Disturbance of neurotransmitters monoamines and indices of reducing-oxidizing processes in patient with the first episode of schizophrenia (FES)

IntroductionEffective treatment of FES patients may lead to achievement of long-term remission, decrease the number of relapses and increase the level of social activity and quality of life.AimTo study some pathophysiological mechanisms of FES.MethodsThe group of patients who were investigated clinically and biochemically consists of 26 persons (11 women and 15 men, average age 28.2 ± 9.5 years) with the first psychotic episode (F20.0; F20.3). Some biochemical parameters, representing the monoaminergic systems, and some biophysical parameters, representing reducing-oxidizing processes, were investigated. These parameters in all patients were estimated following the admission and prior to any treatment.ResultsThe severity of the disorder on admission to the clinic according to PANSS score was 75,5 ± 2,2 (i.e., moderately severe). Patients with FES were characterized by a significant increase of platelet momnoamine oxidase activity (by 107%; р < 0,01) and decrease of serum semicarbazide-sensitive amine oxidase activity (by 29%; p < 0,001) in comparison to the controls. Both reactive capability of SH-group (Cys-34 residue) of serum albumin, the main source of thiols of plasma and intersticial fluid, measured in reaction with thiol-specific reagent - dithyonitrobenzoic acide, and kinetic coefficient were decreased in FES patients (by 24%; p = 0,02) in comparison to controls.ConclusionThese results show that FES patients are characterized by pronounced metabolic disturbances.

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Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.100 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S271-S272

Author(s):

S. Malta Vacas ◽

R. Carvalho ◽

M.J. Heitor

Keyword(s):

Great Majority ◽

First Episode ◽

Psychotic Episode ◽

Term Care ◽

First Psychotic Episode ◽

Effective Interventions ◽

Episode Psychosis ◽

Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Biochemical and biophysical aspects of the pathophysiology of first episode of schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(11)73874-3 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 2171-2171

Author(s):

M. Uzbekov ◽

N. Smolina ◽

T. Syrejshchikova ◽

E. Misionzhnik ◽

Y. Gryzunov ◽

...

Keyword(s):

Steady State ◽

Conformational Changes ◽

Amine Oxidase ◽

Clinical Severity ◽

First Episode ◽

Psychotic Episode ◽

Albumin Concentration ◽

Biophysical Parameters ◽

Fluorescent Spectroscopy ◽

Functional Parameters

IntroductionThe knowledge of pathophysiology of first psychotic episode is still fragmentary.AimTo investigate some biochemical and biophysical parameters in first-episode, drug-naive schizophrenic (FES) patients.Methods26 FES patients (ICD-10; F 20.0 and F 20.3) and 15 age-and gender-match volunteers were investigated. Clinical severity of FES patients were assessed by PANSS scale. Platelet monoamine oxidase (MAO) and serum semicarbazide-sensitive amine oxidase (SSAO) activities, middle-mass endotoxic molecules (MMEM) and malondialdehyde (MDA) levels were measured using respective methods. Steady-state and subnanosecond fluorescent spectroscopy were used for the investigation of albumin conformational changesResults Severity of disorder prior the treatment was 75.5 ± 2.2 (PANSS score). FES patients were characterized by significant increase in MAO activity (99%) and MMEM concentration (124%) and significant decrease in SSAO activity (26%) as compared with controls. Changes of albumin conformational and functional parameters (“effective” albumin concentration and“reserve” of albumin binding) estimated by steady-state fluorescent spectroscopy were insignificant. Factor analysis revealed that MAO and SSAO are more tightly connected with pathogenetic mechanisms of FES then MMEM, MDA and albumin functional parameters. Significant conformational changes of albumin of FES patients were detected using pulse fluorescent spectroscopy with subnanosecond resolution. Results are compared with the data received in chronic schizophrenic patients.ConclusionFrom pathophysiological point of view FES is the initial step in development of pathologically disturbed biochemical status characteristic to chronic schizophrenia.The study was supported by grant # 3156 from International Science and Technology Center (ISTC).

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Biochemical and biophysical aspects of the pathophysiology of first episode of schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(11)73222-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1518-1518

Author(s):

M. Uzbekov ◽

N. Smolina ◽

T. Syrejshchikova ◽

E. Misionzhnik ◽

Y. Gryzunov ◽

...

Keyword(s):

Steady State ◽

Conformational Changes ◽

Amine Oxidase ◽

Clinical Severity ◽

First Episode ◽

Psychotic Episode ◽

Albumin Concentration ◽

Biophysical Parameters ◽

Fluorescent Spectroscopy ◽

Functional Parameters

IntroductionThe knowledge of pathophysiology of first psychotic episode is still fragmentary.AimTo investigate some biochemical and biophysical parameters in first-episode, drug-naive schizophrenic (FES) patients.Methods26 FES patients (ICD-10; F 20.0 and F 20.3) and 15 age-and gender-match volunteers were investigated. Clinical severity of FES patients were assessed by PANSS scale. Platelet monoamine oxidase (MAO) and serum semicarbazide-sensitive amine oxidase (SSAO) activities, middle-mass endotoxic molecules (MMEM) and malondialdehyde (MDA) levels were measured using respective methods. Steady-state and subnanosecond fluorescent spectroscopy were used for the investigation of albumin conformational changes.ResultsSeverity of disorder prior the treatment was 75.5 ± 2.2 (PANSS score). FES patients were characterized by significant increase in MAO activity (99%) and MMEM concentration (124%) and significant decrease in SSAO activity (26%) as compared with controls. Changes of albumin conformational and functional parameters (“effective” albumin concentration and “reserve” of albumin binding) estimated by steady-state fluorescent spectroscopy were insignificant. Factor analysis revealed that MAO and SSAO are more tightly connected with pathogenetic mechanisms of FES then MMEM, MDA and albumin functional parameters. Significant conformational changes of albumin of FES patients were detected using pulse fluorescent spectroscopy with subnanosecond resolution. Results are compared with the data received in chronic schizophrenic patients.ConclusionFrom pathophysiological point of view FES is the initial step in development of pathologically disturbed biochemical status characteristic to chronic schizophrenia. The study was supported by grant # 3156 from International Science and Technology Center (ISTC).

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T38. POSTER PRESENTATION: HAMLETT: HANDLING ANTIPSYCHOTIC MEDICATION, A LONGTERM EVALUATION OF TARGETED TREATMENT A PRAGMATIC SINGLE-BLIND RANDOMISED CONTROLLED TRIAL OF CONTINUATION VERSUS DISCONTINUATION OF PSYCHOTIC MEDICATION

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.598 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S246-S246

Author(s):

Erna van‘t Hag

Keyword(s):

Antipsychotic Medication ◽

Controlled Trial ◽

Well Being ◽

First Episode ◽

Psychotic Episode ◽

Subjective Well Being ◽

First Psychotic Episode ◽

Episode Psychosis ◽

General Functioning

Abstract Background When achieving remission after a first psychotic episode using antipsychotic medication, international guidelines generally recommend continuation of use for >1 year. However, patients often have a strong wish to stop earlier due to side-effects, affecting everyday functioning. Recently, guidelines have been questioned as one Dutch study found that more patients achieved long-term functional remission after early discontinuation. Yet, this finding has not yet been replicated. Psychiatrists, patients and family are unsure which regime to follow: to continue or not to continue? Methods In total 512 participants will be included who achieved remission after first-episode psychosis and use antipsychotic medication. Recruitment takes place at 24 Dutch sites. HAMLETT is a multicenter pragmatic single-blind randomized controlled trial with two conditions (1:1): maintenance treatment versus discontinuation/dose reduction of antipsychotic medication. Main research question: Is long-term general functioning better if patients reduce/discontinue antipsychotic medication at an early stage (3–6 months after remission of their first psychotic episode), than when they continue medication >1 year? General functioning is measured in two ways: with the WHO-DAS interview and with Ecological Momentary Assessments (EMA). EMA is a structured diary method in which individuals are asked in daily life to report on their current thoughts, feelings and symptoms, as well as the context (e.g. location, company, activity) and the appraisal of the context (e.g. stress). Diaries are completed via a smartphone diary app maximally 10 times daily at semi-random moments, over eight consecutive days. Momentary positive/negative affect, self-esteem, subjective well-being, paranoia, hallucinations, sleep, and frequency, type and appraisal of social company and activities are assessed on a 1–7 scale. At baseline and after 6 months, 1, 2, 3 and 4 years follow-up, patients of both arms will perform EMA. This results in an intensive time series of psychopathology, subjective well-being and social functioning in relation to antipsychotic medication and a range of contextual influences. Results The study is active and currently recruiting patients (since September 2017), At present 194 patients have been included, 20% participated in EMA measurements. Results of the interim analysis and preliminary of EMA data will be presented. Discussion The HAMLETT study investigates the effects of maintenance treatment versus discontinuation/dose reduction of antipsychotic medication after remission of first episode psychosis on personal and social functioning, psychotic symptom severity, health-related quality of life and cognitive functioning. The HAMLETT study will offer evidence to guide patients and clinicians when evaluating optimal treatment duration for psychotic disorders. Using different types of outcome measures will provide a more in-depth analysis of effects of continuation/ discontinuation on functioning.

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Brief psychotic disorder associated with quarantine and mild COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240088 ◽

2020 ◽

Vol 13 (12) ◽

pp. e240088

Author(s):

Peter M Haddad ◽

Majid Al Abdulla ◽

Javed Latoo ◽

Yousaf Iqbal

Keyword(s):

Psychotic Disorder ◽

Physical Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Psychiatric Medication ◽

Diagnostic And Statistical Manual ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

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The relationship of emotion recognition with neuropsychological performance in patients with first episode psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2118 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S190-S190

Author(s):

A. Dardagani ◽

E. Dandi ◽

S. Tsotsi ◽

M. Nazou ◽

A. Lagoudis ◽

...

Keyword(s):

Emotion Recognition ◽

Visual Memory ◽

Emotion Perception ◽

First Episode ◽

Psychotic Episode ◽

Visuospatial Ability ◽

Cognitive Domains ◽

Neuropsychological Dysfunction ◽

First Psychotic Episode ◽

The Relationship

The relationship between neuropsychological dysfunction and emotion perception has been frequently noted in various studies. Attention, for example, has been found to play an important role in emotion processing and recognition. Not many studies though, have examined this relationship in first psychotic episode patients. The aim of the present study was to explore the nature of the relation between performance in cognitive tests and a test that measures emotion perception. In a sample of 46 first psychotic episode patients (22 male), we administered a comprehensive battery of neuropsychological non-verbal tests and an emotion recognition test. The cognitive domains of attention, memory, working memory, visuospatial ability and executive function were examined, by using specific tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The emotion recognition assessment comprised a new test that includes 35 coloured pictures of individuals expressing six basic emotions (happiness, sadness, anger, disgust, surprise, fear) and a neutral emotion. We used partial correlation–controlling for the effect of age–and we found a statistically significant relationship between emotion recognition and overall cognitive performance. More specifically, attention, visual memory and visuospatial ability positively correlated with emotion recognition. In regard to specific cognitive domains, attention positively correlated with anger and fear, whereas visual memory correlated with happiness and fear. In conclusion, it seems that the role of underlying visual processes in emotion perception has to be further examined and evaluated in this group of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The pathways to mental health care of first-episode psychosis patients: a systematic review

Psychological Medicine ◽

10.1017/s0033291710000371 ◽

2010 ◽

Vol 40 (10) ◽

pp. 1585-1597 ◽

Cited By ~ 92

Author(s):

K. K. Anderson ◽

R. Fuhrer ◽

A. K. Malla

Keyword(s):

Mental Health ◽

First Episode Psychosis ◽

Pathways To Care ◽

First Episode ◽

Psychotic Episode ◽

First Psychotic Episode ◽

Episode Psychosis ◽

First Contact ◽

Pathway To Care ◽

Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

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Neurological soft signs in first-episode psychosis: A systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.181.43.s50 ◽

2002 ◽

Vol 181 (S43) ◽

pp. s50-s57 ◽

Cited By ~ 132

Author(s):

Paola Dazzan ◽

Robin M. Murray

Keyword(s):

Motor Coordination ◽

First Episode Psychosis ◽

The Body ◽

First Episode ◽

Psychotic Episode ◽

Neurological Soft Signs ◽

First Psychotic Episode ◽

Cerebral Dysfunction ◽

Episode Psychosis ◽

First Onset

BackgroundNeurological soft signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. Their presence has been documented extensively in schizophrenia but not during the first psychotic episode.AimsTo review studies that have specifically investigated NSS at the time of the first psychotic episode.MethodA review of studies investigating neurological function in first-episode psychosis, using a clinical examination.ResultsPatients with first-episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. Furthermore, NSS may be associated with a specific laterality pattern.ConclusionsMore studies on first-onset schizophrenia are needed, evaluating both sensory and motor neurological domains (scoring separately for the two sides of the body), integrating this knowledge with neuroimaging findings and clarifying the role of NSS as markers of cognitive dysfunction.

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M192. SENSITIVITY FOR MOTION IS WEAKENED IN FIRST EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.504 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S209-S209

Author(s):

Francina Badia ◽

Daniel Linares ◽

Albert Compte ◽

Mireia Rosa ◽

Josep Dalmau ◽

...

Keyword(s):

Motion Perception ◽

Response To Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Antipsychotic Treatment ◽

Healthy Controls ◽

Exclusion Criteria ◽

Motion Sensitivity ◽

First Psychotic Episode

Abstract Background Perceptual spatial suppression is a phenomenon in which the perceived strength of a stimulus in space is reduced when the stimulus is surrounded by other stimuli. For motion perception, two studies so far have suggested that spatial suppression and sensitivity to motion perception is also reduced in patients with schizophrenia. Studies to date have been conducted in patients with chronic schizophrenia, however, whether these abnormalities are present at the onset of the disorder or whether they emerge during the course of the illness has not been examined, and no study has assessed whether these abnormalities are specific to schizophrenia or whether they are present in other psychotic disorders. Furthermore, if reduced spatial suppression and sensitivity for motion in schizophrenia are related to a glutamatergic hypofunction, as suggested by a recent study (Schallmo et al., 2019), these reductions may be more accentuated in patients who fail to respond to first-line antipsychotic treatment. Methods Sample: 33 patients with a first psychotic episode (16 females, age=16.4±0.6) and 17 healthy controls (9 females, age=17.2±0.61). Exclusion criteria for both groups were: intellectual disability according to DSM-V criteria. For healthy controls, exclusion criteria also included having a first degree relative with a history of psychotic disorder, current or past diagnosis of psychiatrics disorders. Instruments: The perceptual test was performed on a tablet, and consisted of a briefly presented grating (small or large) drifted sideways (the direction was chosen at random with equal probability), in which the participant was instructed to report the perceived direction. Clinical assessment at illness onset and 12 week follow-up: Positive and Negative Symptom Scales (PANSS), Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version and Structured Clinical Interview for DSM-IV. Non-response to treatment was defined as lack of 50% reduction in PANSS positive or negative scores at 12 weeks, any change in antipsychotics or need for combinations due to lack of clinical response. Psychophysical analysis: Motion sensitivity was estimated independently of lapses of attention, which were assessed by including trials in which the motion stimulus was easily discriminated. Results Patients and healthy controls were homogeneous in age (t=-.720, p=,537) and sex (X2=0.38, p=0.542). In patients, mean treatment response rates was 56.5%. Patients had similar scores of positive and negative symptomatology (positive symptoms= 21±7,13; negative symptoms= 18,4±8,18; general symptoms= 40,7±13,07). At 12 weeks 43,8% had a diagnosis of affective psychosis (bipolar disorder, depressive disorder with psychotic symptoms). Patients with a first psychotic episode, regardless of diagnosis or response to treatment, had less motion sensitivity than healthy controls (f=6.397, p=0.0148). No significant differences were found between groups in surround suppression and no significant correlations were observed between spatial suppression and clinical symptoms. Discussion To our knowledge, this is the first study to find abnormal motion sensitivity in patients with a first episode of psychosis. Our measure of sensitivity, given that it was not contaminated by lapses, indicates that patients had a genuine motion perception deficit rather than an inability to focus on the task. Our results also suggest that motion sensitivity may not be specific to patients with schizophrenia but may also characterize affective psychoses. Larger studies may be needed to clarify whether there is a relationship between motion sensitivity and severity of symptoms and response to treatment.

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From ADHD to psychosis… executive functions and time

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1252 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S353-S353

Author(s):

C.D.M. Isabel

Keyword(s):

Executive Functions ◽

Psychotic Disorders ◽

Stressful Life Event ◽

Auditory Hallucination ◽

First Episode ◽

Psychotic Episode ◽

Positive Symptoms ◽

Memory Work ◽

First Psychotic Episode ◽

Competing Interest

IntroductionCognitive impairment is present from the early stages of psychotic disorders. Alterations are found mainly in areas of attention, memory work and executive functions. During adolescence, ADHD patients often suffer from secondary disorders to lack of efficient procurement processes information by the poor development of executive functions.ObjectiveEvaluation of a patient whose diagnosis of ADD evolve to acute psychotic episode.MethodReview by clinical and psychometric tests developments in executive functions disorders.ResultsTwelve years old patient who comes to the hospital since 2012, was initially diagnosed with literacy difficulties and low academic performance, after MFF-20 speaks of Learning Disabilities. It presents lack of motivation, apathy, difficulty in scheduling and organization and adherence to schedules, so they diagnosed ADD. It is given treatment with methylphenidate and atomoxetine, presenting erratic path.After a year without treatment and the presence of a major stressful life event, at 17, has a first episode, consisting in mutiste attitude, phenomena of self-referenciality, experiences of control, enforcement and dissemination of ideas and auditory hallucination imperative type.ConclusionsThe presence of emocional dysregulation and alterations in the executive functions atribuyen to ADD, in this case, were premorbid symtomatology of a first psychotic episode. The presence of positive symptoms allows to clarify the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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