Premorbid Adjustment and IQ in Patients With First-Episode Psychosis: A Multisite Case-Control Study of Their Relationship With Cannabis Use

Abstract Psychotic patients with a lifetime history of cannabis use generally show better cognitive functioning than other psychotic patients. Some authors suggest that cannabis-using patients may have been less cognitively impaired and less socially withdrawn in their premorbid life. Using a dataset comprising 948 patients with first-episode psychosis (FEP) and 1313 population controls across 6 countries, we examined the extent to which IQ and both early academic (Academic Factor [AF]) and social adjustment (Social Factor [SF]) are related to the lifetime frequency of cannabis use in both patients and controls. We expected a higher IQ and a better premorbid social adjustment in psychotic patients who had ever used cannabis compared to patients without any history of use. We did not expect such differences in controls. In both patients and controls, IQ was 3 points higher among occasional-users than in never-users (mean difference [Mdiff] = 2.9, 95% CI = [1.2, 4.7]). Both cases and control daily-users had lower AF compared to occasional (Mdiff = −0.3, 95% CI = [−0.5; −0.2]) and never-users (Mdiff = −0.4, 95% CI = [−0.6; −0.2]). Finally, patient occasional (Mdiff = 0.3, 95% CI = [0.1; 0.5]) and daily-users (Mdiff = 0.4, 95% CI = [0.2; 0.6]) had better SF than their never-using counterparts. This difference was not present in controls (Fgroup*frequency(2, 2205) = 4.995, P = .007). Our findings suggest that the better premorbid social functioning of FEP with a history of cannabis use may have contributed to their likelihood to begin using cannabis, exposing them to its reported risk-increasing effects for Psychotic Disorders.

Download Full-text

Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis: a 5-year follow-up study of patients in the OPUS trial

Psychological Medicine ◽

10.1017/s0033291713000433 ◽

2013 ◽

Vol 44 (1) ◽

pp. 117-126 ◽

Cited By ~ 30

Author(s):

L. Clausen ◽

C. R. Hjorthøj ◽

A. Thorup ◽

P. Jeppesen ◽

L. Petersen ◽

...

Keyword(s):

Antipsychotic Medication ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Clinical Symptoms ◽

First Episode Psychosis ◽

Cannabis Use ◽

Psychotic Symptoms ◽

First Episode ◽

Episode Psychosis

BackgroundSeveral studies indicate that cannabis use among patients with psychotic disorders is associated with worse outcome, but only a few studies have controlled for baseline condition and medication.MethodAt 5-year follow-up, interviews were carried out with 314 first-episode psychosis patients included in the OPUS trial. The patients included were in the age range of 18 to 45 years old and 59% were male. Cannabis use was extracted from the Schedule for Clinical Assessment in Neuropsychiatry. At follow-up, the patients were divided into different groups according to the variable cannabis use: abstainers, stoppers, starters and continuers. Psychotic, negative and disorganized dimensions (ranging from zero to five) were calculated for each of the four groups based on the Schedule for the Assessment of Positive and Negative Symptoms in Schizophrenia.ResultsCannabis users were younger (24.6 years v. 27.4 years, p < 0.001) and had a lower level of education. At the 5-year follow-up, users of cannabis had higher scores on the psychotic dimension [difference 0.97, 95% confidence interval (CI) 0.41–1.53, p = 0.001] and lower levels of the Global Assessment of Functioning (difference 8.26, 95% CI 2.13–14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted difference in psychotic dimension –1.04, 95% CI –1.77 to –0.31, p = 0.006).ConclusionsContinuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication.

Download Full-text

Risk of first-episode psychosis in migrants to the Republic of Ireland

Psychological Medicine ◽

10.1017/s003329172100177x ◽

2021 ◽

pp. 1-8

Author(s):

Brian O'Donoghue ◽

John Lyne ◽

Eric Roche ◽

Nathan Mifsud ◽

Laoise Renwick ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Census Data ◽

First Episode Psychosis ◽

First Episode ◽

Republic Of Ireland ◽

Episode Psychosis ◽

History Of ◽

The Republic ◽

History Of Migration

Abstract Background Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. Methods We included all presentations of first-episode psychosis over 8.5 years to the DETECT Early Intervention for psychosis service in the Republic of Ireland (573 individuals aged 18–65, of whom 22% were first-generation migrants). Psychotic disorder diagnosis relied on SCID. The at-risk population was calculated using census data, and negative binomial regression was used to estimate incidence rate ratios. Results The annual crude incidence rate for a first-episode psychotic disorder in the total cohort was 25.62 per 100000 population at risk. Migrants from Africa had a nearly twofold increased risk for developing a psychotic disorder compared to those born in the Republic of Ireland (IRR = 1.83, 95% CI 1.11–3.02, p = 0.02). In contrast, migrants from certain Asian countries had a reduced risk, specifically those from China, India, Philippines, Pakistan, Malaysia, Bangladesh and Hong Kong (aIRR = 0.36, 95% CI 0.16–0.81, p = 0.01). Conclusions Further research into the reasons for this inflated risk in specific migrant groups could produce insights into the aetiology of psychotic disorders. This information should also be used, alongside other data on environmental risk factors that can be determined from census data, to predict the incidence of psychotic disorders and thereby resource services appropriately.

Download Full-text

S95. DIFFERENCES IN LIFETIME PATTERNS OF PSYCHOSTIMULANTS AND THEIR IMPACT ON THE PROPORTION OF PATIENTS WITH FIRST-EPISODE PSYCHOSIS ATTRIBUTABLE TO PSYCHOSTIMULANTS USE ACROSS EUROPE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.161 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S70-S71

Author(s):

Manuel Duran-Cutilla ◽

Elisa Rodriguez Toscano ◽

David Fraguas ◽

Gonzalo Lopez ◽

Marta Rapado-Castro ◽

...

Keyword(s):

Case Control Study ◽

First Episode Psychosis ◽

Case Control ◽

Cannabis Use ◽

First Episode ◽

Clinical Symptomatology ◽

Negative Factor ◽

Episode Psychosis ◽

History Of ◽

Control Study

Abstract Background Substance use may be a risk factor for the onset of schizophrenia. Almost 50 % of people with first episode psychosis (FEP) have a history of cannabis or alcohol use. Smaller but significant proportions of this population have a history of psychostimulants (PS) use. Cross-sectional studies have shown a link between recreational and regular use of PS and psychotic symptoms, particularly among individuals with PS dependence, that usually revert after drug withdrawal. Nevertheless, some PS users suffer not just spontaneous relapse of the symptoms but also persistent psychosis in the absence of the drug. European data are not available for a large sample of the prevalence of consumption and its relation to the severity of symptoms in FEP. For this purpose, we described the differences in patterns of use of PS current and lifetime between FEP and healthy controls (HC) and their impact on the severity of the clinical symptomatology. Methods This analysis is based on data from the case-control study work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI), which took part between 2010 and 2015 across six countries. 901 FEP patients (M age=30.76, SD= 10.51; 38.1% females) and 1235 HC (M=36.15, SD=13.30; 53% females) were included in the present case-control study. Data related to amphetamine use were obtained through CEQEU-GEI. To assess psychopathology the OPerational CRITeria (OPCRIT) system was used. Group comparisons were made using t-test or Chi square, and ANCOVA or logistic regression controlling for age, sex and cannabis use when appropriate. Results FEP subjects displayed a trend for higher use of PS in the last year (B=-0.18, p= 0.055: 81 (9%) FEP and 56 (4.5%)) and a significant higher lifetime use (Chi2= 37.33, p<0.001: 196 (21.8%) FEP and 149 (12.1%) HC) than HC, but the frequency of PS use did not differ between groups. Lifetime FEP PS-users showed higher scores, thus is, more severe symptoms in the Mania (t= -3.69, p< 0.001) and the general (t= -3.47, p= 0.001) factors compared to FEP non-PS-users. Current FEP PS-users showed higher scores in the Mania factor (t= -2.52, p= 0.012) than FEP non-PS-users. However, these results were not significant when the comparisons were adjusted for age, sex and cannabis use. FEP PS-users displayed lower scores than the non-users in the negative factor both in the last year (t= 2.10, p= 0.038 and: F1,866= 4.27, p= 0.039 when adjusted for age, sex and cannabis use) and lifetime (t= 1.99, p= 0.046 and F1,869= 1.37, p= 0.243 when adjusted for age, sex and cannabis use). Discussion As previous studies, we confirmed the higher rates of PS use in FEP than HC in a European study with a big sample. PS use was related to severity of clinical symptomatology. PS-users presented more severe general symptoms and, specifically, in the mania factor. Otherwise, FEP non-PS-user showed higher scores in the negative factor which might be related to the usual course of the psychosis without exposure to PS use.

Download Full-text

QUALITY OF INDIVIDUAL AND GROUP LEVEL INTERVENTIONS FOR FIRST EPISODE PSYCHOSIS AT THE TERTIARY PSYCHIATRIC HOSPITAL IN UGANDA.

10.31234/osf.io/hrygs ◽

2020 ◽

Author(s):

Emmanuel Kiiza Mwesiga ◽

Noeline Nakasujja ◽

Lawrence Nankaba ◽

Juliet Nakku ◽

Seggane Musisi

Keyword(s):

Psychiatric Hospital ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

First Episode ◽

Group Level ◽

Group Interventions ◽

Episode Psychosis ◽

Essential Components ◽

The Individual

Introduction: Individual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear.Methods: The study was performed at Butabika National Psychiatric Teaching and referral hospital in Uganda. A retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was first performed to determine the proportion of participants who received the different essential components for individual and group level interventions. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-Episode Psychosis Services Fidelity Scale (FEPS-FS). The FEPS-FS assigns a grade of 1-5 on a Likert scale depending on the proportion of patients received the different components of the intervention. Results: The final sample included 156 first-episode psychosis patients. The median age was 27 years [IOR (24-36)] with 55% of participants of the female gender. 13 essential components across the individual and group interventions were assessed and their quality quantified. All 13 essential components had poor quality with the range of scores on the FEPS-FS of 1-3. Only one essential component assessed (use of single antipsychotics) had moderate quality.Discussion: Among current services at the National psychiatric hospital of Uganda, the essential for individual and group level interventions for psychotic disorders are of low quality. Further studies are required on how the quality of these interventions can be improved.

Download Full-text

Dysregulation of complement and coagulation pathways: emerging mechanisms in the development of psychosis

Molecular Psychiatry ◽

10.1038/s41380-021-01197-9 ◽

2021 ◽

Author(s):

Meike Heurich ◽

Melanie Föcking ◽

David Mongan ◽

Gerard Cagney ◽

David R. Cotter

Keyword(s):

High Risk ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Clinical Symptoms ◽

First Episode Psychosis ◽

Specific Protein ◽

First Episode ◽

Clinical High Risk ◽

Blood Proteins ◽

Episode Psychosis

AbstractEarly identification and treatment significantly improve clinical outcomes of psychotic disorders. Recent studies identified protein components of the complement and coagulation systems as key pathways implicated in psychosis. These specific protein alterations are integral to the inflammatory response and can begin years before the onset of clinical symptoms of psychotic disorder. Critically, they have recently been shown to predict the transition from clinical high risk to first-episode psychosis, enabling stratification of individuals who are most likely to transition to psychotic disorder from those who are not. This reinforces the concept that the psychosis spectrum is likely a central nervous system manifestation of systemic changes and highlights the need to investigate plasma proteins as diagnostic or prognostic biomarkers and pathophysiological mediators. In this review, we integrate evidence of alterations in proteins belonging to the complement and coagulation protein systems, including the coagulation, anticoagulation, and fibrinolytic pathways and their dysregulation in psychosis, into a consolidated mechanism that could be integral to the progression and manifestation of psychosis. We consolidate the findings of altered blood proteins relevant for progression to psychotic disorders, using data from longitudinal studies of the general population in addition to clinical high-risk (CHR) individuals transitioning to psychotic disorder. These are compared to markers identified from first-episode psychosis and schizophrenia as well as other psychosis spectrum disorders. We propose the novel hypothesis that altered complement and coagulation plasma levels enhance their pathways’ activating capacities, while low levels observed in key regulatory components contribute to excessive activation observed in patients. This hypothesis will require future testing through a range of experimental paradigms, and if upheld, complement and coagulation pathways or specific proteins could be useful diagnostic or prognostic tools and targets for early intervention and preventive strategies.

Download Full-text

Context-specific abnormalities of the central executive network in first-episode psychosis: relationship with cognition

Psychological Medicine ◽

10.1017/s0033291720004201 ◽

2020 ◽

pp. 1-10

Author(s):

Deepak K. Sarpal ◽

Goda Tarcijonas ◽

Finnegan J. Calabro ◽

William Foran ◽

Gretchen L. Haas ◽

...

Keyword(s):

Cognitive Control ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

First Episode ◽

Cognitive State ◽

Cognitive States ◽

Episode Psychosis ◽

Dorsolateral Prefrontal ◽

Parietal Lobule ◽

Context Specific

Abstract Background Cognitive impairments, which contribute to the profound functional deficits observed in psychotic disorders, have found to be associated with abnormalities in trial-level cognitive control. However, neural tasks operate within the context of sustained cognitive states, which can be assessed with ‘background connectivity’ following the removal of task effects. To date, little is known about the integrity of brain processes supporting the maintenance of a cognitive state in individuals with psychotic disorders. Thus, here we examine background connectivity during executive processing in a cohort of participants with first-episode psychosis (FEP). Methods The following fMRI study examined background connectivity of the dorsolateral prefrontal cortex (DLPFC), during working memory engagement in a group of 43 patients with FEP, relative to 35 healthy controls (HC). Findings were also examined in relation to measures of executive function. Results The FEP group relative to HC showed significantly lower background DLPFC connectivity with bilateral superior parietal lobule (SPL) and left inferior parietal lobule. Background connectivity between DLPFC and SPL was also positively associated with overall cognition across all subjects and in our FEP group. In comparison, resting-state frontoparietal connectivity did not differ between groups and was not significantly associated with overall cognition, suggesting that psychosis-related alterations in executive networks only emerged during states of goal-oriented behavior. Conclusions These results provide novel evidence indicating while frontoparietal connectivity at rest appears intact in psychosis, when engaged during a cognitive state, it is impaired possibly undermining cognitive control capacities in FEP.

Download Full-text

Treatment response after 6 and 26 weeks is related to baseline glutamate and GABA levels in antipsychotic-naïve patients with psychosis

Psychological Medicine ◽

10.1017/s0033291719002277 ◽

2019 ◽

Vol 50 (13) ◽

pp. 2182-2193 ◽

Cited By ~ 11

Author(s):

Kirsten B. Bojesen ◽

Bjørn H. Ebdrup ◽

Kasper Jessen ◽

Anne Sigvard ◽

Karen Tangmose ◽

...

Keyword(s):

Psychotic Disorders ◽

Poor Response ◽

First Episode Psychosis ◽

Anterior Cingulate ◽

First Episode ◽

Antipsychotic Treatment ◽

Resonance Spectroscopy ◽

Reference Levels ◽

Clinical Prognosis ◽

Episode Psychosis

AbstractBackgroundPoor response to dopaminergic antipsychotics constitutes a major challenge in the treatment of psychotic disorders and markers for non-response during first-episode are warranted. Previous studies have found increased levels of glutamate and γ-aminobutyric acid (GABA) in non-responding first-episode patients compared to responders, but it is unknown if non-responders can be identified using reference levels from healthy controls (HCs).MethodsThirty-nine antipsychotic-naïve patients with first-episode psychosis and 36 matched HCs underwent repeated assessments with the Positive and Negative Syndrome Scale and 3T magnetic resonance spectroscopy. Glutamate scaled to total creatine (/Cr) was measured in the anterior cingulate cortex (ACC) and left thalamus, and levels of GABA/Cr were measured in ACC. After 6 weeks, we re-examined 32 patients on aripiprazole monotherapy and 35 HCs, and after 26 weeks we re-examined 30 patients on naturalistic antipsychotic treatment and 32 HCs. The Andreasen criteria defined non-response.ResultsBefore treatment, thalamic glutamate/Cr was higher in the whole group of patients but levels normalized after treatment. ACC levels of glutamate/Cr and GABA/Cr were lower at all assessments and unaffected by treatment. When compared with HCs, non-responders at week 6 (19 patients) and week 26 (16 patients) had higher baseline glutamate/Cr in the thalamus. Moreover, non-responders at 26 weeks had lower baseline GABA/Cr in ACC. Baseline levels in responders and HCs did not differ.ConclusionGlutamatergic and GABAergic abnormalities in antipsychotic-naïve patients appear driven by non-responders to antipsychotic treatment. If replicated, normative reference levels for glutamate and GABA may aid estimation of clinical prognosis in first-episode psychosis patients.

Download Full-text