Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis

Objectives:To report the neuropsychiatric features and frequency of N-methyl-d-aspartate receptor (NMDAR) and other neuronal IgG antibodies in patients with first episode psychosis (FEP), and assess the performance of reported warning signs and criteria for autoimmune psychosis (AP).Methods:Prospective observational study of patients with FEP assessed for neuropsychiatric symptoms, serum and CSF neuronal antibodies (brain immunohistochemistry, cell-based assays, live neurons), and warning signs and criteria of AP. Previous autoimmune FEP series were reviewed.Findings:105 patients were included; median age 30 years (range 14-75), 44 (42%) female. None had neuronal antibodies. Two/105 (2%) had CSF pleocytosis, 4/100 (4%) brain MRI abnormalities, and 3/73 (4%) EEG alterations. Thirty-four (32%) and 39 (37%) patients fulfilled two sets of warning signs of AP, and 21 (20%) fulfilled criteria of possible or probable AP, yet none developed AP. The cause of FEP was psychiatric in 101 (96%) and non-psychiatric in 4 (4%). During this study, 3 patients with psychosis caused by anti-NMDAR encephalitis were transferred to our center; 2 did not meet criteria for possible AP. Of 1159 reported FEP patients, only 7 (1%) had CSF studies; 36 (3%) had serum NMDAR-antibodies (without definite diagnosis of AP), and 4 had CSF NMDAR-antibodies (3 classic anti-NMDAR encephalitis and 1 with isolated psychiatric features).Conclusions:NMDAR-antibodies were not found in patients with FEP unless they had anti-NMDAR encephalitis. Warning signs and criteria for AP have limited utility when neurological symptoms are absent or paraclinical tests are normal. A diagnostic algorithm for autoimmune FEP is provided.

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Cortical thickness and surface area correlates with cognitive dysfunction among first-episode psychosis patients

Psychological Medicine ◽

10.1017/s0033291716000684 ◽

2016 ◽

Vol 46 (10) ◽

pp. 2145-2155 ◽

Cited By ~ 8

Author(s):

L. Haring ◽

A. Müürsepp ◽

R. Mõttus ◽

P. Ilves ◽

K. Koch ◽

...

Keyword(s):

Structure Function ◽

Surface Area ◽

Cortical Thickness ◽

Brain Structure ◽

Brain Mri ◽

Brain Regions ◽

First Episode Psychosis ◽

First Episode ◽

Neurocognitive Performance ◽

Episode Psychosis

BackgroundIn studies using magnetic resonance imaging (MRI), some have reported specific brain structure–function relationships among first-episode psychosis (FEP) patients, but findings are inconsistent. We aimed to localize the brain regions where cortical thickness (CTh) and surface area (cortical area; CA) relate to neurocognition, by performing an MRI on participants and measuring their neurocognitive performance using the Cambridge Neuropsychological Test Automated Battery (CANTAB), in order to investigate any significant differences between FEP patients and control subjects (CS).MethodExploration of potential correlations between specific cognitive functions and brain structure was performed using CANTAB computer-based neurocognitive testing and a vertex-by-vertex whole-brain MRI analysis of 63 FEP patients and 30 CS.ResultsSignificant correlations were found between cortical parameters in the frontal, temporal, cingular and occipital brain regions and performance in set-shifting, working memory manipulation, strategy usage and sustained attention tests. These correlations were significantly dissimilar between FEP patients and CS.ConclusionsSignificant correlations between CTh and CA with neurocognitive performance were localized in brain areas known to be involved in cognition. The results also suggested a disrupted structure–function relationship in FEP patients compared with CS.

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S10. SCREENING FOR ANTI-NMDAR ANTIBODIES AMONGST PATIENTS WITH FIRST EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.076 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S33-S34

Author(s):

Levente Herman ◽

János Réthelyi ◽

Réka Zsigmond

Keyword(s):

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Antibody Activity ◽

Specific Method ◽

Healthy Controls ◽

Serum Samples ◽

Nmdar Encephalitis ◽

Episode Psychosis ◽

Significant Difference

Abstract Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune limbic encephalitis, where psychiatric symptoms are often dominant in the initial phase. These patients are usually treated in psychiatric wards, due to first episode psychosis (FEP). The antibodies responsible for the symptoms, can be identified from the patients’ sera. During the past decade multiple studies had been launched to investigate whether anti-NMDAR antibodies were present in the sera of patients, treated with the diagnosis of schizophrenia, although results have not confirmed this hypothesis. It is possible, however, that autoimmune antibodies, which are not yet known, play a role in FEP, similarly to anti-NMDAR antibodies, therefore there is a rationale behind screening for other antibodies among these patients. The aim of our study is to screen patients with FEP for anti-NMDAR antibodies. We also would like to check whether there are any other potentially pathogenic antibodies, which are not yet known, but could be responsible for psychotic symptoms. Methods So far 26 patients have been recruited with FEP (with symptoms of schizophrenia), the total number of healthy controls involved in the study is currently 21. All of the patients were treated at Semmelweis University, Department of Psychiatry. Patients with affective psychosis, drug-related psychotic disorder and patients with clear signs of encephalitis had been excluded from the study. The patients’ blood samples were centrifuged, after which serum was separated from whole blood. Serum samples were then tested with EUROIMMUN immune fluorescent assays for anti-NMDAR antibodies. A different, non-specific method was also used to test anti-brain antibody activity on monkey-cerebellum and rat-hippocampus to show possibly relevant (but not yet known) antibodies. All of the immunological laboratory investigations were done at Semmelweis University, Central Laboratory and immunfluorescent slides were evaluated by an expert in this field. Further differentiation of this non-specific activity was not part of our current study. All of the samples had been freezed on -80 degrees Celsius and are stored for possible further investigations in the future. IL-6 levels will be checked in the next phase of our study. Results None of the samples from the 26 patients, nor any of the samples collected from healthy controls contained anti-NMDAR antibodies. However it should be noted that during the period of the study 3 patients were diagnosed with anti-NMDAR encephalitis, but as it was described earlier these cases had not been included in our study, because we focused on patients with pure psychotic symptoms. 11 of the patients’ serum showed positive reaction of the neuroendothelium (6 strong, 5 moderate), whereas only 4 of the samples collected from healthy controls showed similar pattern (all of them showed moderate or mild activity). These results suggest that there is a significant difference between the groups, however we will need to increase our sample size to verify these findings. There were other non-specific reactions in both groups in low numbers. Discussion None of the serum samples of the 26 patients proved positive for anti-NMDAR antibodies, which is in agreement with previous studies in the literature. However, a higher proportion of samples form patients showed activity on the neuroendothelium of non-specific immune fluorescent assays compared to healthy controls. We plan to increase our samples sizes in the near future and check the serum samples for interleukins and cytokines.

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Neurocognitive status in different stages of psychosis: Changes from the first episode psychosis to remission

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2109 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S187-S187

Author(s):

D. Bošnjak ◽

P. Makarić ◽

I. Kekin ◽

T. Sabo ◽

M. Živković ◽

...

Keyword(s):

Acute Phase ◽

Neuropsychiatric Symptoms ◽

Verbal Learning ◽

First Episode Psychosis ◽

Neurocognitive Impairment ◽

University Hospital ◽

First Episode ◽

Psychotic Episode ◽

Learning Abilities ◽

Episode Psychosis

IntroductionNeurocognitive impairment in schizophrenia is associated with functional disability and poorer quality of life, and is the most resistant of all schizophrenia symptoms to current psychopharmacotherapy.ObjectivesTo compare the differences in neurocognitive status during the acute phase of first psychotic episode and stable symptomatic remission.AimsTo investigate the pattern of neurocognitive impairment in patients with first episode psychosis during acute phase and stable remission phase.MethodsWe performed a longitudinal study, including 150 patients with first episode of psychosis at two time points: during their hospitalization at Zagreb university hospital centre or university psychiatric hospital Vrapče, at acute phase of illness and after 12–18 months, during stable remission. Assessment included detailed clinical interview, clinical rating of neuropsychiatric symptoms using standardized psychiatric scales, self-assessment scales and comprehensive neurocognitive testing.ResultsWhile our preliminary results (n = 40) showed statistically significant improvement in various neurocognitive domains, including visuo-learning abilities, verbal learning, executive functions, attention and processing speed, initial impairment in semantic and phonetic fluency observed in acute psychosis remained unchanged in remission as well.ConclusionsAlthough our results showed improvement in most of cognitive domains during time, language abilities remained unchanged. This further confirms the hypothesis that language impairment is a trait marker of psychotic disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Jumping to social conclusions?: The implications of early and uninformed social judgements in first episode psychosis.

Journal of Abnormal Psychology ◽

10.1037/abn0000490 ◽

2020 ◽

Vol 129 (1) ◽

pp. 131-141

Author(s):

Michael J. Grossman ◽

Christopher R. Bowie

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis

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Gender differences in response to metacognitive training in people with first-episode psychosis.

Journal of Consulting and Clinical Psychology ◽

10.1037/ccp0000468 ◽

2020 ◽

Vol 88 (6) ◽

pp. 516-525 ◽

Cited By ~ 1

Author(s):

Miriam Salas-Sender ◽

Raquel López-Carrilero ◽

Ana Barajas ◽

Esther Lorente-Rovira ◽

Esther Pousa ◽

...

Keyword(s):

Gender Differences ◽

First Episode Psychosis ◽

First Episode ◽

Metacognitive Training ◽

Episode Psychosis

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Cognitive clusters in first-episode psychosis: Overlap with healthy controls and relationship to concurrent and prospective symptoms and functioning.

Neuropsychology ◽

10.1037/neu0000367 ◽

2017 ◽

Vol 31 (7) ◽

pp. 787-797 ◽

Cited By ~ 18

Author(s):

Jacqueline Uren ◽

Susan M. Cotton ◽

Eoin Killackey ◽

Michael M. Saling ◽

Kelly Allott

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Healthy Controls ◽

Episode Psychosis

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Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

Die Psychiatrie ◽

10.1055/s-0038-1672286 ◽

2016 ◽

Vol 13 (03) ◽

pp. 152-157

Author(s):

A. O. Berg ◽

K. Leopold ◽

S. Zarafonitis-Müller ◽

M. Nerhus ◽

L. H. Stouten ◽

...

Keyword(s):

Mental Health ◽

Help Seeking ◽

Service Use ◽

First Episode Psychosis ◽

Pathways To Care ◽

First Episode ◽

Factors Influencing ◽

Increased Risk ◽

Episode Psychosis ◽

The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

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