Longitudinal symptom network structure in first-episode psychosis: a possible marker for remission

2021 ◽  
pp. 1-9
Author(s):  
Yan Hong Piao ◽  
Je-Yeon Yun ◽  
Thong Ba Nguyen ◽  
Woo-Sung Kim ◽  
Jing Sui ◽  
...  
Keyword(s):  
Network Structure ◽  
Graphical Model ◽  
First Episode Psychosis ◽  
Global Network ◽  
Local Network ◽  
First Episode ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Network Metrics ◽  
Over Time

Abstract Background Network approach has been applied to a wide variety of psychiatric disorders. The aim of the present study was to identify network structures of remitters and non-remitters in patients with first-episode psychosis (FEP) at baseline and the 6-month follow-up. Methods Participants (n = 252) from the Korean Early Psychosis Study (KEPS) were enrolled. They were classified as remitters or non-remitters using Andreasen's criteria. We estimated network structure with 10 symptoms (three symptoms from the Positive and Negative Syndrome Scale, one depressive symptom, and six symptoms related to schema and rumination) as nodes using a Gaussian graphical model. Global and local network metrics were compared within and between the networks over time. Results Global network metrics did not differ between the remitters and non-remitters at baseline or 6 months. However, the network structure and nodal strengths associated with positive-self and positive-others scores changed significantly in the remitters over time. Unique central symptoms for remitters and non-remitters were cognitive brooding and negative-self, respectively. The correlation stability coefficients for nodal strength were within the acceptable range. Conclusion Our findings indicate that network structure and some nodal strengths were more flexible in remitters. Negative-self could be an important target for therapeutic intervention.

Risk factors associated with treatment-resistant schizophrenia in first-episode psychosis

2017 ◽  
Vol Ano 7 ◽  
pp. 8-12
Author(s):  
Ana Beatriz de Oliveira Assis ◽  
Jayse Gimenez Pereira Brandão ◽  
Pedro Otávio Piva Espósito ◽  
Osmar Tessari Junior ◽  
Bruno Berlucci Ortiz
Keyword(s):  
Risk Factors ◽  
First Episode Psychosis ◽  
First Episode ◽  
Treatment Resistant ◽  
Factors Associated ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Negative Syndrome

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.

scholarly journals Assessing apathy: The use of the Apathy Evaluation Scale in first episode psychosis

2008 ◽  
Vol 23 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Ann Faerden ◽  
Ragnar Nesvåg ◽  
Elizabeth Ann Barrett ◽  
Ingrid Agartz ◽  
Arnstein Finset ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
First Episode Psychosis ◽  
One Dimension ◽  
First Episode ◽  
Social Contacts ◽  
Ongoing Work ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Negative Syndrome ◽  
Main Factor

AbstractBackgroundRecently there has been a renewed interest in defining the boundaries and subdomains of the negative syndrome in schizophrenia and new scales have been asked for. Apathy is one of the symptoms in focus. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. The main aims of this study were to examine the psychometric properties of the AES-C and its relationship to the Positive and Negative Syndrome Scale (PANSS).MethodsA total of 104 patients with first episode psychosis from the ongoing Thematic Organized Psychosis Research (TOP) study were included.ResultsA factor analysis of the AES-C identified three subscales: Apathy, Insight and Social Contacts. Only the Apathy subscale showed satisfactory psychometric properties and showed acceptable convergent and discriminate properties by correlating strongly with the apathy-related items of the PANSS.ConclusionsThis study shows that the AES-C measures more than one dimension. The main factor, the Apathy subscale, can however be used to assess apathy in first episode psychosis patients in the ongoing work of refining the subdomains of the negative syndrome.

scholarly journals Influence of social perception and social knowledge on cognitive and social functioning in early psychosis

2006 ◽  
Vol 189 (4) ◽  
pp. 373-378 ◽  
Author(s):  
Jean Addington ◽  
Huma Saeedi ◽  
Donald Addington
Keyword(s):  
Social Cognition ◽  
Social Functioning ◽  
Social Perception ◽  
First Episode Psychosis ◽  
Social Knowledge ◽  
First Episode ◽  
Episode Psychosis ◽  
Interpersonal Problem Solving ◽  
The Relationship ◽  
Over Time

BackgroundSocial cognition has been implicated in the relationship between cognition and social functioning.AimsTo test the hypothesis that social cognition mediates the relationship between cognitive and social functioning.MethodThis was a 1-year longitudinal cohort study comparing three groups: 50 people with first-episode psychosis, 53 people with multi-episode schizophrenia and 55 people without psychiatric disorder as controls. Participants were assessed on social perception, social knowledge, interpersonal problem-solving, cognition and social functioning.ResultsThere were significant associations between social cognition, cognition and social functioning in all three groups. Deficits in social cognition were stable over time. In the first two groups, controlling for social cognition reduced the relationship between cognitive and social functioning.ConclusionsThis study provides some evidence that social cognition mediates the relationship between cognitive and social functioning.

Is there an optimal factor structure of the Positive and Negative Syndrome Scale in patients with first-episode psychosis?

2012 ◽  
Vol 54 (2) ◽  
pp. 160-165 ◽  
Author(s):  
JOHANNES LANGEVELD ◽  
OLE A. ANDREASSEN ◽  
BJØRN AUESTAD ◽  
ANN FAERDEN ◽  
LARS JOHAN HAUGE ◽  
...  
Keyword(s):  
Factor Structure ◽  
First Episode Psychosis ◽  
First Episode ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Negative Syndrome

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

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
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.

Serum Level Measurements Optimize Aripriprazole Treatment in Adolescent Patients

2019 ◽  
Vol 47 (3) ◽  
pp. 261-264 ◽  
Author(s):  
Jochen Gehrmann ◽  
Peter Götz Lampe
Keyword(s):  
Serum Level ◽  
Significant Variation ◽  
Second Generation ◽  
Serum Levels ◽  
First Episode Psychosis ◽  
First Episode ◽  
Off Label ◽  
Episode Psychosis ◽  
Second Generation Antipsychotic ◽  
Over Time

Abstract. 21 minors suffering from first-episode psychosis or related disorders were treated with the second-generation antipsychotic aripriprazole with serum levels being monitored over time. A significant variation of serum levels was observed in about half of the patients. Patients from Africa showed high levels of aripriprazole. In seven patients, i. e. ca. 35 % of the sample, aripriprazole treatment had to be stopped for various reasons. Therefore, serum levels of this antipsychotic (which in Germany is still considered off-label treatment before the age of 18) should be regularly monitored particularly in patients from Africa.

State-dependent microstructural white matter changes in drug-naïve patients with first-episode psychosis

2017 ◽  
Vol 47 (15) ◽  
pp. 2613-2627 ◽  
Author(s):  
M. H. Serpa ◽  
J. Doshi ◽  
G. Erus ◽  
T. M. Chaim-Avancini ◽  
M. Cavallet ◽  
...  
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
Clinical Status ◽  
First Episode Psychosis ◽  
Rate Of Change ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Sustained Remission ◽  
Episode Psychosis ◽  
Over Time

BackgroundDiffusion tensor imaging (DTI) studies have consistently shown white matter (WM) microstructural abnormalities in schizophrenia. Whether or not such alterations could vary depending on clinical status (i.e. acute psychosis v. remission) remains to be investigated.MethodsTwenty-five treatment-naïve first-episode psychosis (FEP) patients and 51 healthy-controls (HC) underwent MRI scanning at baseline. Twenty-one patients were re-scanned as soon as they achieved sustained remission of symptoms; 36 HC were also scanned twice. Rate-of-change maps of longitudinal DTI changes were calculated for in order to examine WM alterations associated with changes in clinical status. We conducted voxelwise analyses of fractional anisotropy (FA) and trace (TR) maps.ResultsAt baseline, FEP presented reductions of FA in comparison with HC [p < 0.05, false-discovery rate (FDR)-corrected] affecting fronto-limbic WM and associative, projective and commissural fasciculi. After symptom remission, patients showed FA increase over time (p < 0.001, uncorrected) in some of the above WM tracts, namely the right anterior thalamic radiation, right uncinate fasciculus/inferior fronto-occipital fasciculus, and left inferior fronto-occipital fasciculus/inferior longitudinal fasciculus. We also found significant correlations between reductions in PANSS scores and FA increases over time (p < 0.05, FDR-corrected).ConclusionsWM changes affecting brain tracts critical to the integration of perceptual information, cognition and emotions are detectable soon after the onset of FEP and may partially reverse in direct relation to the remission of acute psychotic symptoms. Our findings reinforce the view that WM abnormalities in brain tracts are a key neurobiological feature of acute psychotic disorders, and recovery from such WM pathology can lead to amelioration of symptoms.

Longitudinal relationship between expressed emotion and cannabis misuse in young people with first-episode psychosis

2015 ◽  
Vol 30 (1) ◽  
pp. 20-25 ◽  
Author(s):  
C. González-Blanch ◽  
J.F. Gleeson ◽  
S.M. Cotton ◽  
K. Crisp ◽  
P.D. McGorry ◽  
...  
Keyword(s):  
Young People ◽  
Family Environment ◽  
Temporal Relationship ◽  
Expressed Emotion ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
Substance Involvement ◽  
Over Time

AbstractCarers’ expressed emotion (EE) and patients’ cannabis misuse are two of the most robust predictors of psychotic relapse. We aimed to examine the temporal relationship between EE and cannabis misuse. Sixty-three key carers of young people with first-episode psychosis (FEP) were assessed at baseline and 7-month follow-up. EE was measured in carers using the Family Questionnaire (FQ) and cannabis misuse in patients using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Correlational and hierarchical logistic regression analyses were conducted to examine the temporal relationship between EE components (i.e. criticism and emotional over involvement) and cannabis misuse. Carers’ criticism at baseline significantly predicted cannabis misuse according to the ASSIST at 7-month follow-up. The association remained significant after controlling for baseline symptom severity and social functioning (B = 0.15, P = .02). Conversely, baseline cannabis misuse was not associated with carers’ criticism at 7-month follow-up. Patients in families with high criticism showed a tendency to increase cannabis misuse over time whereas the opposite trend was observed in those with carers with low criticism. A family environment characterized by high criticism may become a key risk factor for worsening cannabis misuse over time in young people with FEP. Further studies should investigate the potential mechanisms (e.g., patient's anxiety or perceived stress) through which criticism increases cannabis misuse in FEP.

Structural brain changes in schizophrenia at different stages of the illness: A selective review of longitudinal magnetic resonance imaging studies

2017 ◽  
Vol 51 (5) ◽  
pp. 500-508 ◽  
Author(s):  
Bruno Dietsche ◽  
Tilo Kircher ◽  
Irina Falkenberg
Keyword(s):  
Gray Matter ◽  
Chronically Ill ◽  
First Episode Psychosis ◽  
First Episode ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Episode Psychosis ◽  
Chronically Ill Patients ◽  
Over Time ◽  
Structural Brain

Objective: Schizophrenia is a devastating mental disorder accompanied by aberrant structural brain connectivity. The question whether schizophrenia is a progressive brain disorder is yet to be resolved. Thus, it is not clear when these structural alterations occur and how they develop over time. Methods: In our selective review, we summarized recent findings from longitudinal magnetic resonance imaging studies investigating structural brain alterations and its impact on clinical outcome at different stages of the illness: (1) subjects at ultra-high risk of developing psychosis, (2) patients with a first episode psychosis, and (3) chronically ill patients. Moreover, we reviewed studies examining the longitudinal effects of medication on brain structure in patients with schizophrenia. Results: (1) Studies from pre-clinical stages to conversion showed a more pronounced cortical gray matter loss (i.e. superior temporal and inferior frontal regions) in those individuals who later made transition to psychosis. (2) Studies investigating patients with a first episode psychosis revealed a decline in multiple gray matter regions (i.e. frontal regions and thalamus) over time as well as progressive cortical thinning in the superior and inferior frontal cortex. (3) Studies focusing on patients with chronic schizophrenia showed that gray matter decreased to a greater extent (i.e. frontal and temporal areas, thalamus, and cingulate cortices)—especially in poor-outcome patients. Very few studies reported effects on white matter microstructure in the longitudinal course of the illness. Conclusion: There is adequate evidence to suggest that schizophrenia is associated with progressive gray matter abnormalities particularly during the initial stages of illness. However, causal relationships between structural changes and illness course—especially in chronically ill patients—should be interpreted with caution. Findings might be confounded by longer periods of treatment and higher doses of antipsychotics or epiphenomena related to the illness.

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