1-year follow-up study of cognitive function in first-episode non-affective psychosis

The longitudinal course of primary cognitive dysfunction seen in schizophrenia has yet to be fully clarified. Whereas some studies in chronic patients have revealed a progressive decline in cognitive abilities, those studies with first-episode patients have indicated that initial cognitive deficits might remain stable over time. The aim of this study was to examine the longitudinal course of cognitive functioning in patients with a first episode of schizophrenia. 112 patients with a first episode of schizophrenia-spectrum disorders and 22 healthy controls completed clinical and cognitive evaluations at baseline and again after 1 year. An extensive neuropsychological battery that comprised seven cognitive domains was used. Patients and controls improved their cognitive performance in virtually all the cognitive domains after one year. However, patients continued to show marked cognitive deficits after one year, unlike healthy volunteers. The longitudinal cognitive changes were similar in patients and controls in all domains except Verbal Memory (F = 11.67; df = 1; P = 0.001). The increase in cognitive scores found during early phases of the illness seems to be associated to practice-related changes and would not reflect a real cognitive enhancement but rather stability of deficit. Patients' deficits remained stable over time in all cognitive domains except Verbal Memory, in which less performance improvement was found. Further investigations are warranted to discern the variability in patterns of specific cognitive deficits over time.     

Relapse prevention and remission attainment in first-episode non-affective psychosis. A randomized, controlled 1-year follow-up comparison of haloperidol, risperidone and olanzapine

The effectiveness of antipsychotics in preventing relapses and attaining symptomatic remission is a relevant topic of psychopharmacological research. The purpose of the present study was to compare the relapse and symptomatic remission rates during the first year of treatment between low doses of haloperidol and SGAs (olanzapine and risperidone) in drug-naïve first-episode non-affective psychosis individuals. This is a prospective, randomized, open-label study conducted from February 2001 to February 2006. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention program of first-episode psychosis (DSM-IV criteria) conducted at the University Hospital Marques de Valdecilla, Santander, Spain. One hundred and seventy four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 1 year. Primary effectiveness measures were the time up to relapse and rates of relapse and symptomatic remission. There were no significant differences in the relapse rate between treatments (11.1% haloperidol; 18.5% olanzapine, and 13.8% risperidone) (χ² = 1.230; p = 0.541) or in the time up to relapse (Log Rank χ² = 0.308; p = 0.857). The rates of relapse for adherent (11.2%) and non-adherent (26.9%) patients were significantly different (χ² = 4.215; df = 1; p = 0.040). The remission rate did not differ significantly between treatment groups (χ² = 2.760; p = 0.252) and adherence to medication did not seem to significantly influence remission rates. We conclude that haloperidol, olanzapine and risperidone show a similar effectiveness in relapse prevention or in remission attainment during the first year of treatment.     

Substance abuse in first-episode non-affective psychosis

Abuse of alcohol and drugs is an important and clinically challenging aspect of first-episode psychosis. Only a few studies have been carried out on large-sized and reliably characterized samples. These are reviewed, and the results are compared with a sample of 300 first-episode psychosis patients recruited for the TIPS (Early Treatment and Identification of Psychosis) study from Norway and Denmark. Prevalence rates from the literature vary from 6% to 44% for drugs and 3% to 35% for alcohol. In our sample, 23% abused drugs and 15% abused alcohol during the last 6 months. When compared to non-abusers, the drug-abusing group is characterized by the following: male gender, younger age, better premorbid social, poor premorbid academic functioning, and more contact with friends in the last year before onset. Alcohol abusers were the oldest group and they had the least contact with friends. A group of patients abusing both drugs and alcohol had poor premorbid academic functioning from early childhood. Overall, drug and alcohol abuse are highly prevalent in contemporary first-episode psychosis samples. In our study, substance abuse comorbidity did not generate differences on diagnosis, duration of untreated psychosis, psychiatric symptoms, or global functioning at onset/baseline. The premorbid profiles of the substance abusers were clearly different from the non-abusers. Drug abusers, in particular, were more socially active both premorbidly and during the year preceding the start of treatment.     

Perceived and experienced stigma in first-episode psychosis: A 1-year follow-up study

ObjectivesPerceived/experienced stigma and its relationship with clinical outcome were investigated across the first year of treatment in a large sample with first-episode psychosis (FEP).MethodsFEP participants (n = 112) in the TOP study were investigated at baseline and 1-year follow-up. Perceived/experienced stigma was measured with items from the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), assessing problems because of barriers and hindrances, and living with dignity because of attitudes and actions of others. Clinical outcome included: symptoms, global functioning, self-rated disability and self-rated life satisfaction.ResultsIn the total sample, 46% perceived/experienced stigma at baseline, which decreased significantly to 32% at 1-year follow-up. Perceived/experienced stigma was present in 1/5 at both time-points (Sustained stigma), in 2/5 at only one time-point (Transient stigma), and in 2/5 it was not present at either time-point (No stigma). Compared to the No stigma group, the Sustained stigma group had significantly higher levels of positive, excited and depressive symptoms and self-rated disability, as well as lower levels of global functioning and life satisfaction at 1 year follow-up, while the Transient stigma group only had poorer functioning and higher self-rated disability. Yet the outcome variables improved across the first year of treatment in all three stigma groups.ConclusionPerceived/experienced stigma was common in FEP, yet the rate decreased across the first year of treatment. Although there was some clinical improvement across the first year of treatment irrespective of stigma, stigma was related to poorer clinical outcome in a bidirectional manner. This suggests that perceived/experienced stigma is an important target in the early stages of treatment.     

First-episode non-affective psychosis in a total urban population: a 5-year follow-up

Background: The aim of this study is to investigate incidence rates, treatment, and outcome of a total in- and outpatient population of 71 patients (of 18–45 years of age) treated for a first-episode psychosis (DSM-IV) in three catchment areas in Stockholm. Methods: The study is based on the investigation of records and databases and on information by staff members and patients. Results: The incidence rate was 34.8 per 100,000 inhabitants (aged 18–45 years) and 16.5 per 100,000 inhabitants (total population). Sixty percent were diagnosed with schizophrenia syndromes. At 5-year follow-up, 73 % of the patients in the schizophrenia syndromes group versus 47 % of the non-schizophrenia group had a sick pension or were on long-term sick leave. Nine percent of the schizophrenia patients and 39 % of the non-schizophrenia psychosis patients were rated as not being in need of treatment. Non-compliance of medication was present in one-third of those patients prescribed neuroleptic medication. Seven percent had never received neuroleptic medication, all of whom were rated as ill at the 5-year follow-up. Conclusions: Incidence of treated first-episode psychosis is higher than has earlier been found, when exclusively outpatient treated individuals are also included. The social outcome is negative, even in the non-schizophrenia group. Non-compliance with medication and insufficient clinical follow-up may have worsened the results. Accepted: 23 March 2001     

Neurocognition and occupational functioning in patients with first-episode psychosis: a 2-year follow-up study

Neurocognitive deficits are a core feature of schizophrenia that is associated with poor occupational functioning. Few studies have investigated this relationship in patients with first-episode psychosis. The current study examined the characteristics of employed and unemployed patients with first-episode psychosis at baseline and 2-year follow-up, and the predictive value of neurocognition on employment status. One-hundred and twenty-two first-episode psychosis patients were assessed with clinical and neurocognitive measures at baseline. Occupational status was assessed at baseline and 2-year follow-up. Those unemployed at baseline were rated lower on global functioning and were more likely to have a schizophrenia spectrum disorder. Total employment rates were 41% at baseline and 38% at 2-year follow-up. Four employment paths emerged at follow-up, defined as persistently employed, becoming unemployed, entering employment and persistently unemployed. The persistently employed group had the highest global functioning score. For the total sample, baseline employment status and sustained attention predicted employment status at follow-up. For those employed at baseline, better sustained attention, higher global functioning, more positive symptoms and less alcohol use predicted persistent employment at follow-up. For those unemployed at baseline, none of the variables predicted change in employment status. Implications of these results are discussed.     

Involuntary hospitalization of first-episode psychosis with substance abuse during a 2-year follow-up

Opsal A, Clausen T, Kristensen Ø, Elvik I, Joa I, Larsen TK. Involuntary hospitalization of first‐episode psychosis with substance abuse during a 2‐year follow‐up. Objective: To investigate whether substance abuse (alcohol or illegal drugs) in patients with first‐episode psychosis (FEP) influenced treatment outcomes such as involuntary hospitalization during follow‐up. Method: First‐episode psychosis patients (n = 103) with consecutive admissions to a comprehensive early psychosis program were included and followed for 2 years. Assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale (for substance abuse). Results: Twenty‐four per cent of patients abused either alcohol or drugs at baseline. The dropout rate at 2 years was the same for substance abusers as for non‐abusers. Substance use was not reduced over the 2‐year period. At 2‐year follow‐up, 72% of substance abusers and 31% of non‐abusers had experienced at least one occasion of involuntary hospitalization. Patients with substance abuse had significantly higher risk for involuntary hospitalization during follow‐up (OR 5.2). Conclusion: To adequately treat patients with FEP, clinicians must emphasize treatment of the substance abuse disorder, as well as the psychotic illness. Patients with defined comorbid substance use disorders and FEP are likely to have poorer treatment response than those with psychosis alone.     

Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis

Objective: The study aimed to establish clinical predictors of non‐affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile. Method: First‐episode never treated psychotic patients diagnosed of paranoid schizophrenia (n = 35; 21 men and 14 women) or NARP (n = 28; 15 men and 13 women) were included. Results: NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5‐HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5‐HT2A receptors; good premorbid adjustment; low score in the item ‘hallucinatory behaviour’ and reduced duration of untreated psychosis. Conclusion: Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non‐affective psychosis such as schizophrenia, and highlight the need for its validation.     

Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia

BACKGROUND: In first-episode schizophrenia, longer duration of untreated psychosis (DUP) predicts poorer outcomes. AIMS: To address whether the relationship between DUP and outcome is a direct causal one or the result of association between symptoms and/or cognitive functioning and social functioning at the same time point. METHOD: Symptoms, social function and cognitive function were assessed in 98 patients with first-episode schizphrenia at presentation and 1 year later. RESULTS: There was no significant clinical difference between participants with short and long DUP at presentation. Linear regression analyses revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation. Path analyses revealed independent direct relationships between DUP and social function, core negative symptoms and positive symptoms. There was no significant association between DUP and cognition. CONCLUSIONS: Longer DUP predicts poor social function independently of symptoms. The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP.     

Comparison of adolescent- and adult-onset unipolar depression

The author compared the longitudinal clinical profiles of patients with adolescent-onset (N = 20) and adult-onset (N = 38) unipolar depression. The findings support the validity of subtyping depression by age at onset and comorbid substance abuse.     

Outpatient vs. comprehensive first-episode psychosis services, a 5-year follow-up of Soteria Nacka

Three years experience of an outpatient unit for first-episode psychosis showed that most of the patients at some point became hospitalized in a psychiatric ward with discontinuity in care as a consequence. Adding "need-adapted" inpatient care in the form of a small and calm crisis home guaranteed continuity in approach and treatment, as the same caregivers staffed the inpatient and outpatient parts of Soteria. Information on early signs of psychosis was given to other units of the psychiatric clinic and to general practitioners. As the organization was considerably changed from that point of time, the patients could be divided into two separate groups. The aim of the present study was to follow the patients in the two groups for 5 years, comparing the outcome. The results showed that easily accessible need-adapted treatment with integrated overnight care might be advantageous for first-episode psychotic patients. The duration of untreated psychosis was shorter and the outcome better.     

Outpatient vs. comprehensive first-episode psychosis services,a 5-year follow-up of Soteria Nacka

Three years experience of an outpatient unit for first-episode psychosis showed that most of the patients at some point became hospitalized in a psychiatric ward with discontinuity in care as a consequence. Adding “need-adapted” inpatient care in the form of a small and calm crisis home guaranteed continuity in approach and treatment, as the same caregivers staffed the inpatient and outpatient parts of Soteria. Information on early signs of psychosis was given to other units of the psychiatric clinic and to general practitioners. As the organization was considerably changed from that point of time, the patients could be divided into two separate groups. The aim of the present study was to follow the patients in the two groups for 5 years, comparing the outcome. The results showed that easily accessible need-adapted treatment with integrated overnight care might be advantageous for first-episode psychotic patients. The duration of untreated psychosis was shorter and the outcome better.     

首发精神分裂症未经治疗时间与临床疗效间关系:4年随访研究（英文）

背景:精神疾病未经治疗的时间和长期临床结局之间关系仍然存在争议。目标:前瞻性评估浦东精神卫生中心2007年1月至2008年12月收治的首发精神分裂症患者未经治疗的时间与临床结果之间的关系。方法:采用简明精神病评定量表(BPRS)、不良反应量表(TESS)、康复状态量表(MRSS)、以及社会功能缺陷筛选量表(SDSS)分别于基线、2010年6月和2012年6月收集一般健康状况,精神症状和社会功能相关信息。结果:共43例首发精神分裂症患者参与研究,将其分为精神疾病未治疗(DUP)短期(≤24周)和精神疾病未治疗(DUP)长期(24周)两组。短期DUP组的平均随访时间为1197(SD=401)天,长期DUP组平均随访时间为1412(SD=306)天(t=9.98,p=0.055)。尽管初诊时长期DUP组患者的精神病性症状较短期DUP组不明显(BPRS平均分,42.5[8.4]v.50.0[10.6],t=2.42,p=0.0210),并且两组临床复发次数类似(基于BPRS阳性症状量表评估),长期DUP组患者更可能在初诊时需要住院治疗(52%[11/21]v.9%[2/22],χ2=9.55,p=0.002),并且在治疗的头两年更有可能再次住院(67%[14/21]v.32%[7/22],χ2=5.22,p=0.022)。另外,经过四年的常规治疗后,虽然两组患者的阳性症状严重程度类似,但是治疗前具有较长DUP的患者比DUP较短的患者社会功能减退更明显。(SDSS平均,7.0[5.2]v.3.4[4.9],t=2.20,p=0.035)。结论:这些结果表明,与治疗前DUP较短的精神分裂症患者相比,尽管DUP较长的患者精神病性症状的严重程度类似(由BPRS测量),但长期社会功能较差。这证实了对慢性精神障碍患者早期识别和及时治疗的临床重要性。     

Interleukin-1 receptor antagonist genotype and brain morphometry in first-episode non-affective psychosis

Studies of schizophrenia that combine imaging and genetic approaches attempt to map structural brain anomalies associated with genetic risk variants. The aim of the present study was to investigate whether variations in the interleukin-1 receptor antagonist (IL-1RN) were associated with structural brain characteristics of 73 minimally medicated first-episode non-affective psychotic patients. We did not find evidence for association between genetic variation in the IL-1RN gene and brain morphometry at early phases of the illness.     

Predicting prognosis in patients with first-episode psychosis using auditory P300: A 1-year follow-up study

ObjectiveTo clarify the role of auditory P300 in predicting prognosis in patients with first-episode psychosis (FEP) during a 1-year follow-up.MethodsAuditory P300 of 24 patients with FEP and 24 matched healthy control (HC) participants were measured at baseline. The clinical status of the FEP patients was assessed at baseline and reassessed after 1 year. P300 amplitudes and latencies among the groups were analyzed using repeated measures analysis of variance. Multiple regression analysis was conducted to assess the predictive value of P300 in patients with FEP during the 1-year follow-up.ResultsAuditory P300 amplitudes were significantly smaller in FEP patients than HCs. Higher baseline P300 amplitudes at CPz significantly predicted better improvements in the Positive and Negative Syndrome Scale total, positive, and general scores, as well as in the Global Assessment of Functioning and Brief Psychiatric Rating Scale.ConclusionsP300 may predict improvements in symptoms, functional status, and overall psychiatric status in patients with FEP.SignificanceWe first show that P300 amplitude at baseline predicts symptomatic and functional improvements after 1 year of treatment in patients with FEP. This finding may aid in effective interventions from the beginning of a psychotic episode to improve subsequent outcomes in clinical practice.     

Enduring negative symptoms in first-episode psychosis: comparison of six methods using follow-up data

Targeted intervention in the early treatment of enduring positive and negative symptoms in first-episode psychosis is contingent on adequate case-identification procedures. Six methods of determining enduring negative symptoms in a sample of 238 individuals with first-episode psychosis who were assessed at three time points over a 12-month period are described. Results were examined at each of the seven combinations of follow-up points, revealing a highly fluid pattern. The percentage of the sample achieving caseness varied dramatically, depending on the method used. Compared with non-cases, the enduring negative symptom group had significantly lower scores on quality of life, poorer premorbid adjustment, and longer durations of prodrome and untreated psychosis. Notwithstanding the 'ebb and flow' of negative symptoms in first-episode psychosis, the results suggest that early identification of enduring negative symptoms is a feasible goal.     

Temporal relationship of first-episode non-affective psychosis with cannabis use: A clinical verification of an epidemiological hypothesis

Background

We analyzed the association of age at onset of psychosis treatment (AOPT) with having a history of cannabis use in patients with a first episode of non-affective psychosis. We also investigated the impact on the AOPT of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.

Method

We recruited 112 consecutive patients (66 men and 46 women; age range, 18-57 years) with a first psychotic episode. The composite international diagnostic interview (CIDI) was used to assess drug use and to define the age at onset of heaviest use (AOHU) of a drug, defined as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOPT was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOPT of patients with and without a history of cannabis use, or associated cocaine use.

Results

We found that the AOPT was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOPT: the earlier the AOHU the earlier the AOPT. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first-episode psychosis than the rest of the patients (sex-adjusted log-rank χ² = 23.43, df = 1, p < 0.001). Their respective median AOPT (25th, 75th percentiles) were 23.5 (21, 28) and 33.5 years (27, 45) (for log-transformed AOPT, t = 5.6, df = 110, p < 0.001). The sex-adjusted hazard ratio of psychosis onset comparing both groups was 2.66 (95% CI, 1.74-4.05).

Conclusions

Our results are in favor of a catalytic role for cannabis use in the onset of psychosis.     

Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP)

European Archives of Psychiatry and Clinical Neuroscience - Relapses may represent a critical hazard in schizophrenia spectrum disorders as they are associated with an increased risk of a clinical...