Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’

Objetivo: Ainda não está claro quais são os fatores de risco para a esquizofrenia resistente ao tratamento (ERT) em primeiro episódio psicótico (PEP). O objetivo deste trabalho é investigar indicadores de risco para ERT em PEP. Métodos: Foram selecionados 53 pacientes em primeiro episódio psicótico, com diagnóstico de esquizofrenia, que deram entrada à enfermaria de psiquiatria do Hospital das Clínicas Luzia de Pinho Melo entre 2011 e 2015. Ao ser admitido na enfermaria, o paciente era avaliado com a Escala de Sintomas para as Síndromes Positiva e Negativa (Positive and Negative Syndrome Scale – PANSS) e recebia tratamento inicial por 4 semanas. Caso sua resposta fosse inferior a 40% de redução na PANSS, o antipsicótico era trocado, e as escalas eram aplicadas novamente após mais 4 semanas. Após a falha com dois antipsicóticos, em doses plenas, por 4 semanas cada, a clozapina era introduzida, e o paciente era considerado ERT. Uma regressão logística foi aplicada onde sexo, idade de início, tempo de doença não tratada, uso de substâncias, avaliação global do funcionamento inicial e PANSS inicial total foram inseridos como variáveis independentes, e ERT foi inserida como variável dependente. Resultados: Tempo de doença não tratada apresentou significância de p = 0,038 e Exp (B) = 4,29, enquanto que PANSS total apresentou p = 0,012 e Exp (B) = 1,06. Conclusão: Identificar os fatores associados à resistência precoce ao tratamento poderia permitir aos clínicos evitar o atraso na introdução da clozapina e prevenir um pior prognóstico para esses pacientes.

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Circulating lipids associate with future weight gain in individuals with an at-risk mental state and in first-episode psychosis

10.1101/2020.01.30.20019711 ◽

2020 ◽

Author(s):

Santosh Lamichhane ◽

Alex M. Dickens ◽

Partho Sen ◽

Heikki Laurikainen ◽

Jaana Suvisaari ◽

...

Keyword(s):

At Risk ◽

Weight Gain ◽

High Risk ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

Molecular Signature ◽

First Episode ◽

Baseline Serum ◽

Average Life Span ◽

Episode Psychosis

AbstractPatients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic co-morbidities. Identification of individuals with psychotic disorders with a high risk of rapid weight gain, and the associated development of metabolic complications, is an unmet need as regards public health. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 controls (CTR), 44 first-episode psychosis (FEP) patients and 22 individuals at clinical-high-risk (CHR) for psychosis, from two study centers (Turku/Finland and London/UK). Baseline serum samples were analyzed by lipidomics, while body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols with low double bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of two triacylglycerols (TG(48:0) and TG(45:0)), was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals, and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic co-morbidities.

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Urbanicity and risk of first-episode psychosis: incidence study in Brazil

The British Journal of Psychiatry ◽

10.1192/bjp.2019.110 ◽

2019 ◽

Vol 215 (6) ◽

pp. 726-729 ◽

Cited By ~ 5

Author(s):

Cristina Marta Del-Ben ◽

Rosana Shuhama ◽

Camila Marcelino Loureiro ◽

Taciana Cristina Carvalho Ragazzi ◽

Daniela Perocco Zanatta ◽

...

Keyword(s):

At Risk ◽

First Episode Psychosis ◽

Incidence Rates ◽

First Episode ◽

World Population ◽

Middle Income ◽

Middle Income Countries ◽

Episode Psychosis ◽

Gender And Age ◽

Lower Population

We estimated the incidence of first-episode psychosis over a 3-year period in a Brazilian catchment area comprising the region's main city, Ribeirão Preto (1 425 306 persons-years at risk), and 25 other municipalities with a total of 1 646 556 persons-years at risk. The incidence rates were estimated and adjusted by gender and age, using the direct standardisation method to the world population as reference. The incidence of psychosis was higher in the younger groups, men, and among Black and minority ethnic Brazilians. Psychosis incidence was lower in Ribeirão Preto (16.69/100 000 person-years at risk; 95% CI 15.68–17.70) compared with the average incidence in the remaining municipalities (21.25/100 000 person-years at risk; 95% CI 20.20–22.31), which have lower population density, suggesting a distinct role for urbanicity in the incidence of first-episode psychosis in low- and middle-income countries.

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Book Reviews: CBT for Those at Risk of a First Episode Psychosis: evidence-based psychotherapy for people with an “At Risk Mental State” – Erratum

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465815000090 ◽

2015 ◽

Vol 43 (3) ◽

pp. 384-384

Author(s):

C. Collinson

Keyword(s):

At Risk ◽

First Episode Psychosis ◽

Clinical Psychologist ◽

First Episode ◽

Evidence Based ◽

Episode Psychosis ◽

Evidence Based Psychotherapy ◽

At Risk Mental State

Please note the author of this book review is Dr Catherine Campbell, Clinical Psychologist, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, and not Collinson, C. (2015) as cited in the original article. The book review editors extend their sincere apologies to Dr Campbell for this error.

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