Cerebrospinal fluid abnormalities in first- and multi-episode schizophrenia-spectrum disorders: impact of clinical and demographical variables

AbstractMultiple lines of evidence indicate that immunological and inflammatory alterations contribute at least in a subgroup to the pathophysiology of schizophrenia. In this retrospective chart review, we investigated whether clinical factors contribute to altered cerebrospinal fluid (CSF) findings in schizophrenia-spectrum disorders. Clinical data from electronic medical records of patients with psychotic disorders (ICD-10: F20-F29) who received routine CSF diagnostics at the Department of Psychiatry and Psychotherapy, LMU Munich, Germany, were included. Chi² tests for dichotomous outcomes and independent t tests for continuous outcomes were used to compare differences between groups. A total of 331 patients were included in the analyses (43.2% female and 56.8% male). The mean age was 37.67 years (±15.58). The mean duration of illness was 71.96 months (±102.59). In all, 40% (128/320) were first-episode psychosis (FEP) patients and 60% (192/320) were multi-episode psychosis (MEP) patients. Elevated CSF protein levels were found in 19.8% and elevated CSF/serum albumin ratios (QAlb) in 29.4% of the cases. Pleocytosis was found in 6.1% of patients. MEP patients showed significantly higher mean QAlb compared with FEP patients (t(304.57) = −2.75, p = 0.006), which did not remain significant after correcting for age. QAlb elevation occurred more frequently in men (X2(1) = 14.76, p = <0.001). For treatment resistance, family history, and cMRI alterations, no significant differences in CSF-related outcomes were detected. Our work extends other retrospective cohorts confirming a relevant degree of CSF alterations in schizophrenia-spectrum disorders and shows the difficulty to relate these alterations to clinical and disease course trajectories. More research is needed to develop treatment response predictors from CSF analyses.

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Negative symptom dimensions in first episode psychosis: Is there a difference between schizophrenia and non‐schizophrenia spectrum disorders?

Early Intervention in Psychiatry ◽

10.1111/eip.13088 ◽

2020 ◽

Author(s):

Lorenzo Pelizza ◽

Silvia Azzali ◽

Federica Paterlini ◽

Sara Garlassi ◽

Ilaria Scazza ◽

...

Keyword(s):

Negative Symptom ◽

First Episode Psychosis ◽

First Episode ◽

Schizophrenia Spectrum Disorders ◽

Symptom Dimensions ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Spectrum Disorders

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Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

Psychological Medicine ◽

10.1017/s0033291709992182 ◽

2010 ◽

Vol 40 (10) ◽

pp. 1619-1626 ◽

Cited By ~ 16

Author(s):

M. Nordentoft ◽

J. Øhlenschlæger ◽

A. Thorup ◽

L. Petersen ◽

Pia Jeppesen ◽

...

Keyword(s):

Standard Treatment ◽

Supported Housing ◽

First Episode ◽

Schizophrenia Spectrum Disorders ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Bed Days ◽

Spectrum Disorders ◽

First Episode Schizophrenia

BackgroundThe effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.ResultsIt was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.ConclusionsThe study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

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Predicting first-episode psychosis patients who will never relapse over 10 years

Psychological Medicine ◽

10.1017/s0033291718003070 ◽

2018 ◽

Vol 49 (13) ◽

pp. 2206-2214 ◽

Cited By ~ 2

Author(s):

Christy LM Hui ◽

William G Honer ◽

Edwin HM Lee ◽

WC Chang ◽

Sherry KW Chan ◽

...

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Psychotic Episode ◽

Positive Symptoms ◽

Schizophrenia Spectrum Disorders ◽

Medication Discontinuation ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Spectrum Disorders

AbstractBackgroundAlthough relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.MethodPatients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.ResultsOut of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.ConclusionsTreatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

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