The association between first-episode psychosis and abnormal glycaemic control: Systematic review and meta-analysis of clinical studies

BackgroundSchizophrenia, which is linked to a range of physical health conditions, might share intrinsic inflammatory disease pathways with type-two diabetes mellitus (T2DM). Psychotropic medication has presented a major confounder in examining this association. First-episode psychosis (FEP) patients present an interesting cohort to study this potential association, being generally younger with less comorbidity, and with limited exposure to antipsychotic medication.AimsTo assess whether FEP, which could be described as ‘developing schizophrenia’, is associated with prediabetes, or ‘developing diabetes’, to determine whether intrinsic disease links could cause the conditions to develop in unison.MethodsUsing PRISMA criteria, we searched Embase, Medline, PsychInfo, Web of Science, and Google Scholar to 6th January 2016. We assessed case-control studies with biochemical assessment of prediabetic states in FEP patients alongside matched controls.ResultsTwelve studies were included, involving 1137 participants. Several measurements examined prediabetes, including fasting plasma glucose, impaired glucose tolerance, and insulin resistance. Pooled analysis found FEP to be related to impaired glucose tolerance (mean difference 1.31 [0.37, 2.25]), insulin resistance (mean difference 0.30 [0.18, 0.42]), and the number of patients with impaired glucose tolerance (odds ratio 5.44 [2.63–11.27]).ConclusionOur findings suggest a potential link between prediabetic markers, in particular impaired glucose tolerance and insulin resistance, and FEP. However, we cannot establish causality, and the studies contributing to this review were at some risk of bias. Nevertheless, the findings might help to explain the increased prevalence of T2DM in patients with schizophrenia and could have implications for the management of schizophrenia patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Faculty Opinions recommendation of Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969279.793469614 ◽

2013 ◽

Author(s):

John Davis

Keyword(s):

Systematic Review ◽

First Generation ◽

Second Generation ◽

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Efficacy And Safety ◽

Episode Psychosis

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Multimodal meta-analysis of structural and functional brain changes in first episode psychosis and the effects of antipsychotic medication

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2012.07.012 ◽

2012 ◽

Vol 36 (10) ◽

pp. 2325-2333 ◽

Cited By ~ 173

Author(s):

J. Radua ◽

S. Borgwardt ◽

A. Crescini ◽

D. Mataix-Cols ◽

A. Meyer-Lindenberg ◽

...

Keyword(s):

Antipsychotic Medication ◽

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Functional Brain ◽

Episode Psychosis ◽

Brain Changes

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Differences in duration of untreated psychosis for racial and ethnic minority groups with first-episode psychosis: an updated systematic review and meta-analysis

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01737-3 ◽

2019 ◽

Vol 54 (10) ◽

pp. 1295-1298 ◽

Cited By ~ 1

Author(s):

Nicole Schoer ◽

Chen Wei Huang ◽

Kelly K. Anderson

Keyword(s):

Systematic Review ◽

Ethnic Minority ◽

Minority Groups ◽

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Duration Of Untreated Psychosis ◽

Ethnic Minority Groups ◽

Episode Psychosis ◽

Racial And Ethnic Minority

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Glucose metabolism dysregulation at the onset of mental illness is not limited to first episode psychosis: A systematic review and meta‐analysis

Early Intervention in Psychiatry ◽

10.1111/eip.12749 ◽

2018 ◽

Vol 13 (5) ◽

pp. 1021-1031 ◽

Cited By ~ 6

Author(s):

Suat Kucukgoncu ◽

Urska Kosir ◽

Elton Zhou ◽

Erin Sullivan ◽

Vinod H. Srihari ◽

...

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Glucose Metabolism ◽

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis

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Effect of discontinuation v. maintenance of antipsychotic medication on relapse rates in patients with remitted/stable first-episode psychosis: a meta-analysis

Psychological Medicine ◽

10.1017/s0033291718001393 ◽

2018 ◽

Vol 49 (5) ◽

pp. 772-779 ◽

Cited By ~ 5

Author(s):

Taro Kishi ◽

Toshikazu Ikuta ◽

Yuki Matsui ◽

Ken Inada ◽

Yuki Matsuda ◽

...

Keyword(s):

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Antipsychotic Treatment ◽

Episode Psychosis ◽

Numbers Needed To Treat ◽

Reported Data ◽

Relapse Rates ◽

Risk Of Relapse ◽

Maintenance Group

AbstractBackgroundDiscontinuation of antipsychotics predisposes patients with remitted/stable first-episode psychosis (FEP) to a higher risk of relapse, but it remains unclear how long discontinuation increases the relapse rate in these patients compared with maintenance.MethodsThis meta-analysis of randomized controlled trials (RCTs) compared relapse rates in FEP patients between antipsychotic treatment discontinuation and maintenance groups at 1, 2, 3, 6, 9, 12 (primary), and 18–24 months. The risk ratio (RR) and numbers needed to treat/harm (NNT/NNH) were calculated using a random-effects model.ResultsTen RCTs were identified (n = 776; mean study duration, 18.6 ± 6.0 months). The antipsychotics were discontinued abruptly in four RCTs (which reported data only at 12 months) and after tapering off gradually over several months (mean length, 3 months) in six RCTs. Compared with the discontinuation group, the maintenance group experienced significantly fewer relapses at all time points except 1 month [RR (NNT): 2 months, 0.49 (13); 3 months, 0.46 (9); 6 months, 0.55 (6); 9 months, 0.48 (3); 12 months, 0.47 (3); and 18–24 months, 0.57 (4)]. The maintenance group was associated with higher discontinuation due to adverse events (RR, 2.61; NNH, not significant).ConclusionsMaintaining antipsychotic treatment prevented relapse for up to 24 months in FEP patients. Discontinuation of antipsychotics for ⩾2 months significantly increased the risk of relapse. However, 45.7% of patients who discontinued antipsychotics for 12 months (39.4% after 18–24 months) did not experience a relapse.

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Impaired glucose tolerance in first-episode drug-naïve patients with schizophrenia: relationships with clinical phenotypes and cognitive deficits

Psychological Medicine ◽

10.1017/s0033291716001902 ◽

2016 ◽

Vol 46 (15) ◽

pp. 3219-3230 ◽

Cited By ~ 25

Author(s):

D. C. Chen ◽

X. D. Du ◽

G. Z. Yin ◽

K. B. Yang ◽

Y. Nie ◽

...

Keyword(s):

Insulin Resistance ◽

Cognitive Impairment ◽

Glucose Tolerance ◽

Impaired Glucose Tolerance ◽

Cognitive Deficits ◽

First Episode ◽

Oral Glucose ◽

Model Assessment ◽

Clinical Phenotypes ◽

Drug Naïve

BackgroundSchizophrenia patients have a higher prevalence of type 2 diabetes mellitus with impaired glucose tolerance (IGT) than normals. We examined the relationship between IGT and clinical phenotypes or cognitive deficits in first-episode, drug-naïve (FEDN) Han Chinese patients with schizophrenia.MethodA total of 175 in-patients were compared with 31 healthy controls on anthropometric measures and fasting plasma levels of glucose, insulin and lipids. They were also compared using a 75 g oral glucose tolerance test and the homeostasis model assessment of insulin resistance (HOMA-IR). Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS).ResultsOf the patients, 24.5% had IGT compared with none of the controls, and they also had significantly higher levels of fasting blood glucose and 2-h glucose after an oral glucose load, and were more insulin resistant. Compared with those patients with normal glucose tolerance, the IGT patients were older, had a later age of onset, higher waist or hip circumference and body mass index, higher levels of low-density lipoprotein and triglycerides and higher insulin resistance. Furthermore, IGT patients had higher PANSS total and negative symptom subscale scores, but no greater cognitive impairment except on the emotional intelligence index of the MCCB.ConclusionsIGT occurs with greater frequency in FEDN schizophrenia, and shows association with demographic and anthropometric parameters, as well as with clinical symptoms but minimally with cognitive impairment during the early course of the disorder.

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COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽

10.1192/bjo.2021.329 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S112-S112

Author(s):

Adam Whyte ◽

Alastair Reid

Keyword(s):

Mental Health ◽

Early Intervention ◽

Mental Health Services ◽

Health Services ◽

First Episode Psychosis ◽

First Episode ◽

Intervention Service ◽

Number Of Patients ◽

Episode Psychosis ◽

The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

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Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

Psychological Medicine ◽

10.1017/s0033291719000904 ◽

2019 ◽

Vol 50 (6) ◽

pp. 991-1001 ◽

Cited By ~ 2

Author(s):

Olesya Ajnakina ◽

Brendon Stubbs ◽

Emma Francis ◽

Fiona Gaughran ◽

Anthony S. David ◽

...

Keyword(s):

Systematic Review ◽

Longitudinal Studies ◽

Meta Analysis ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Hospitalised Patients ◽

Episode Psychosis ◽

Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

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Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning

European Psychiatry ◽

10.1192/j.eurpsy.2019.9 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

Teresa Sánchez-Gutiérrez ◽

Belén Fernandez-Castilla ◽

Sara Barbeito ◽

Ana González-Pinto ◽

Juan Antonio Becerra-García ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

First Episode Psychosis ◽

Cannabis Use ◽

Effect Sizes ◽

Neurocognitive Functioning ◽

Psychotic Symptoms ◽

First Episode ◽

Moderator Variables ◽

Episode Psychosis

Abstract Background. The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP. Methods. Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age. Results. Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (β = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (β = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (β = 0.266, t = 2.06, p = 0.043). Conclusions. This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.

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