Short-term functional outcome in psychotic patients: results of the Turku early psychosis study (TEPS)

Background Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). Methods Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. Results During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. Conclusions In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.

Evaluación de las experiencias de tipo psicótico en adolescentes españoles: Baremación del Prodromal Questionnaire-Brief (PQ-B)

Assessment of psychotic-like experiences in Spanish adolescents: Normative data of the Prodromal Questionnaire-Brief (PQ-B)Abstract: The main objective of this work was to establish the normative data of the Prodromal Questionnaire-Brief (PQ-B) in a representative sample of Spanish adolescents. A total of 3,441 adolescents (M = 15.91 years, SD = 1.33 years) were selected by sampling stratified by clusters. The results showed that the point prevalence of psychotic-like experiences varied between 12% and 48%. An 82.9% of the sample reported at least one attenuated psychotic-like experience. Percentile norms were made for the total score and according to gender. The PQ-B is a brief, simple, useful measuring instrument with adequate psychometric properties for the assessment of subclinical psychosis phenotype in the Spanish adolescent population. It is transcendental that the psychologists have adequate tools for a reliable and valid assessment of this phenomenon in order to make informed decisions and optimize educational and socio-health resources.Keywords: Psychosis; psychotic experiences; adolescents; youth; validation; norms.Resumen: El principal objetivo de este trabajo fue baremar el Cuestionario de Pródromos-Breve (Prodromal Questionnaire- Brief, PQ-B) a partir de una muestra representativa de adolescentes españoles. Un total de 3441 adolescentes (M = 15.91 años, DT = 1.33 años) fueron seleccionados mediante muestreo estratificado por conglomerados. Los resultados mostraron que la prevalencia puntual de experiencias psicóticas osciló entre el 12% y el 48%. Un 82.9% de la muestra refirió al menos una experiencia psicótica atenuada. Los baremos tipo percentiles se confeccionaron para la puntuación total y en función del género. El PQ-B es un instrumento de medida breve, sencillo, útil y con adecuadas propiedades psicométricas para la valoración de las experiencias de tipo psicótico en población adolescente española. Es transcendental que el profesional de la psicología disponga de adecuadas herramientas para la evaluación fiable y válida de este fenómeno de cara a tomar decisiones fundamentadas y optimizar los recursos educativos y socio-sanitarios.Palabras clave: Psicosis; experiencias de tipo psicótico; adolescentes; jóvenes; validación; baremación.

Psychotic Experiences Are Associated With Paternal Age But Not With Delayed Fatherhood in a Large, Multinational, Community Sample

Advanced paternal age has been consistently associated with an increased risk of schizophrenia. It is less known if such an association also exists with subclinical/attenuated forms of psychosis. Additionally, it has been suggested that it is not paternal age per se, but rather delayed fatherhood, as a marker of a genetic liability of psychosis, that is the cause of the association. The aim of the current study was to examine whether paternal age and/or delayed fatherhood (paternity age) predict self-reported positive, negative, and/or depressive dimensions of psychosis in a large sample from the general population. The sample (N = 1465) was composed of control subjects from the 6 countries participating in the European Union Gene-Environment Interaction study. The CAPE, a self-report questionnaire, was used to measure dimensions of subclinical psychosis. Paternal age at the time of respondents’ birth and age of paternity were assessed by self-report. We assessed the influence of the variables of interest (paternal age or paternity age) on CAPE scores after adjusting for potential confounders (age, gender, and ethnicity). Paternal age was positively associated with the positive dimension of the CAPE. By contrast, paternity age was not associated with any of the psychosis dimensions assessed by the CAPE. Thus, our results do not support the idea that delayed fatherhood explains the association between age of paternity and psychosis risk. Furthermore, our results provide arguments for the hypothesis of an etiologic continuum of psychosis.

Subclinical psychosis in adult migrants and ethnic minorities: systematic review and meta-analysis

BackgroundIt is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits).AimsWe aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis.MethodWe conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates.ResultsWe included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries.ConclusionsMore generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status.Declaration of interestNone.