Abstract
BackgroundSome studies of first psychotic episodes have suggested the association between childhood trauma, such as sexual abuse, and the risk of hallucinations.1 Furthermore, other studies indicated that environment can alter the phenomenological presentation of first psychotic episodes.2However, there are no studies about the association between hallucinations in first psychotic episodes and the prognosis of the disease. This is the main objective of this study. We also compared the phenomenological differences between hallucinations in first episode psychosis and persistent hallucinations in patients with chronic psychosis.MethodsNaturalistic, longitudinal follow-up study in a sample of 173 patients of first psychotic episode attending public mental health service in Area 5 of Valencia region (Spain) in a period between 2010–2017.We compared first-episode patients with hallucinations (N=38) with two samples: A) First-episode patients without hallucinations (N=137). B) Chronic patients with persistent hallucinations (N=45) from a previous study.3In the first comparison we used the following variables: sociodemographic data, risk factors (such as cannabis consume and immigration), psychiatric pathology (CIE-10), psicopathology (including clinical scales GAF, CGI and PANSS), number of emercengy visits and number of hospitalization after the first psychotic episode.In the second one, we use the PSYRATS scale to compare both groups.ResultsIn the first comparison, First Episode Psychotic patients with and without hallucinations,we only found significant differences in the number of hospital income, with more hospitalizations in the non hallucinating group (P= 0.001).In the second comparison, First Episode Hallucinations versus Chronic Persistent Hallucinations, significant differences were only found in the duration of the hallucinations, which was much higher in chronic persistent hallucinations group (P= 0.001)DiscussionConsequently, it seems that first psychotic episode patients without hallucinations have more hospitalizations than first-episode patients with hallucinations. Moreover, we can conclude that the duration of voices is higher in chronic patients with persistent hallucinations than in first psychotic episode hallucinations.Both results have practical implications in the prognostic importance of hallucinations in first psychotic episodes.
Highlights
The predictive value of psychiatric diagnosis is inadequate compared to other medical fields
Machine learning methods hold promise for making more effective, personalized treatment decisions to improve outcomes and reduce the cost of care. The use of these techniques remains nascent in psychiatry, and relatively little research has focused on the extent to which models derived in one sample make accurate predictions in unseen samples
Statistical research indicates that model performance in unseen samples is generally lower than performance in the derivation sample
Summary
Robust evidence has demonstrated that cannabis use increases the risk to develop psychotic disorders. A limited number of studies have investigated if and how cannabis use influences psychopathology profiles at first episode psychosis (FEP). Based on the evidence that dopamine dysfunction contributes to explain positive symptoms in psychosis, and that the main cannabis’ psychoactive component, Δ9-Tetrahydrocannabinol (THC), modulates the dopamine system, we hypothesise that: 1) positive symptoms at FEP are more common among psychotic patients who used cannabis compared with never users; 2) this association is a dose-response relationship. The Cannabis Experience Questionnaire modified version (CEQmv) was administered to collect information on cannabis, and different patterns of use were computed based on frequency of consumption and type of cannabis, as a proxy of exposure to THC. Fifty-five percent of cannabis users consumed mostly high-potency cannabis, and 46% showed a daily frequency. Users of high-potency cannabis presented with the strongest
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