The association between psychopathology of first-episode psychosis patients within the schizophrenia spectrum and previous offending

Currently there is no cure for schizophrenia and no sure way to prevent it. However, people who possess risk factors for schizophrenia can minimize their symptoms or prevent them from getting worse by taking preventative measures. And if symptoms do appear, early treatment may lessen the severity of the symptoms and improve the trajectory of the disorder. This chapter covers the prescribing of psychotropic medications for treating children and adolescents with schizophrenia and discusses promising and effective treatments, including multisystemic therapy-psychiatric, cognitive-behavioral therapy, and coordinated specialty care for first-episode psychosis. Chapter 16 returns to the case studies presented in Chapter 15 and describes the real-life outcomes along with questions for class discussion.

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S102. DIAGNOSTIC CHALLENGES AT TIME OF INPATIENT ADMISSION: DIAGNOSTIC SHIFTS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.168 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S73-S73

Author(s):

Marlene Koch ◽

Melanie Trimmel ◽

Josef Baumgartner ◽

Barbara Hinterbuchinger ◽

Zsuzsa Litvan ◽

...

Keyword(s):

First Episode Psychosis ◽

Inpatient Unit ◽

Early Psychosis ◽

First Episode ◽

Organic Psychosis ◽

Affective Psychosis ◽

Clinical Phenotypes ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Time Of Admission

Abstract Background First episode psychoses (FEP) may present with diffuse symptoms and a broad range of clinical phenotypes, leading to difficulties in the early detection of the different pluripotent trajectories and consequently to instability of the diagnoses. The aim of this study was to assess the stability of diagnoses at time of admission compared to discharge in patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital. Methods Charts of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna between 01.01.2016 and 31.03.2017 were reviewed. FEP was defined as a first presentation of affective, schizophreniform, acute polymorphic, organic or substance-related psychosis according to ICD-10. Results 127 patients were admitted during the said period, among whom 92 (72,4%) were diagnosed with a psychotic disorder at time of admission. 39,1% (n=36) of those had a FEP, whereof 58,3% (n=21) were diagnosed with schizophrenia spectrum psychosis, 27,8% (n=10) with affective psychosis, 11,1% (n=4) with substance-related psychosis and 2,8% (n=1) with organic psychosis as main diagnosis at time of discharge. In 50% (n=18) of FEP patients, diagnosis at time of admission was not maintained. 54,2% (n=13) of FEP patients who were admitted with a schizophrenia spectrum diagnosis had a shift in diagnosis at time of discharge, whereof 46,2% (n=6) were adjusted to another diagnosis of the same spectrum and 53,8% (n=7) to a diagnosis of either affective spectrum, substance-related psychosis or organic psychosis. 100% (n=2) of those with a persistent delusional disorder had a different diagnosis at discharge, as well as 56,3% (n=9=) of those admitted with a diagnosis of acute and transient psychotic disorders. Changes in the admission diagnoses of affective psychosis were necessary in 44,4% (n=4), whereof one half was adjusted to another diagnosis of the same spectrum and the other half to a diagnosis of the schizophrenia spectrum. Discussion The diagnostic instability in this study underlines the concept of the highly dynamic and changeable nature of psychopathology in the early stages and the pluripotent trajectories of psychosis. Furthermore, inadequate information available for specific diagnosis at time of admission as well as diagnostic uncertainty at the onset of psychosis could be implicated in the described diagnostic instability. The broad range of clinical phenotypes of early psychosis and the limitations of current diagnostic risk and identification approaches for the assessment of first episode psychosis indicate psychopathology conformed to a more dimensional rather than categorical model, as well as the need of a more dynamic model of prediction, such as the clinical staging model.

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Do psychosis prodrome onset negative symptoms predict first presentation negative symptoms?

European Psychiatry ◽

10.1016/j.eurpsy.2013.02.003 ◽

2014 ◽

Vol 29 (3) ◽

pp. 153-159 ◽

Cited By ~ 14

Author(s):

J. Lyne ◽

L. Renwick ◽

K. Madigan ◽

B. O’Donoghue ◽

M. Bonar ◽

...

Keyword(s):

Negative Symptoms ◽

Treatment Phase ◽

First Episode Psychosis ◽

Diagnostic Group ◽

First Episode ◽

Regression Analyses ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Psychosis Prodrome ◽

The Relationship

AbstractBackground:Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear.Objectives:We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment.Methods:Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding.Results:PONS prevalence was 50.3% in the schizophrenia spectrum group (n = 155) and 31.2% in the non-schizophrenia spectrum group (n = 218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ2 = 10.41, P < 0.001) and adjusted (OR = 2.40, 95% CI = 1.11–5.22, P = 0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group.Conclusion:PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.

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MMN/P3a deficits in first episode psychosis: Comparing schizophrenia-spectrum and affective-spectrum subgroups

Schizophrenia Research ◽

10.1016/j.schres.2011.03.025 ◽

2011 ◽

Vol 130 (1-3) ◽

pp. 203-209 ◽

Cited By ~ 61

Author(s):

Manreena Kaur ◽

Robert A. Battisti ◽

Philip B. Ward ◽

Arnab Ahmed ◽

Ian B. Hickie ◽

...

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Schizophrenia Spectrum ◽

Episode Psychosis

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Not all first-episode psychosis is the same: preliminary evidence of greater basic self-disturbance in schizophrenia spectrum cases

Early Intervention in Psychiatry ◽

10.1111/j.1751-7893.2012.00381.x ◽

2012 ◽

Vol 7 (2) ◽

pp. 200-204 ◽

Cited By ~ 40

Author(s):

Barnaby Nelson ◽

Andrew Thompson ◽

Alison R. Yung

Keyword(s):

Preliminary Evidence ◽

First Episode Psychosis ◽

First Episode ◽

Schizophrenia Spectrum ◽

Episode Psychosis

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Integrated treatment of first-episode psychosis: effect of treatment on family burden

The British Journal of Psychiatry ◽

10.1192/bjp.187.48.s85 ◽

2005 ◽

Vol 187 (S48) ◽

pp. s85-s90 ◽

Cited By ~ 98

Author(s):

Pia Jeppesen ◽

Lone Petersen ◽

Anne Thorup ◽

Maj-Britt Abel ◽

Johan ⊘ehlenschlæger ◽

...

Keyword(s):

Standard Treatment ◽

Burden Of Illness ◽

Skills Training ◽

First Episode Psychosis ◽

Integrated Treatment ◽

Family Burden ◽

First Episode ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

Satisfaction With Treatment

BackgroundThe families of patients with first-episode psychosis often play a major role in care and often experience lack of support.AimsTo determine the effect of integrated treatment v. standard treatment on subjective burden of illness, expressed emotion (EE), knowledge of illness and satisfaction with treatment in key relatives of patients with a first episode of schizophrenia-spectrum disorder.MethodPatients with ICD-10 schizophrenia-spectrum disorders (first episode) were randomly assigned to integrated treatment or to standard treatment. Integrated treatment consisted of assertive community treatment, psychoeducational multi-family groups and social skills training. Key relatives were assessed with the Social Behaviour Assessment Schedule (SBAS, burden of illness), the 5-min speech sample (EE), and a multiple choice questionnaire at entry and after 1 year.ResultsRelatives in integrated treatment felt less burdened and were significantly more satisfied with treatment than relatives in standard treatment. There were no significant effects of intervention groups on knowledge of illness and EE.ConclusionsThe integrated treatment reduced family burden of illness and improved satisfaction with treatment.

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Deficits in context-dependent adaptive coding in early psychosis and healthy individuals with schizotypal personality traits

Brain ◽

10.1093/brain/awy203 ◽

2018 ◽

Vol 141 (9) ◽

pp. 2806-2819 ◽

Cited By ~ 2

Author(s):

Matthias Kirschner ◽

Amelie Haugg ◽

Andrei Manoliu ◽

Joe J Simon ◽

Quentin J M Huys ◽

...

Keyword(s):

Personality Traits ◽

Symptom Severity ◽

First Episode Psychosis ◽

First Episode ◽

Healthy Individuals ◽

Adaptive Coding ◽

Schizotypal Personality ◽

Schizophrenia Spectrum ◽

Episode Psychosis ◽

The Right

Abstract Adaptive coding of information is a fundamental principle of brain functioning. It allows for efficient representation over a large range of inputs and thereby alleviates the limited coding range of neurons. In the present study, we investigated for the first time potential alterations in context-dependent reward adaptation and its association with symptom dimensions in the schizophrenia spectrum. We studied 27 patients with first-episode psychosis, 26 individuals with schizotypal personality traits and 25 healthy controls. We used functional MRI in combination with a variant of the monetary incentive delay task and assessed adaptive reward coding in two reward conditions with different reward ranges. Compared to healthy controls, patients with first-episode psychosis and healthy individuals with schizotypal personality traits showed a deficit in increasing the blood oxygen level-dependent response slope in the right caudate for the low reward range compared to the high reward range. In other words, the two groups showed inefficient neural adaptation to the current reward context. In addition, we found impaired adaptive coding of reward in the caudate nucleus and putamen to be associated with total symptom severity across the schizophrenia spectrum. Symptom severity was more strongly associated with neural deficits in adaptive coding than with the neural coding of absolute reward outcomes. Deficits in adaptive coding were prominent across the schizophrenia spectrum and even detectable in unmedicated (healthy) individuals with schizotypal personality traits. Furthermore, the association between total symptom severity and impaired adaptive coding in the right caudate and putamen suggests a dimensional mechanism underlying imprecise neural adaptation. Our findings support the idea that impaired adaptive coding may be a general information-processing deficit explaining disturbances within the schizophrenia spectrum over and above a simple model of blunted absolute reward signals.

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Orbitofrontal-striatal structural alterations linked to negative symptoms at different stages of the schizophrenia spectrum

10.1101/2020.04.07.20057166 ◽

2020 ◽

Author(s):

Matthias Kirschner ◽

André Schmidt ◽

Benazir Hodzic-Santor ◽

Achim Burrer ◽

Andrei Manoliu ◽

...

Keyword(s):

Negative Symptoms ◽

Ventral Striatum ◽

Disease Onset ◽

Chronic Schizophrenia ◽

Brain Regions ◽

First Episode Psychosis ◽

First Episode ◽

Phenotypic Trait ◽

Schizophrenia Spectrum ◽

Episode Psychosis

AbstractAmong the most debilitating manifestations of schizophrenia are negative symptoms such as anhedonia and apathy. Imaging studies have linked these symptoms to morphometric abnormalities in two brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and ventral striatum. Negative symptoms generally are associated with reduced OFC thickness, while apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment, or an underlying phenotypic trait. Here we use multicentre MRI data to investigate orbitofrontal-striatal abnormalities across the schizophrenia-spectrum from healthy populations with schizotypy, to unmedicated and medicated first-episode psychosis patients, and patients with chronic schizophrenia. Striatal volumes and OFC thickness were estimated from T1-weighted images acquired in all three diagnostic groups and controls from four sites (n=337). Results were first established in one test cohort (“Zurich sample”) and replicated in three independent samples. There was a correlation between apathy and striatal volume only in healthy individuals with schizotypy; however, medicated patients exhibited larger striatal volumes, which appears to be a consequence of antipsychotic medications. The association between reduced OFC thickness and negative symptoms generally also appeared to vary along the disease course, being significant only in first-episode psychosis patients. In schizotypy there was increased OFC relative to controls. Our findings suggest that negative symptoms associate with a temporal continuum of orbitofrontal-striatal abnormalities that may predate the occurrence of schizophrenia. Thicker OFC in schizotypy may represent either compensatory or pathological mechanisms prior to disease-onset.

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