Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.

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4.3 ENHANCING SOCIAL FUNCTIONING AND LONG-TERM RECOVERY IN YOUNG PEOPLE WITH FIRST EPISODE PSYCHOSIS (FEP) AND YOUNG PEOPLE AT ULTRA HIGH RISK (UHR) FOR PSYCHOSIS: A NOVEL ONLINE SOCIAL THERAPY APPROACH

Schizophrenia Bulletin ◽

10.1093/schbul/sby014.010 ◽

2018 ◽

Vol 44 (suppl_1) ◽

pp. S4-S5 ◽

Cited By ~ 2

Author(s):

Mario Alvarez-Jimenez ◽

John F Gleeson ◽

Simon Rice ◽

Sarah Bendall ◽

Simon D’Alfonso ◽

...

Keyword(s):

High Risk ◽

Young People ◽

Social Functioning ◽

First Episode Psychosis ◽

First Episode ◽

Social Therapy ◽

Therapy Approach ◽

Episode Psychosis ◽

Ultra High Risk

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Formal thought disorder in people at ultra-high risk of psychosis

BJPsych Open ◽

10.1192/bjpo.bp.116.004408 ◽

2017 ◽

Vol 3 (4) ◽

pp. 165-170 ◽

Cited By ~ 8

Author(s):

Arsime Demjaha ◽

Sara Weinstein ◽

Daniel Stahl ◽

Fern Day ◽

Lucia Valmaggia ◽

...

Keyword(s):

High Risk ◽

First Episode Psychosis ◽

High Risk Group ◽

Thought Disorder ◽

Psychotic Symptoms ◽

First Episode ◽

Control Group ◽

Formal Thought Disorder ◽

Episode Psychosis ◽

Ultra High Risk

BackgroundFormal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear.AimsExamine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis.MethodThe Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis.ResultsTLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04).ConclusionsTLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group.

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OBSESSIVE COMPULSIVE SYMPTOMS IN FIRST EPISODE PSYCHOSIS AND IN SUBJECTS AT ULTRA HIGH RISK TO DEVELOP PSYCHOSIS; ONSET AND RELATIONSHIP TO PSYCHOTIC SYMPTOMS

Schizophrenia Research ◽

10.1016/j.schres.2010.02.852 ◽

2010 ◽

Vol 117 (2-3) ◽

pp. 457

Author(s):

Bouke Sterk ◽

Kay Landreijer ◽

Don Linszen ◽

Lieuwe de Haan

Keyword(s):

High Risk ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Obsessive Compulsive ◽

Obsessive Compulsive Symptoms ◽

Episode Psychosis ◽

Ultra High Risk

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Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders

Psychological Medicine ◽

10.1017/s0033291716000325 ◽

2016 ◽

Vol 46 (9) ◽

pp. 1839-1851 ◽

Cited By ~ 12

Author(s):

H. K. Ising ◽

S. Ruhrmann ◽

N. A. F. M. Burger ◽

J. Rietdijk ◽

S. Dragt ◽

...

Keyword(s):

High Risk ◽

Social Functioning ◽

Prognostic Model ◽

Prognostic Index ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Risk Class ◽

Episode Psychosis ◽

Ultra High Risk

BackgroundCurrent ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders.MethodBaseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14–35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses.ResultsAt 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56–7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21–6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14–6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01–1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00–1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class.ConclusionsPredicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.

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Obsessive–Compulsive Symptoms in First Episode Psychosis and in Subjects at Ultra High Risk for Developing Psychosis; Onset and Relationship to Psychotic Symptoms

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048674.2010.533363 ◽

2011 ◽

Vol 45 (5) ◽

pp. 400-406 ◽

Cited By ~ 25

Author(s):

Bouke Sterk ◽

Kay Lankreijer ◽

Don H Linszen ◽

Lieuwe de Haan

Keyword(s):

High Risk ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Obsessive Compulsive ◽

Obsessive Compulsive Symptoms ◽

Episode Psychosis ◽

Ultra High Risk

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S150. EMOTIONAL BEHAVIOUR IN HIGH-RISK AND FIRST-EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.216 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S93-S93

Author(s):

Irina Falkenberg ◽

Huai-Hsuan Tseng ◽

Gemma Modinos ◽

Barbara Wild ◽

Philip McGuire ◽

...

Keyword(s):

High Risk ◽

Emotion Recognition ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

First Episode ◽

Healthy Controls ◽

Emotional Faces ◽

Facial Movements ◽

Episode Psychosis ◽

Ultra High Risk

Abstract Background Studies indicate that people with schizophrenia and first-episode psychosis experience deficits in their ability to accurately detect and display emotions through facial expressions, and that functioning and symptoms are associated with these deficits. This study aims to examine how emotion recognition and facial emotion expression are related to functioning and symptoms in a sample of individuals at ultra-high risk, first-episode psychosis and healthy controls. Methods During fMRI, we combined the presentation of emotional faces with the instruction to react with facial movements predetermined and assigned. 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs) were examined while viewing happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects’ facial movements were recorded with an MR-compatible video camera. Results Neurofunctional and behavioral response to emotional faces were measured. Analyses have only recently commenced and are ongoing. Full results of the clinical and functional impact of behavioral and neuroimaging results will be presented at the meeting. Discussion Increased knowledge about abnormalities in emotion recognition and behaviour as well as their neural correlates and their impact on clinical measures and functional outcome can inform the development of novel treatment approaches to improve social skills early in the course of schizophrenia and psychotic disorders.

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Circulating lipids associate with future weight gain in individuals with an at-risk mental state and in first-episode psychosis

10.1101/2020.01.30.20019711 ◽

2020 ◽

Author(s):

Santosh Lamichhane ◽

Alex M. Dickens ◽

Partho Sen ◽

Heikki Laurikainen ◽

Jaana Suvisaari ◽

...

Keyword(s):

At Risk ◽

Weight Gain ◽

High Risk ◽

Psychotic Disorders ◽

First Episode Psychosis ◽

Molecular Signature ◽

First Episode ◽

Baseline Serum ◽

Average Life Span ◽

Episode Psychosis

AbstractPatients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic co-morbidities. Identification of individuals with psychotic disorders with a high risk of rapid weight gain, and the associated development of metabolic complications, is an unmet need as regards public health. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 controls (CTR), 44 first-episode psychosis (FEP) patients and 22 individuals at clinical-high-risk (CHR) for psychosis, from two study centers (Turku/Finland and London/UK). Baseline serum samples were analyzed by lipidomics, while body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols with low double bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of two triacylglycerols (TG(48:0) and TG(45:0)), was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals, and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic co-morbidities.

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Dilemmas in the treatment of early-onset first-episode psychosis

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125318765725 ◽

2018 ◽

Vol 8 (8) ◽

pp. 231-239 ◽

Cited By ~ 3

Author(s):

Daniel Hayes ◽

Marinos Kyriakopoulos

Keyword(s):

Young People ◽

Early Onset ◽

Clinical Decision Making ◽

Clinical Decision ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Close Monitoring ◽

Optimal Outcomes ◽

Episode Psychosis

Early-onset first-episode psychosis (EOP) is a severe mental disorder that can pose a number of challenges to clinicians, young people and their families. Its assessment and differentiation from other neurodevelopmental and mental health conditions may at times be difficult, its treatment may not always lead to optimal outcomes and can be associated with significant side effects, and its long-term course and prognosis seem to be less favourable compared with the adult-onset disorder. In this paper, we discuss some dilemmas associated with the evaluation and management of EOP and propose approaches that can be used in the clinical decision-making process. A detailed and well-informed assessment of psychotic symptoms and comorbidities, a systematic approach to treatment with minimum possible medication doses and close monitoring of its effectiveness and adverse effects, and multidimensional interventions taking into consideration risks and expectations associated with EOP, are paramount in the achievement of the most favourable outcomes for affected children and young people.

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