Early psychosis in young women

IntroductionIt is well known that young women are at lower risk for schizophrenic psychoses than young men. However, little is known about the peculiarities of emerging psychosis in young women.ObjectivesTo describe characteristics of emerging psychosis in women.MethodsWithin the FePsy (Früherkennung von Psychosen = early detection of psychosis) study at the University of Basel Psychiatric Clinics we have examined consecutively all patients with a first episode of psychosis (FEP) or an at-risk mental state (ARMS) referred to us between 2000 and 2015.ResultsWomen did not significantly differ from men regarding psychopathology, neither in the ARMS nor in the FEP group. This was true for positive as well as negative symptoms and basic symptoms. Interestingly, women had a higher correlation of self-rating with observer-rating regarding psychotic symptoms. Duration of untreated psychosis was significantly lower in women than in men. Women seek help more quickly than men and their first contact is more often their partner.Regarding neurocognition women showed a slightly better performance in verbal tasks. They also had higher prolactin levels and larger pituitary volumes, even when drug-naive.Transition to psychosis occurred as often and as quickly in women as in men.ConclusionsThere are only few gender differences in patients with emerging psychosis, which resemble mainly those found in the general population, with women showing a better help-seeking behavior, being more partner-oriented, having a better verbal performance and potentially also a higher stress reactivity [1].Disclosure of interestThe author has not supplied his declaration of competing interest.

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Changes in the cytokine profile in first episode, drug-naïve patients with psychosis after short-term antipsychotic treatment

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.382 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S371-S371

Author(s):

P. Petrikis ◽

P. Voulgari ◽

V. Boumba ◽

D. Archimandriti ◽

P. Skapinakis ◽

...

Keyword(s):

Antipsychotic Medication ◽

Transforming Growth Factor ◽

Serum Levels ◽

Psychotic Symptoms ◽

First Episode ◽

Enzyme Linked Immunosorbent Assay ◽

Antipsychotic Treatment ◽

Before And After ◽

Drug Naïve ◽

Competing Interest

IntroductionAn increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial.ObjectiveOur aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naïve, first-episode patients with psychosis before and after six weeks of antipsychotic medication.MethodsThirty-nine first episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotic medication. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment.ResultsSerum levels of IL-2 were significantly higher in the study group six weeks after the initiation of antipsychotic treatment (P < 0.001) while TGF-β2 levels were decreased (P < 0.001) and IL-6 levels were slightly reduced (P < 0.004).ConclusionThe changes in cytokine levels may be attributed to the action of antipsychotic medication and the remission of psychopathology. The reduction in TGF-β2 levels is observed in all patients and with all antipsychotic medications used. TGF-β2 may be a marker of clinical efficacy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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First-episode psychosis: What does it mean?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.656 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s258-s258

Author(s):

S. Marques ◽

F. Godinho ◽

A.L. Melo ◽

D. Barrocas

Keyword(s):

Real World ◽

Negative Symptoms ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Real World Setting ◽

Episode Psychosis ◽

Competing Interest ◽

Disorganized Speech ◽

Psychotic Features

IntroductionFirst-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. The majority of existing studies about FEP only address schizophrenia spectrum psychosis (SSP), which may limit the capacity to fully characterize this entity.Objectives/AimsReport the clinical and socio-demographic characteristics of patients with FEP in real-world setting, and compare the differences among SSP and affective FEP.MethodsRetrospective analysis of clinical files of patients admitted to our hospital unit with FEP diagnosis from January/2012 to April/2015. Clinician-rated dimensions of psychosis symptom severity scales (DSM-5) were applied.ResultsAnnual incidence of FEP was 11,3/100,000. From a total of 755 patients, 57 (7,5%) corresponded to FEP; 38 (66,7%) were diagnosed with SSP, 11 (19,3%) affective psychosis, 3 (5,2%) toxic psychosis and 5 (8,8%) organic psychosis. Most were female (61,4%), with a mean age of 49 years. The majority were unemployed (66,7%), lived with family (57,9%), and presented with moderate-severe delusions (80,1%), but without hallucinations (57,8%), disorganized speech (59,6%) or negative symptoms (85,9%). Affective FEP patients were older (61 vs 45 years), presented with less severe psychotic symptoms (7,2 vs 8,3 points), but with higher hospital admission (26,1 vs 21,1 days).ConclusionsRegardless the growing interest concerning FEP, its conceptualization and characterization remains controversial. Our results differ from pre-existing literature data, especially concerning gender and age. By including all the possible etiologies of FEP, we aimed to obtain a more realistic characterization of this entity in a real-world setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Relationship between TNF-α levels and psychiatric symptoms in first-episode drug-naïve patients with schizophrenia before and after risperidone treatment and in chronic patients

BMC Psychiatry ◽

10.1186/s12888-021-03569-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chen Lin ◽

Ke Chen ◽

Jianjin Yu ◽

Wei Feng ◽

Weihong Fu ◽

...

Keyword(s):

Negative Symptoms ◽

Psychiatric Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Healthy Controls ◽

Chronic Patients ◽

Tnf Α ◽

Before And After ◽

Drug Naïve ◽

Factor Α

Abstract Background The influence of antipsychotic drugs on tumor necrosis factor-α (TNF-α) levels is unclear, and there is no consensus on the association between TNF-α and psychotic symptoms. This study aimed to investigate the differences in TNF-α levels and clinical correlations in first-episode drug-naïve (FEDN) patients with schizophrenia before and after treatment and in chronic patients. Methods A total of 103 (51 FEDN and 52 chronic) patients and 114 healthy controls were recruited. Demographic and clinical data, including TNF-α levels, were recorded. We used the Positive and Negative Syndrome Scale (PANSS) to measure the psychopathology of all patients. Results TNF-α levels before treatment were significantly higher in FEDN patients than in chronic patients and healthy controls. No significant sex differences were found in the TNF-α levels of patients with schizophrenia. The TNF-α levels before treatment were significantly positively related to changes in PANSS negative symptoms in FEDN patients. The TNF-α levels in chronic patients were significantly negatively correlated with the general psychopathology subscales and PANSS total scores. Conclusions Increased TNF-α levels in FEDN patients and their correlation with psychopathology indicate that inflammatory cytokines may play a crucial role in the etiopathogenesis of schizophrenia, and inflammation-directed therapy may, therefore, improve negative symptoms.

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Effect of Disrupted-in-Schizophrenia 1 gene on treatment response in patients with a first episode of psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.401 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S183-S183

Author(s):

J. Vázquez Bourgon ◽

R. Ayesa Arriola ◽

P. Suarez Pinilla ◽

R. Roiz Santiañez ◽

D. Tordesillas Gutierrez ◽

...

Keyword(s):

Treatment Response ◽

Negative Symptoms ◽

Rating Scale ◽

Genetic Alterations ◽

Individual Variability ◽

First Episode ◽

Antipsychotic Treatment ◽

Positive Symptoms ◽

Drug Naïve ◽

Competing Interest

IntroductionThere is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.ObjectivesThe aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.MethodsTwo hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.ResultsWe found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).ConclusionsOur results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Associations between expression of indoleamine 2, 3-dioxygenase enzyme and inflammatory cytokines in patients with first-episode drug-naive Schizophrenia

Translational Psychiatry ◽

10.1038/s41398-021-01688-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yan Zhang ◽

Han Shi ◽

Ge Yang ◽

Yongfeng Yang ◽

Wenqiang Li ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Negative Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Controlled Clinical Trial ◽

Double Blind ◽

Indoleamine 2 ◽

Tryptophan Degradation ◽

Tnf Α ◽

Drug Naïve

AbstractThe indoleamine 2,3-dioxygenase (IDO) enzyme is the first rate-limiting enzyme of the tryptophan degradation pathway in which dysfunction of neuroactive metabolites has been implicated in the pathophysiology of schizophrenia. Inflammatory molecules such as pro-inflammatory cytokines could enhance the activity of IDO. There are few studies on the expression of IDO levels and its correlation with levels of inflammatory cytokines in first-episode drug-naive patients with schizophrenia. One hundred inpatients (female = 33, male = 67) with first-episode drug-naive schizophrenia entered a 6-week, double-blind, randomized, placebo-controlled clinical trial. All individuals were assigned celecoxib or placebo combined with risperidone. Serum levels of IDO and six inflammatory cytokines (IL-1β, IL-6, TNF-α IL-17, IL-4, and INF-γ) were measured. The Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychotic symptoms. Compared to healthy subjects, patients had significantly elevated levels of IDO and six cytokines at baseline. Over the 6-week treatment period, the decrease in the levels of IDO and TNF-α and the improvement in the PANSS total score, positive scores, and negative scores in the celecoxib group were significantly greater than in the placebo group. There was a significantly positive correlation between IDO levels and the PANSS negative scores and between IDO levels and TNF-α and IFN-γ levels in the celecoxib group. These findings showed abnormal expression of IDO levels which correlated with negative symptoms and pro-inflammatory cytokine levels in patients with first-episode drug-naive schizophrenia, suggesting the important role of IDO in the pathological mechanism of schizophrenia. Registration number: ChiCTR2000041403.

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Evaluation of positive and negative symptoms in schizophrenia

Psychiatry and Psychobiology ◽

10.1017/s0767399x00003199 ◽

1986 ◽

Vol 1 (2) ◽

pp. 108-122 ◽

Cited By ~ 29

Author(s):

Nancy C. Andreasen ◽

William M. Grove

Keyword(s):

Negative Symptoms ◽

The United States ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

University Of Iowa ◽

Normal Functions ◽

Subsequent Investigation ◽

The University ◽

The Relationship ◽

Positive And Negative Symptoms

SummaryMost investigators concur that schizophrenia is probably a heterogeneous group of disorders that share the common features of psychotic symptoms, partial response to neuroleptics, and a relatively poor outcome. The subdivision of schizophrenia into two subtypes, positive versus negative, has achieved wide acceptance throughout the world during recent years. This distinction has heuristic and theoretical appeal because it unites phenomenology, pathophysiology, and etiology into a single comprehensive hypothesis.In spite of its wide appeal, the distinction has a number of problems. These include the failure to distinguish between symptom syndromes and diseases; failure to deal with the mixed patient; failure to take longitudinal course into account; and failure to address conceptually and methodologically the distinction between positive and negative symptoms.This paper focuses primarily on the conceptual basis for two instruments designed to measure positive and negative symptoms, the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), originally described in 1982. Since their description, these scales have been used in a variety of other centers. These scales are based on the hypothesis that negative symptoms represent a deficit or diminution in normal psychological functions wliile positive symptoms represent an excess or distortion of normal functions. Reliability data are now available from Italy, Spain, and Japan which suggest that these scales can be used reliably in cultural settings outside the United States. The results of these studies are summarized in this paper. In addition, a replication study involving a new sample of 117 schizophrenics collected at the University of Iowa is described. In this second study of the SANS and SAPS, internal consistency is found to be quite high in the SANS. Thus negative symptoms appear to be more internally correlated with one another than are positive symptoms. The implications of this result are discussed. A principal components analysis is used to explore the relationship between positive and negative symptoms. While the study reported in 1982 suggested that positive and negative symptoms are negatively correlated, in the present study they appear to be uncorrelated. Overall, the results suggest that the SANS and SAPS are useful comprehensive instruments for the evaluation of positive and negative symptoms. The relationship between these symptoms and external validators such as cognitive functioning or CT scan abnormalities will be reported in a subsequent investigation.

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University students’ understanding and perceptions of schizophrenia in the UK: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-025813 ◽

2019 ◽

Vol 9 (4) ◽

pp. e025813

Author(s):

Charlotte Cadge ◽

Charlotte Connor ◽

Sheila Greenfield

Keyword(s):

Qualitative Study ◽

University Students ◽

Help Seeking ◽

Negative Symptoms ◽

Health Campaigns ◽

Structured Interviews ◽

African Caribbean ◽

Lay Understanding ◽

The Uk ◽

The University

ObjectiveTo explore lay understanding and perceptions of schizophrenia in university students.DesignQualitative study using semi-structured interviews and thematic analysis.SettingThe University of Birmingham, West Midlands.Participants20 UK home students of white British (n=5), Indian (n=5), Pakistani (n=5), African Caribbean (n=4) and dual white British and African Caribbean ethnicity (n=1).ResultsFindings revealed a lack of knowledge about schizophrenia, particularly the negative symptoms that were not mentioned. There were mixed ideas on the causes and sources of available help for schizophrenia; however, positively many said they would consult their general practitioner. While there was a general misconception among the students that schizophrenia caused multiple personalities and was a dangerous illness, there were some differences in perceptions and understanding between ethnic groups, with more Indian students perceiving upbringing as a causal factor in the development of the illness and more Pakistani students perceiving possession by a spirit as a cause.ConclusionsThe university students interviewed lacked knowledge about schizophrenia and stigma was widespread, both of which may delay help-seeking. Public health campaigns educating young people about schizophrenia are required to improve early identification and intervention and improve outcomes. Further research exploring ways to effectively tackle stigma is also required.

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The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

Psychological Medicine ◽

10.1017/s0033291713003188 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2419-2430 ◽

Cited By ~ 17

Author(s):

F. J. Oher ◽

A. Demjaha ◽

D. Jackson ◽

C. Morgan ◽

P. Dazzan ◽

...

Keyword(s):

Depressive Symptoms ◽

Population Density ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Urban Environments ◽

Psychotic Symptoms ◽

First Episode ◽

Multilevel Regression ◽

Symptom Dimensions ◽

Reality Distortion

BackgroundThe extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.MethodWe collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.ResultsReality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).ConclusionsIn people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

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Psychotic symptoms in first‐episode and drug naïve patients with major depressive disorder: Prevalence and related clinical factors

Depression and Anxiety ◽

10.1002/da.23026 ◽

2020 ◽

Vol 37 (8) ◽

pp. 793-800

Author(s):

Yanmei Shen ◽

Ying Wei ◽

Xu‐Na Yang ◽

Guangya Zhang ◽

Xiangdong Du ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Psychotic Symptoms ◽

First Episode ◽

Clinical Factors ◽

Major Depressive ◽

Drug Naïve

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Risperidone-induced topological alterations of anatomical brain network in first-episode drug-naive schizophrenia patients: a longitudinal diffusion tensor imaging study

Psychological Medicine ◽

10.1017/s0033291716001380 ◽

2016 ◽

Vol 46 (12) ◽

pp. 2549-2560 ◽

Cited By ~ 7

Author(s):

M. Hu ◽

X. Zong ◽

J. Zheng ◽

J. J. Mann ◽

Z. Li ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Negative Symptoms ◽

Diffusion Tensor ◽

Imaging Study ◽

First Episode ◽

Longitudinal Diffusion ◽

Before And After ◽

Drug Naïve ◽

Diffusion Tensor Imaging Study

BackgroundIt remains unclear whether the topological deficits of the white matter network documented in cross-sectional studies of chronic schizophrenia patients are due to chronic illness or to other factors such as antipsychotic treatment effects. To answer this question, we evaluated the white matter network in medication-naive first-episode schizophrenia patients (FESP) before and after a course of treatment.MethodWe performed a longitudinal diffusion tensor imaging study in 42 drug-naive FESP at baseline and then after 8 weeks of risperidone monotherapy, and compared them with 38 healthy volunteers. Graph theory was utilized to calculate the topological characteristics of brain anatomical network. Patients’ clinical state was evaluated using the Positive and Negative Syndrome Scale (PANSS) before and after treatment.ResultsPretreatment, patients had relatively intact overall topological organizations, and deficient nodal topological properties primarily in prefrontal gyrus and limbic system components such as the bilateral anterior and posterior cingulate. Treatment with risperidone normalized topological parameters in the limbic system, and the enhancement positively correlated with the reduction in PANSS-positive symptoms. Prefrontal topological impairments persisted following treatment and negative symptoms did not improve.ConclusionsDuring the early phase of antipsychotic medication treatment there are region-specific alterations in white matter topological measures. Limbic white matter topological dysfunction improves with positive symptom reduction. Prefrontal deficits and negative symptoms are unresponsive to medication intervention, and prefrontal deficits are potential trait biomarkers and targets for negative symptom treatment development.

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