Steinberg and Durell (1968) revisited: increased rates of First Episode Psychosis following military induction in Greek Army Recruits

Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.

Download Full-text

Patterns and predictors of hospitalisation in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.178.6.518 ◽

2001 ◽

Vol 178 (6) ◽

pp. 518-523 ◽

Cited By ~ 47

Author(s):

Attila Sipos ◽

Glynn Harrison ◽

David Gunnell ◽

Shazad Amin ◽

Swaran P. Singh

Keyword(s):

Negative Symptoms ◽

First Episode Psychosis ◽

Psychiatric Services ◽

First Episode ◽

Psychotic Episode ◽

Duration Of Untreated Illness ◽

Specialist Services ◽

Increased Risk ◽

Episode Psychosis

BackgroundLittle is known about predictors of hospitalisation in patients with first-episode psychosis.AimsTo identify the pattern and predictors of hospitalisation of patients with a first psychotic episode making their first contact with specialist services.MethodThree-year follow-up of a cohort of 166 patients with a first episode of psychosis making contact with psychiatric services in Nottingham between June 1992 and May 1994.ResultsEighty-eight (53.0%) patients were admitted within 1 week of presentation; 32 (19.3%) were never admitted during the 3 years of follow-up. Manic symptoms at presentation were associated with an increased risk of rapid admission and an increased overall risk of admission; negative symptoms and a longer duration of untreated illness had an increased risk of late admission.ConclusionsCommunity-oriented psychiatric services might only delay, rather than prevent, admission of patients with predominantly negative symptoms and a longer duration of untreated illness. First-episode studies based upon first admissions are likely to be subject to selection biases, which may limit their representativeness.

Download Full-text

Aggressive incidents in first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.178.5.433 ◽

2001 ◽

Vol 178 (5) ◽

pp. 433-440 ◽

Cited By ~ 64

Author(s):

John Milton ◽

Shazad Amin ◽

Swaran P. Singh ◽

Glynn Harrison ◽

Peter Jones ◽

...

Keyword(s):

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Increased Risk ◽

Episode Psychosis ◽

Clinical Associations ◽

Independent Effects ◽

One Act ◽

Service Contact

BackgroundRecent research has reported increased risk of aggressive incidents by individuals with psychotic illness.AimsTo examine acts of aggression in first-episode psychosis.MethodSubjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records.ResultsOf the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95%CI 1.6–8.0), comorbid substance misuse (OR=3.1, CI 1.1–8.8) and symptoms of overactivity at service contact (OR=6.9, CI 2.7–17.8) had independent effects on risk of aggression.ConclusionsWe confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed.

Download Full-text

White Matter Microstructural Abnormalities in the Broca’s-Wernicke’s-Putamen “Hoffman Hallucination Circuit” and Auditory Transcallosal Fibers in First-Episode Psychosis With Auditory Hallucinations

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa105 ◽

2020 ◽

Author(s):

Dean F Salisbury ◽

Yiming Wang ◽

Fang-Cheng Yeh ◽

Brian A Coffman

Keyword(s):

White Matter ◽

Left Hemisphere ◽

Structural Integrity ◽

Right Hemisphere ◽

First Episode Psychosis ◽

Auditory Hallucinations ◽

First Episode ◽

Psychotic Episode ◽

Arcuate Fasciculus ◽

Episode Psychosis

Abstract Background Functional connectivity abnormalities between Broca’s and Wernicke’s areas and the putamen revealed by functional magnetic resonance imaging (fMRI) are related to auditory hallucinations (AH). In long-term schizophrenia, reduced white matter structural integrity revealed by diffusion imaging in left arcuate fasciculus (connecting Broca’s and Wernicke’s areas) is likely related to AH. The structural integrity of connections with putamen and their relation to AH are unknown. Little is known about this relationship in first-episode psychosis (FEP), although auditory transcallosal connections were reported to play a role. White matter in the Broca’s-Wernicke’s-putamen language-related circuit and auditory transcallosal fibers was examined to investigate associations with AH in FEP. Methods White matter connectivity was measured in 40 FEP and 32 matched HC using generalized fractional anisotropy (gFA) derived from diffusion spectrum imaging (DSI). Results FEP and HC did not differ in gFA in any fiber bundle. In FEP, AH severity was significantly inversely related to gFA in auditory transcallosal fibers and left arcuate fasciculus. Although the right hemisphere arcuate fasciculus-AH association did not attain significance, the left and right arcuate fasciculus associations were not significantly different. Conclusions Despite overall normal gFA in FEP, AH severity was significantly related to gFA in transcallosal auditory fibers and the left hemisphere connection between Broca’s and Wernicke’s areas. Other bilateral tracts’ gFA were weakly associated with AH. At the first psychotic episode, AH are more robustly associated with left hemisphere arcuate fasciculus and interhemispheric auditory fibers microstructural deficits, likely reflecting mistiming of information flow between language-related cortical centers.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Patients with First Episode Psychosis Take More and Stronger Cannabis than Controls

European Psychiatry ◽

10.1016/s0924-9338(09)70377-3 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

M. Di Forti

Keyword(s):

Employment Status ◽

Epidemiological Studies ◽

First Episode Psychosis ◽

First Episode ◽

Active Constituent ◽

Level Of Education ◽

Increased Risk ◽

Episode Psychosis ◽

Education And Employment ◽

The Uk

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007). We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. Cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls (OR*= 7.4 95% CI 3.4- 17.2, Adjusted for age, gender, ethnicity, level of Education and employment status).The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Download Full-text

A Young Man with First-Episode Psychosis: Case Presentation and Discussion

The Canadian Journal of Psychiatry ◽

10.1177/07067437980430s102 ◽

1998 ◽

Vol 43 (1_suppl) ◽

pp. 4S-6S

Author(s):

Angelo Fallu ◽

Lili Kopala ◽

Ashok Malla ◽

Lilian Thorpe

Keyword(s):

Young Patients ◽

Antipsychotic Agents ◽

First Episode Psychosis ◽

First Episode ◽

Psychotic Episode ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Dosing Regimens ◽

History Of ◽

Patient’S History

Objective: To review and discuss the issues and challenges involved in the treatment of first-episode psychosis in young patients, including choice of appropriate antipsychotic agents and adjunctive medications, dosing regimens, and biopsychosocial interventions. Methods: The case of a young man in his late teens with a history of substance abuse who experienced an acute dystonic reaction to treatment for his first psychotic episode is presented and discussed. Results: Each contributing author provides an evaluation of the intervention strategies presented in the patient's history and factors that influenced the treatment outcomes. Conclusions: The successful management of young patients with psychosis must go beyond the control of positive symptoms. A comprehensive psychosocial and psychoeducational approach combined with a well-tolerated treatment regimen can help the patient achieve positive outcomes.

Download Full-text

Very Low-Dose Risperidone in First-Episode Psychosis: A Safe and Effective Way to Initiate Treatment

Schizophrenia Research and Treatment ◽

10.1155/2011/631690 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Patrick D. McGorry ◽

John Cocks ◽

Paddy Power ◽

Peter Burnett ◽

Susy Harrigan ◽

...

Keyword(s):

Low Dose ◽

Chronic Schizophrenia ◽

First Episode Psychosis ◽

First Episode ◽

Psychotic Episode ◽

Open Label ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Open Label Trial ◽

Risperidone Treatment

Patients experiencing a first psychotic episode have high rates of extrapyramidal symptoms (EPSs) when treated with the doses of neuroleptics used in multiepisode or chronic schizophrenia. There is some evidence that lower doses may be equally, if not more, effective but less toxic in this population. Here, we report the results of a biphasic open label trial designed to assess the efficacy, safety, and tolerability of low-dose (2–4 mg/day) risperidone treatment in a group of 96 first-episode nonaffective psychosis patients. At the end of the trial, 62% of patients met the response criteria although approximately 80% had achieved a response at some time during the study. Reports of EPS remained low, and there were no dystonic reactions. We conclude that even at a dose of 2 mg/day, risperidone was highly effective in reducing acute symptomatology in a real world sample of young first-episode psychosis patients.

Download Full-text

Substance use in a population-based clinic sample of people with first-episode psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.106.024448 ◽

2007 ◽

Vol 190 (6) ◽

pp. 515-520 ◽

Cited By ~ 176

Author(s):

Jennifer H. Barnett ◽

Ursula Werners ◽

Sandra M. Secher ◽

Katherine E. Hill ◽

Rossa Brazil ◽

...

Keyword(s):

Substance Use ◽

General Population ◽

Population Based ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Intervention Service ◽

Episode Psychosis ◽

British Crime Survey

BackgroundSubstance use is implicated in the cause and course of psychosis.AimsTo characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire.MethodCurrent and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey.ResultsSubstance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom.ConclusionsSubstance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications.

Download Full-text