Early Psychosis Patients Research Articles

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

Although social cognition is now understood to be a key determinant of functional outcome in psychosis, the factors associated with impaired performance on tasks of social cognition still remain unclear. Jumping to conclusions (JTC) is a cognitive bias that is commonly observed in psychosis, and features of this bias may be implicated in the accurate processing of social information. In the present study, a sample of patients in the early stages of psychosis (n = 35) and demographically matched community controls (n = 35) were presented with a modified version of the Interpersonal Perception Task in which video clips of naturalistic social scenarios were paused at 3 predetermined time points. All participants were prompted to answer a series of questions during these time points to examine the processes by which individuals arrive at social judgments. A JTC response pattern was defined as endorsing overconfident responses and a low need for additional social information at the beginning time points of the video clips when limited social cues were available. Compared with controls, a greater proportion of patients exhibited a response pattern suggestive of JTC, which was also strongly associated with poorer overall task accuracy, regardless of group status. Results from this study provide evidence that overconfidence in premature and uninformed social judgments has direct consequences for the accurate processing of social information. Furthermore, this response pattern, which was more characteristic of early psychosis patients, may represent JTC in real-world social contexts, and could be an important therapeutic target for social cognition in the early stages of illness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial

BackgroundPatients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. MethodsA total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. ResultsThere were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). ConclusionsWe did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis.ClinicalTrials.gov Identifier: NCT01511406.

Sleep spindle and slow wave abnormalities in schizophrenia and other psychotic disorders: Recent findings and future directions

Sleep spindles and slow waves are the two main oscillatory activities occurring during NREM sleep. Slow waves are ∼1 Hz, high amplitude, negative-positive deflections that are primarily generated and coordinated within the cortex, whereas sleep spindles are 12–16 Hz, waxing and waning oscillations that are initiated within the thalamus and regulated by thalamo-cortical circuits. In healthy subjects, these oscillations are thought to be responsible for the restorative aspects of sleep and have been increasingly shown to be involved in learning, memory and plasticity. Furthermore, deficits in sleep spindles and, to lesser extent, slow waves have been reported in both chronic schizophrenia (SCZ) and early course psychosis patients. In this article, we will first describe sleep spindle and slow wave characteristics, including their putative functional roles in the healthy brain. We will then review electrophysiological, genetic, and cognitive studies demonstrating spindle and slow wave impairments in SCZ and other psychotic disorders, with particularly emphasis on recent findings in early course patients. Finally, we will discuss how future work, including sleep studies in individuals at clinical high risk for psychosis, may help position spindles and slow waves as candidate biomarkers, as well as novel treatment targets, for SCZ and related psychotic disorders.

Hyperactivity and Reduced Activation of Anterior Hippocampus in Early Psychosis.

In schizophrenia, the anterior hippocampus is hyperactive and shows reduced task-related recruitment, but the relationship between these two findings is unclear. The authors tested the hypothesis that hyperactivity impairs recruitment of the anterior hippocampus during scene processing. Functional MRI data from 45 early-psychosis patients and 35 demographically matched healthy control subjects were analyzed using a block-design 1-back scene-processing task. Hippocampal activation in response to scenes and faces compared with scrambled images was measured. In a subset of 20 early-psychosis patients and 31 healthy control subjects, baseline hippocampal activity using cerebral blood volume (CBV) mapping was measured. Correlation analyses were used to examine the association between baseline hippocampal activity and task-related hippocampal activation. Activation of the anterior hippocampus was significantly reduced and CBV in the anterior hippocampus was significantly increased in the early stages of psychosis. Increased CBV in early-psychosis patients was inversely correlated with task-related activation during scene processing in the anterior hippocampus. Anterior hippocampal hyperactivity in early-psychosis patients appears to limit effective recruitment of this region during task performance. These findings provide novel support for the anterior hippocampus as a therapeutic target in the treatment of cognitive deficits in psychosis.

A retrospective study of the role of long-acting injectable antipsychotics in preventing rehospitalization in early psychosis with cannabis use

BackgroundDespite compelling evidence that cannabis use is associated with neurocognitive deficits, loss of cerebral gray matter, relapse and rehospitalization, a substantial number of individuals with early psychosis continue to use recreational or medicinal marijuana. One identified pathway to relapse is non-adherence. Recurrent relapses modify the trajectory of illness and culminate in long-term disability. Long-acting antipsychotic medications are superior to oral equivalents in preventing relapse. PurposeThe current paper sought to examine the role of long-acting antipsychotics in preventing relapse in cannabis using early psychosis patients. MethodsThe present retrospective study, which was based in an early psychosis program in mid-Michigan, examined the association between patient perceptions of antipsychotic medication and subsequent rehospitalization, among cannabis users (n = 24) and non-users (n = 27). Patient perceptions of antipsychotic medications were assessed using a single question from the NAVIGATE Patient Self-Rating Form: “Between now and your next visit, do you think we should keep your medication the same, or consider changing the medication?”. ResultsCannabis users were substantially more likely to report dissatisfaction with antipsychotic medication (Pearson Chi-square 9.67, df = 1.0, p < 0.002), and more likely to experience rehospitalization (Pearson Chi-square 4.40, df = 1.0, p = 0.036). Those maintained on long-acting injectable antipsychotic medications were rehospitalized less frequently when compared to others maintained on oral formulations (Pearson Chi-square 4.61, df = 1.0, p = 0.032). ConclusionsDissatisfaction with antipsychotics may predict non-adherence and subsequent rehospitalization in early psychosis patients who use cannabis. Long-acting antipsychotics may prevent rehospitalization.

Neural correlates of positive and negative symptoms through the illness course: an fMRI study in early psychosis and chronic schizophrenia

Psychotic illness is associated with cognitive control deficits and abnormal recruitment of neural circuits subserving cognitive control. It is unclear to what extent this dysfunction underlies the development and/or maintenance of positive and negative symptoms typically observed in schizophrenia. In this study we compared fMRI activation on a standard Stroop task and its relationship with positive and negative symptoms in early psychosis (EP, N = 88) and chronic schizophrenia (CHR-SZ, N = 38) patients. CHR-SZ patients showed reduced frontal, striatal, and parietal activation across incongruent and congruent trials compared to EP patients. Higher positive symptom severity was associated with reduced activation across both trial types in supplementary motor area (SMA), middle temporal gyrus and cerebellum in EP, but not CHR-SZ patients. Higher negative symptom severity was associated with reduced cerebellar activation in EP, but not in CHR-SZ patients. A negative correlation between negative symptoms and activation in SMA and precentral gyrus was observed in EP patients and in CHR-SZ patients. The results suggest that the neural substrate of positive symptoms changes with illness chronicity, and that cognitive control related neural circuits may be most relevant in the initial development phase of positive symptoms. These findings also highlight a changing role for the cerebellum in the development and later maintenance of both positive and negative symptoms.

N-Acetyl-Cysteine Supplementation Improves Functional Connectivity Within the Cingulate Cortex in Early Psychosis: A Pilot Study.

BackgroundThere is increasing evidence that redox dysregulation, which can lead to oxidative stress and eventually to impairment of oligodendrocytes and parvalbumin interneurons, may underlie brain connectivity alterations in schizophrenia. Accordingly, we previously reported that levels of brain antioxidant glutathione in the medial prefrontal cortex were positively correlated with increased functional connectivity along the cingulum bundle in healthy controls but not in early psychosis patients. In a recent randomized controlled trial, we observed that 6-month supplementation with a glutathione precursor, N-acetyl-cysteine, increased brain glutathione levels and improved symptomatic expression and processing speed.MethodsWe investigated the effect of N-acetyl-cysteine supplementation on the functional connectivity between regions of the cingulate cortex, which have been linked to positive symptoms and processing speed decline. In this pilot study, we compared structural connectivity and resting-state functional connectivity between early psychosis patients treated with 6-month N-acetyl-cysteine (n = 9) or placebo (n = 11) supplementation with sex- and age-matched healthy control subjects (n = 74).ResultsWe observed that 6-month N-acetyl-cysteine supplementation increases functional connectivity along the cingulum and more precisely between the caudal anterior part and the isthmus of the cingulate cortex. These functional changes can be partially explained by an increase of centrality of these regions in the functional brain network.ConclusionsN-acetyl-cysteine supplementation has a positive effect on functional connectivity within the cingulate cortex in early psychosis patients. To our knowledge, this is the first study suggesting that increased brain glutathione levels via N-acetyl-cysteine supplementation may improve brain functional connectivity.

City Avoidance in the Early Phase of Psychosis: A Neglected Domain of Assessment and a Potential Target for Recovery Strategies.

Background: A considerable amount of research has explored the link between living in an urban environment during childhood and the increased risk to develop psychosis. However, the urban milieu is more than a risk factor as it is also a place for socialization and enrichment. The aims of the current study were to explore, in a large sample of early psychosis (EP) patients, their pattern of use of the city, their perception when exposed to various critical stressors, and their sensitivity to diverse forms of stimuli. Methods: We sent a questionnaire (based on previous work conducted in a group of patients, including video-recorded walk-along in the city and a literature review) to 305 EP patients and to 220 medical students. Results: Response rate in patients was low (38%). City avoidance and negative perceptions towards the urban environment increased in patients after onset of psychosis. Patients’ tendency to avoid city center correlates with both problematic social interactions and stimuli perceived as unpleasant. Patients seemed less likely to enjoy urban spaces considered as relaxing, suggesting a lower capacity to benefit from positive aspects of this environment. Conclusions: The development of psychosis influences the way EP patients perceive the city and their capacity to feel at ease in the urban environment, leading to a high rate of city avoidance. Considering the possible influence of city avoidance on social relations and the recovery process, the development of strategies to help patients in this regard may have a significant effect on their recovery process.

Global and Specific Profiles of Executive Functioning in Prodromal and Early Psychosis.

Objective: Numerous reports on neurocognitive functioning deficits in individuals at clinical high risk (CHR) and first-episode psychosis (FEP) patients suggest particular deficits in executive functioning (EF). However, to date, most of the studies have administered a single or a few EF tests to participants, and few investigations have examined the different components of EF to identify specific subdomains of relative strength and weakness. Method: Forty CHR subjects, 85 FEP patients, and 85 healthy controls (HCs) were assessed with a neuropsychological battery to elucidate the profiles of EF in the subdomains of shift, attention, fluency, and planning. Results: In the subdomains of shift, attention, and fluency, CHR individuals and FEP patients showed deficits compared to HC. The post hoc analysis revealed that CHR individuals had comparable attention shifting and phonemic fluency compared to FEP. CHR showed intermediate deficits between FEP and HCs in spatial working memory and semantic fluency, and the largest effect size was observed in semantic fluency both for CHR and FEP. Conclusion: Overall, the findings of this study, in addition to providing detailed profiles of EF in prodromal and early psychosis patients, highlight the informative value of the specific subdomains of semantic fluency and spatial working memory.

"They Are Not Hard-to-Reach Clients. We Have Just Got Hard-to-Reach Services." Staff Views of Digital Health Tools in Specialist Mental Health Services.

Background: Digital health products designed to help people with severe mental health problems appear to be feasible, acceptable, and efficacious. The challenge facing the digital mental health field is implementing digital tools in routine service delivery. To date, there has been a paucity of qualitative research exploring staff views of digital health solutions in the context of mental healthcare. Engaging and involving frontline staff in the design and rollout of new technology to improve utilization is imperative for successful uptake and adoption of digital tools. The aim of the current study is to explore frontline staff views regarding the utility and appropriateness of using digital tools in the healthcare pathway for people accessing specialist secondary care mental health services. Method: Qualitative study using framework analysis was used with 48 mental health staff working in early intervention for psychosis services. Six groups comprising 5–10 early intervention service staff members in each group were conducted across the Northwest of England. Robust measures were used to develop a stable framework, including member checking, triangulation, and consensus meetings. Results: Three themes were identified a priori: i) perceived barriers to adopting smartphone apps for early psychosis; ii) acceptability of digital health tools for early psychosis patients; and iii) data security, safety, and risk. Alongside exploring the a priori topics, one theme was generated a posteriori: iv) relationships. Conclusions: Staff working in specialist early intervention for psychosis services found digital tools on the whole acceptable in mental health service provision, but raised a number of concerns that will likely affect implementation of such systems into routine service delivery and practice. Thirteen recommendations are made in this paper as a result of the themes generated in these data. Implementing of digital systems needs to be simple and uncomplicated and improve clinical workflows for staff rather than hinder and increase clinical workflows. Furthermore, organizational support with a clear plan for implementing technological innovations is required for successful adoption of digital systems. Consideration of staff views around digital systems is important if successful adoption and implementation of such systems are to occur.Clinical Trial Registration: http://www.isrctn.com, identifier ISRCTN34966555.

233. Anterior Hippocampal Hyperactivity Limits fMRI Activation During Scene Processing in Early Psychosis

Extant data provide strong evidence for hippocampal hyperactivity in schizophrenia. We have found that volume deficits in early psychosis patients are more prominent in the anterior hippocampus. The origin of functional abnormalities along the hippocampal long axis is unclear. Models of hippocampal function have highlighted a role for the anterior hippocampus in scene processing and construction. Here we test the hypothesis that anterior hippocampal hyperactivity impairs the recruitment of this region during a cognitive task.

T184. Anterior Hippocampal Hyperactivity Limits fMRI Activation During Scene Processing in Early Psychosis

Extant data provide strong evidence for hippocampal hyperactivity in schizophrenia. We have found that volume deficits in early psychosis patients are more prominent in the anterior hippocampus. The origin of functional abnormalities along the hippocampal long axis is unclear. Models of hippocampal function have highlighted a role for the anterior hippocampus in scene processing and construction. Here we test the hypothesis that anterior hippocampal hyperactivity impairs the recruitment of this region during a cognitive task.

29.3 TOPOLOGICAL ANALYSIS ENABLES PREDICTION OF FUNCTIONAL AND SOCIAL OUTCOMES IN EARLY PSYCHOSIS

Abstract Background Predicting functional outcome is a major challenge in service care of early psychosis patients (EPP). We investigated clinical and metabolic features that enable objective assessment of the risk of poor functional outcomes in early psychosis patients (EPP), using state-of-the-art topological data analysis (TDA). The guiding philosophy of TDA is that the shape of large data sets, encoded by a mathematical signature, should reveal important relations among the data points. Our primary TDA tool is Mapper, which provides unsupervised multivariate pattern analysis of high-dimensional data, producing a compressed visual representation of the data giving a strong indication of where to look for meaningful clustering. Application of Mapper has already led to a number of remarkable results, including the identification of a new subtype of breast cancer and of two phenotypically distinct types of fragile X syndrome. Methods Recruitment: 101 EPP with informed consent were recruited from the Lausanne “Treatment and early Intervention in Psychosis Program”. They had reached the psychosis threshold on the CAARMS scale. Patients were assessed at entrance of the program by PANSS and MADRS, functioning by SOFAS and GAF scales. After 3 years of clinical follow-up, EPP were evaluated for symptoms levels, social and occupational functioning. Metabolomics: Plasma extracts at the program begin were analyzed by liquid-chromatography-mass spectrometry. Features data (m/z, retention time, integrated ion intensity) were extracted using xMSanalyser v1.3.5 with apLCMS v5.9.4. Mapper: Using the Mapper algorithm, we built a topological map representing the EP cohort through the lens of the PANSS scores at baseline. The mapper algorithm captures the shape of high dimensional data through a graph. Nodes represent patients or groups of patients. Edges between nodes represent shared patients. Results Three distinct clusters of patients could be identified: Group A, characterized by low levels of negative (N2) and depression symptoms (G6); group B, characterized by high levels of positive symptoms (P1, 6) having the worst outcome; and group C with high levels of negative (N2) and depression symptoms. Comparison of the groups after 3-years of clinical follow-up showed that group A displayed significantly better social and occupational functioning. The same grouping and predictions were confirmed in a second independent cohort of EPP. Inclusion of the metabolomics data revealed that group A had a distinct profile, which may serve as predictor of functional outcome in EEP. Conclusions These novel findings suggest that topological analysis of a combination of symptoms and blood metabolic profile might contribute to the prediction of functional outcome at early stages of psychosis.

ACT in daily life in early psychosis: an ecological momentary intervention approach

ABSTRACTThe current article describes the Acceptance and Commitment Therapy (ACT) in Daily Life (ACT-DL) training, a new mobile health treatment protocol for ACT applied in a randomized controlled trial in early psychosis individuals. Between weekly ACT therapy sessions, patients fill out brief questionnaires on an app about their mood, symptoms, activity, and current context, thus promoting awareness - a crucial component of ACT. The app also provides them with visual cues and exercises specifically related to the ACT sessions, to help them implement the techniques previously learned in therapy into their daily lives. Here we assess the feasibility of this protocol in 16 early psychosis individuals, as part of an ongoing randomized controlled trial. Specifically, we investigate the experienced usefulness of the ACT therapy and app, and burden of the protocol. Results indicate that participants find both the therapy sessions and the app useful, and that ACT-DL guides them in putting ACT into everyday practice, although the protocol may be moderately burdensome. These findings indicate that ACT-DL may help early psychosis patients applying ACT skills to diverse contexts of everyday life. Since ACT is not symptom-specific, ACT-DL may also be suited for different target populations. Limitations and future directions are discussed.

Migration in patients with early psychosis: A 3-year prospective follow-up study

Early psychosis programs treat high ratios of migrants, given they display higher rates of psychosis. Studies on this topic are limited and less is known about outcomes. The aim of this study was to compare the premorbid, baseline and outcome profile of patients according to migration (M) and migration in psychosocial adversity (MA) in order to explore if there were differences suggesting particular needs in terms of treatment. 257 early psychosis patients aged 18–35 years old were followed-up over 36 months. MA (29.6%) and M (17.9%) were compared to patients who were born in Switzerland (NM). At entry to the program, MA patients had poorer functional levels and higher symptom intensity. MA patients were more likely to report past exposure to trauma. While M patients have similar outcome compared to NM patients, MA patients were less likely to reach symptom remission, displayed lower functioning and were more likely to relapse. Results suggests that migration in adversity is a potential determinant of functional impairment in early psychosis. While patients who migrated in other contexts have a better outcome, patients who experienced migration in adversity have specific needs considering they are less integrated and more likely to have been exposed to trauma.

Brain connectivity alterations in early psychosis: from clinical to neuroimaging staging

Early in the course of psychosis, alterations in brain connectivity accompany the emergence of psychiatric symptoms and cognitive impairments, including processing speed. The clinical-staging model is a refined form of diagnosis that places the patient along a continuum of illness conditions, which allows stage-specific interventions with the potential of improving patient care and outcome. This cross-sectional study investigates brain connectivity features that characterize the clinical stages following a first psychotic episode. Structural brain networks were derived from diffusion-weighted MRI for 71 early-psychosis patients and 76 healthy controls. Patients were classified into stage II (first-episode), IIIa (incomplete remission), IIIb (one relapse), and IIIc (two or more relapses), according to the course of the illness until the time of scanning. Brain connectivity measures and diffusion parameters (fractional anisotropy, apparent diffusion coefficient) were investigated using general linear models and sparse linear discriminant analysis (sLDA), studying distinct subgroups of patients who were at specific stages of early psychosis. We found that brain connectivity impairments were more severe in clinical stages following the first-psychosis episode (stages IIIa, IIIb, IIIc) than in first-episode psychosis (stage II) patients. These alterations were spatially diffuse but converged on a set of vulnerable regions, whose inter-connectivity selectively correlated with processing speed in patients and controls. The sLDA suggested that relapsing-remitting (stages IIIb, IIIc) and non-remitting (stage IIIa) patients are characterized by distinct dysconnectivity profiles. Our results indicate that neuroimaging markers of brain dysconnectivity in early psychosis may reflect the heterogeneity of the illness and provide a connectomics signature of the clinical-staging model.

Cost Evaluation During Decision-Making in Patients at Early Stages of Psychosis.

Jumping to conclusions during probabilistic reasoning is a cognitive bias reliably observed in psychosis and linked to delusion formation. Although the reasons for this cognitive bias are unknown, one suggestion is that psychosis patients may view sampling information as more costly. However, previous computational modeling has provided evidence that patients with chronic schizophrenia jump to conclusions because of noisy decision-making. We developed a novel version of the classical beads task, systematically manipulating the cost of information gathering in four blocks. For 31 individuals with early symptoms of psychosis and 31 healthy volunteers, we examined the numbers of “draws to decision” when information sampling had no, a fixed, or an escalating cost. Computational modeling involved estimating a cost of information sampling parameter and a cognitive noise parameter. Overall, patients sampled less information than controls. However, group differences in numbers of draws became less prominent at higher cost trials, where less information was sampled. The attenuation of group difference was not due to floor effects, as in the most costly block, participants sampled more information than an ideal Bayesian agent. Computational modeling showed that, in the condition with no objective cost to information sampling, patients attributed higher costs to information sampling than controls did, Mann–Whitney U = 289, p = 0.007, with marginal evidence of differences in noise parameter estimates, t(60) = 1.86, p = 0.07. In patients, individual differences in severity of psychotic symptoms were statistically significantly associated with higher cost of information sampling, ρ = 0.6, p = 0.001, but not with more cognitive noise, ρ = 0.27, p = 0.14; in controls, cognitive noise predicted aspects of schizotypy (preoccupation and distress associated with delusion-like ideation on the Peters Delusion Inventory). Using a psychological manipulation and computational modeling, we provide evidence that early-psychosis patients jump to conclusions because of attributing higher costs to sampling information, not because of being primarily noisy decision makers.

High prevalence of metabolic alterations in Latin American patients at initial stages of psychosis.

Studies conducted in the United States have highlighted a higher prevalence of metabolic alterations (MA) in Latino population and Latino psychotic patients. Metabolic risk in psychosis is known to be present from initial stages of the disease. To better characterize this population, we explored the prevalence of MA and metabolic syndrome (MS) in early psychosis patients in a Latin American country. Transversal, observational study comparing the prevalence of MA and MS in patients with early psychosis from an outpatient program in Chile (n = 148) with a community representative sample from the 2009-2010 National Health Survey (n = 568). ANOVA and regression analysis were performed obtaining odds ratio for MA and MS. The prevalence of MS was 44.7% in patients compared to 11.4% in the community sample (odds ratio [OR] 5.28, confidence interval [CI] 95% 3.07-9.08; P-value <0.001). There was no effect of gender. Subgroup analyses showed no significant association of MS with clozapine/olanzapine use, treatment duration or tobacco use. There was an association between treatment duration and hypertriglyceridemia (P = 0.024; OR 1.02, CI 95% 1.00-1.04) and obesity (P = 0.007; OR 5.93, CI 95% 1.82-20.22). Clozapine/olanzapine use was associated with hyperglycaemia (P = 0.007; OR 6.04, CI 95% 1.63-22.38) and high low density lipoprotein (P = 0.033 ANOVA; OR 5.28, CI 95% 1.14-24.37). Latino psychotic patients have a high risk of MA and MS at initial stages of the disease which is not entirely explained by the higher risk in the whole Latino population, is irrespective of gender, and does not seem to be entirely a response to atypical antipsychotic use.

Comparisons and associations between personality, creative potential and achievement in creative, non-creative and early psychosis participants

ABSTRACTEpidemiological evidence supports common genetic determinants between psychosis spectrum populations and creative individuals. Aspects of personality may contribute to protecting the creative artist from psychosis vulnerability. This study examines the similarities and differences in personality within a sample of early psychosis (EP), creative control (CC) and non-creative control (NCC) participants. Findings indicated that the CC group shared closer personality commonalities with the EP group than with NCC participants, on traits such as Neuroticism, Openness and Impulsive Non-Conformity as well as on variables such as Unusual Experiences, Cognitive Disorganisation and Paranoia/Suspiciousness. However, the CC group may better manage their emotional sensitivity and interpersonal suspiciousness than the EP participants. In separate analyses, CC and EP participants recorded higher creative cognition than NCC participants. Unsurprisingly, the CC group reported significantly higher creative achievement than the EP and NCC samples. Of note, the findings indicate that EP participants recorded significantly higher creative achievement than NCC, suggesting that EP patients demonstrate some capacity for creative cognition and creative achievement. These preliminary findings may encourage further research and promote avenues of treatment for at-risk creative individuals and EP individuals.

N-acetylcysteine add-on treatment leads to an improvement of fornix white matter integrity in early psychosis: a double-blind randomized placebo-controlled trial

Mechanism-based treatments for schizophrenia are needed, and increasing evidence suggests that oxidative stress may be a target. Previous research has shown that N-acetylcysteine (NAC), an antioxidant and glutathione (GSH) precursor almost devoid of side effects, improved negative symptoms, decreased the side effects of antipsychotics, and improved mismatch negativity and local neural synchronization in chronic schizophrenia. In a recent double-blind randomized placebo-controlled trial by Conus et al., early psychosis patients received NAC add-on therapy (2700 mg/day) for 6 months. Compared with placebo-treated controls, NAC patients showed significant improvements in neurocognition (processing speed) and a reduction of positive symptoms among patients with high peripheral oxidative status. NAC also led to a 23% increase in GSH levels in the medial prefrontal cortex (GSHmPFC) as measured by 1H magnetic resonance spectroscopy. A subgroup of the patients in this study were also scanned with multimodal MR imaging (spectroscopy, diffusion, and structural) at baseline (prior to NAC/placebo) and after 6 months of add-on treatment. Based on prior translational research, we hypothesized that NAC would protect white matter integrity in the fornix. A group × time interaction indicated a difference in the 6-month evolution of white matter integrity (as measured by generalized fractional anisotropy, gFA) in favor of the NAC group, which showed an 11% increase. The increase in gFA correlated with an increase in GSHmPFC over the same 6-month period. In this secondary study, we suggest that NAC add-on treatment may be a safe and effective way to protect white matter integrity in early psychosis patients.