209 patients, 126 were diagnosed of schizophrenia 6 months after their inclusion in the clinical program. Prospective analyses showed that eight of those 126 schizophrenia patients had changed to a different diagnosis after 10 years, and predictors of change were better childhood premorbid adjustment, less severity of clinical global impression at baseline, and diagnosis of comorbid personality disorder during follow‐up. Retrospectively, out of the 154 patients with schizophrenia in the 10‐year assessment, 36 had a different diagnosis at baseline, and those factors related to a different prior diagnosis than schizophrenia were better socioeconomic status and shorter duration of untreated psychosis (DUP). A survival analysis on the timing of schizophrenia diagnosis showed that male gender and longer DUP were predictors of earlier definite diagnosis.
Conclusions
Diagnostic stability of schizophrenia in our FEP sample is high, especially prospective stability, and the group of patients with diagnostic change corresponded to a milder psychopathological profile before and at the onset of disease. Moreover, we observed a cautious attitude in the diagnosis of schizophrenia in patients with shorter DUP who had schizophrenia diagnosis after 10 years.
Numerous studies show the existence of a high prevalence of cannabis use among patients with psychosis. However, the differences between men and women who debut with a first episode of psychosis ...(FEP) regarding cannabis use have not been largely explored. The aim of this study was to identify the specific sex factors and differences in clinical evolution associated with cannabis use.
Sociodemographic characteristics at baseline were considered in our sample of FEP patients to find differences depending on sex and the use of cannabis. Clinical, functional and neurocognitive variables at baseline, 1-year, and 3-years follow-up were also explored.
A total of 549 patients, of whom 43% (N = 236) were cannabis users, 79% (N = 186) male and 21% (N = 50) female, were included in the study. There was a clear relationship between being male and being a user of cannabis (OR = 5.6). Cannabis users were younger at illness onset. Longitudinal analysis showed that women significantly improved in all three dimensions of psychotic symptoms, both in the subgroup of cannabis users and in the non-users subgroup. Conversely, subgroups of men did not show improvement in the negative dimension. In cognitive function, only men presented a significant time by group interaction in processing speed, showing a greater improvement in the subgroup of cannabis users.
Despite knowing that there is a relationship between cannabis use and psychosis, due to the high prevalence of cannabis use among male FEP patients, the results showed that there were very few differences in clinical and neurocognitive outcomes between men and women who used cannabis at the start of treatment compared to those who did not.
Objectives
The aim of this study was to assess the effectiveness of a cognitive intervention based on modern board and card games.
Methods
We conducted two two‐arm parallel‐group, randomized ...controlled trials. The first one (pilot study) was nonblind. The second one (main study) was a double‐blind design. Participants (14 in a pilot study and 35 in the main study) were healthy older adults over 65 years old who were assisting to adult care institutions. In the pilot study, participants in the experimental group (n = 6) played modern board and card games which activated cognitive processes; whereas the control group (n = 6) was in the wait‐list condition. In the main study, participants in the experimental group (n = 12) also played modern board and card games; whereas the control group (n = 15) performed standardized paper‐and‐pencil cognitive tasks. Psychologists specialized in older‐people conducted all the interventions. In both studies, intervention sessions were bi‐weekly for 5 weeks. The outcomes of both studies were cognitive status and executive functioning, depressive symptomatology, and quality of life measures. All assessment and intervention sessions took place in their habitual centers.
Results
In the pilot study, participants in the games intervention showed a significant improvement in semantic verbal fluency. In the main study, both interventions showed significant improvements in phonemic verbal fluency. Whilst board and card games maintained motor impulsivity control, paper‐and‐pencil tasks improved speed in an inhibition task.
Conclusions
Modern board and card games could be an effective cognitive intervention to maintain some cognitive functions.
Key Points
Modern board and card game and paper‐and‐pencil trainings improved verbal fluency, but only game training group maintained this benefit 3 months later
Modern board and card game training maintained levels of motor impulsivity control, while paper‐and‐pencil training decreased
The modern board and card games may be useful as a cognitive training in healthy older institutionalized adults
Objective
Comorbid social anxiety is common in psychotic disorders and is associated with multiple negative consequences. However, the long‐term effects of persistent social anxiety versus ...fluctuating or no anxiety on social functioning and health‐related quality of life (HR‐QoL) have received scant attention. Therefore, we aimed to examine the prevalence of persistent social anxiety to determine its effect on social functioning and HR‐QoL in first‐episode psychosis (FEP).
Methods
One hundred and eight individuals with remitted FEP were classified into three groups (persistent, fluctuating or no social anxiety) according to the Social Interaction Anxiety Scale over an 18‐month follow‐up period. The three groups were then compared at 18 months follow‐up to assess the influence of social anxiety on social functioning and HR‐QoL before and after controlling for confounders.
Results
Of the 108 individuals with FEP, 25 (23.1%) had persistent social anxiety. This group presented lower social functioning and HR‐QoL levels compared to the groups with fluctuating or no anxiety symptoms. The effect on HR‐QoL remained significant after controlling for positive psychotic and depressive symptoms.
Conclusions
In this study, nearly one‐quarter of young people with remitted FEP experienced persistent social anxiety symptoms, which had a negative impact on HR‐QoL. Thus, individuals with persistent social anxiety constitute a highly vulnerable group and may require targeted interventions to improve their social functioning and HR‐QoL.
Background
Disability encompasses impairments, activity limitations, and restrictions on participation. Improvement in functioning has therefore become a crucial outcome of treatment in psychosis.
...Objective
The main aim of this study was to analyze the potential relationship between suicidal behavior after first episode of psychosis (FEP) and family disability. The second aim was to find out whether personality traits are associated with disability dimensions.
Method
The study sample was composed of 65 FEP patients. The personal care, occupational, family, and social dimensions of disability were evaluated at 12 months after FEP. Bivariate and multivariate analyses were performed to explore any putative outcome factors associated with dimensions of disability.
Results
Personal care during the 1‐year follow‐up was significantly impaired in suicide attempters and significantly associated with sociopathic personality traits. A decline in occupational functioning was significantly associated with schizotypy traits. On the other hand, deterioration in family, social, and global functioning at 1 year after FEP was related to poor premorbid adjustment during late adolescence.
Conclusions
Suicidal behavior prevention could improve psychosocial functioning, particularly personal care, in FEP. In addition, sociopathic and schizotypy personality traits as well as poor premorbid adjustment during late adolescence appear to be useful early markers of future disability.
The intelligence quotient (IQ) of patients with first-episode psychosis (FEP) and their unaffected relatives may be related to the genetic burden of schizophrenia (SCZ). The polygenic score approach ...can be useful for testing this question.
To assess the contribution of the polygenic risk scores for SCZ (PGS-SCZ) and polygenic scores for IQ (PGS-IQ) to the individual IQ and its difference from the mean IQ of the family (named family-IQ) through a family-based design in an FEP sample.
The PAFIP-FAMILIES sample (Spain) consists of 122 FEP patients, 131 parents, 94 siblings, and 176 controls. They all completed the WAIS Vocabulary subtest for IQ estimation and provided a DNA sample. We calculated PGS-SCZ and PGS-IQ using the continuous shrinkage method. To account for relatedness in our sample, we performed linear mixed models. We controlled for covariates potentially related to IQ, including age, years of education, sex, and ancestry principal components.
FEP patients significantly deviated from their family-IQ. FEP patients had higher PGS-SCZ than other groups, whereas the relatives had intermediate scores between patients and controls. PGS-IQ did not differ between groups. PGS-SCZ significantly predicted the deviation from family-IQ, whereas PGS-IQ significantly predicted individual IQ.
PGS-SCZ discriminated between different levels of genetic risk for the disorder and was specifically related to patients' lower IQ in relation to family-IQ. The genetic background of the disorder may affect neurocognition through complex pathological processes interacting with environmental factors that prevent the individual from reaching their familial cognitive potential.
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.
Women present a second peak of incidence of psychosis during the menopausal transition, partially explained by the loss of estrogen protection conferred during the reproductive years. In view of the ...lack of studies comparing sociodemographic, biological, and clinical variables and neurocognitive performance between women with early onset of psychosis (EOP) and those with late onset of psychosis (LOP), our aim was to characterize both groups in a large sample of 294 first-episode psychosis (FEP) patients and 85 healthy controls (HC). In this cross-sectional study, the participants were interviewed to gather information on sociodemographic variables. We assessed laboratory features of interest and conducted a clinical assessment of psychopathological symptoms and neurocognitive abilities. From the latter, we derived a global cognitive functioning score. Analysis of covariance (ANCOVA) was used to compare EOP and LOP groups, and each group with age-comparable HC. EOP women were more frequently single and unemployed than HC age peers. While cholesterol levels in LOP women were higher than those in EOP women, no statistically significant differences were found in leptin levels. Women with LOP presented with less severe negative symptoms and higher cognitive processing speed scores than women with EOP. Cannabis and alcohol use was greater in EOP than in LOP women. Within the total FEP group, there was a history of significantly more recent traumatic events than in the HC group. Women with EOP and LOP show several sociodemographic and clinical differences, which may be valuable for planning personalized treatment.