Episode Psychosis Patients Research Articles

Alteration in NMDAR-related amino acids in first episode psychosis.

The aim of the present study was to explore the role of N-methyl-D-aspartate receptor (NMDAR) related amino acids in drug-naive first episode psychosis (FEP) patients. The medication naïve patients with FEP (n=40) and healthy volunteers with no family history of schizophrenia (n=35) were recruited to the study and followed up for 10weeks. Liquid chromatography-mass spectrometry method was used to measure plasma levels of the amino acids. The plasma glutamine, glutamic acid, proline, serine, asparagine, and hydroxyproline levels were significantly higher in the FEP patients compared to healthy controls (p values<.0001). The glutamine/glutamic acid ratio in FEP patients was not different from the healthy controls (p>.05). After the antipsychotic treatment, plasma glutamic acid, proline, and hydroxyproline levels were significantly increased (p values<.05) while the asparagine level and glutamine/glutamic acid ratio were decreased (p values<.05). The serine and glutamine levels did not show any differences with the treatment (p>.05). The initial plasma glutamine levels were negatively correlated with the initial Scale for the Assessment of Positive Symptoms (SAPS) score (r=-.45, p=.003). The initial plasma proline levels were negatively correlated with the initial and follow-up SAPS scores (r=-.51 and -.39, p values<.05). The initial plasma proline and hydroxyproline levels were both negatively correlated with the initial Brief Psychiatric Rating Scale score (r=-.37, p=.017 and r=-.33, p=.033, respectively). Increase in NMDAR-related amino acid levels during the FEP may be a compensatory response to glutamatergic hypofunction. Their plasma levels were significantly correlated with several psychotic symptoms before and after 10-week treatment. Antipsychotic treatment has differential effects on the plasma levels of these amino acids.

Clinical and neurodevelopmental correlates of aggression in early psychosis

BackgroundAlthough mental illness accounts for only 4% of aggressive behavior in the general population, there remains a modest association between aggressive behavior and psychotic disorders, particularly in the early stages of the illness. However, little is known about the specific factors associated to this increased risk. AimsThe present study aims to assess the rates, characteristics and risk factors of aggressive behavior in first episode psychosis patients (FEP). MethodWe conducted a retrospective chart review of 449 FEP patients recruited from an outpatient early psychosis clinic. Aggressive behavior and clinical information were rated based upon information gathered from the chart review of data collected at baseline and after 6 months of follow-up. ResultsRates of aggressive behavior were 54.3% in FEP patients. Aggressive behavior was significantly associated with higher rates of history of birth complications, neurodevelopmental delays, learning difficulties, alcohol use disorders, and the clinical domain of poverty symptoms. In addition to aggressive behavior, 16.7% of FEP patients exhibited suicidal ideation or behaviors and 11.4% exhibited non-suicidal self-injurious behavior (NSSIB). In contrast to baseline, aggressive behaviors at 6 months follow up were almost entirely absent. ConclusionsPatients at early stages of psychosis have high rates of aggressive and suicidal behavior prior to contact with clinical services. Neurodevelopmental adversities, alcohol use disorders and poverty symptoms are associated to higher risk of aggression in early psychosis. Participation in early psychosis specialty care resulted in a dramatic reduction in aggressive behavior.

Self and world experience in non-affective first episode of psychosis

A disturbance of “minimal self,” — of the immediate sense of mine-ness inherent in experience—is hypothesized to be the core disturbance in schizophrenia. Research with the Examination of Anomalous Self Experience (EASE) has demonstrated the selective aggregation of anomalous self-experiences in the schizophrenia spectrum. Conceptual research suggests that anomalous world experiences, including changes in the experience of space, time, and other persons, occur alongside anomalous self-experiences and are an important aspect of subjectivity in schizophrenia. The Examination of Anomalous World Experience (EAWE) is a recently published interview format designed to explore changes in world experience in schizophrenia. In the current study, 24 hospital outpatients with non-affective first-episode psychosis and 24 healthy-control participants were assessed with the EAWE and the EASE. First episode psychosis patients had total EAWE and EASE scores that were both, on average, significantly higher than the healthy-control group. EAWE and EASE scores were highly correlated, even after removing overlapping items. The distribution of EAWE items and subtypes in the first-episode psychosis sample was heterogeneous. We conclude that anomalous world experiences represent a relevant aspect of first-episode psychosis, and that they may be related to the self-disturbances thought to underlie schizophrenia spectrum disorders.

Clinical and Sociodemographic Characteristics in First-Episode Psychosis Patients in a Rural Region of Latvia

Abstract The first psychosis is a crucial point for further development of mental disorders. Previous evidence has demonstrated that psychotic disorders, including schizophrenia, are associated with a large number of years living with the disability. It is a global aim to improve prognosis of psychotic disorders, especially in rural regions, where mental health care possibly is not so easily accessible for patients. The aim of this study was to investigate clinical and sociodemographic determinants in association with patient and illness related factors to improve knowledge and understanding of first time psychosis patients in a rural region. This is a descriptive, cohort-based study of all consecutive first episode psychosis (F20, F23, ICD 10) patients admitted in the Daugavpils Psychoneurological Hospital (DPNH) between January 2016 and December 2017. Of the 94 first-time patients hospitalised in DPNH with symptoms of psychosis, 69 met the inclusion criteria. Our results showed that median age of patients was 33 years (IQR 27.5–42.0), median duration of untreated illness (DUI) was 30 months (IQR 11.0–60.0), and median duration of untreated psychosis (DUP) was 8 weeks (IQR 4.0–48.0). The results showed that 55.1% of first psychosis patients had not seen any health care specialist before being admitted to the psychiatric hospital. We found statistically significant differences between some sociodemographic aspects in DUI/DUP. Patients who lived with relatives had the longest DUI — 36 months, compared with 12 months for those who had established their own family. Unemployed patients had longer DUI — 36 months, compared with 12 months for employed patients. Similar findings were shown for associations with DUP. To our knowledge this study adds several important findings that help to better understand first psychosis patients.

Glutamate levels in the anterior cingulate cortex in un-medicated first episode psychosis: a proton magnetic resonance spectroscopy study

Converging lines of evidence suggest that glutamatergic dysfunction may contribute to the pathophysiology of first episode psychosis. We investigated whether first episode psychosis patients free from all pharmacological treatments and illicit substances show cortical glutamatergic alterations. One-hundred and eleven volunteers including 65 healthy volunteers and 46 first episode psychosis patients free from all pharmacological treatments (28 drug naïve) underwent a proton magnetic resonance spectroscopy scan measuring glutamate levels in the bilateral anterior cingulate cortex. Symptom severity was measured using the Positive and Negative Syndrome Scale (PANSS) and cognition was measured using the Wechsler Adult Intelligence Scale (WAIS) digit symbol test. There were no differences in glutamate levels between patients and controls. These findings remained unchanged when adjusting for the effects of age, sex and ethnicity or when restricting the analyses to patients who were both medication naïve to all pharmacological treatments and illicit substances. Whilst these findings do not preclude glutamatergic alterations in psychosis, methodological advances are needed for us to investigate whether patients show alterations in other aspects of glutamate function, such as pre-synaptic glutamate or release.

Personality traits, theory of mind and their relationship with multiple suicide attempts in a sample of first episode psychosis patients: One-year follow-up study

BackgroundHigh rates of suicidal behaviour (SB) have been found in first episode psychosis (FEP) patients. It has been suggested that the presence of multiple suicide attempts (mSA) increases the risk of later SA and the risk of eventual death by suicide. ObjectiveOur main objective was to study the baseline factors associated with the presence of mSA during the first year after FEP. In addition, a second aim was to find out whether there were any differences between single and multiple suicide attempters in the timing of the first SA after FEP. MethodA total of 65 FEP patients were evaluated. The presence of SAs were recorded at two different times after FEP. Bivariate and multivariate analyses were performed to explore the relationship between SA with sociodemographic and clinical variables. ResultsMultiple linear regression showed that mSA was associated with the presence of increased symptom severity (B = 0.35; t = 3.67; p < 0.01) and errors in first-order false-belief task (B = 0.48; t = 2.11; p = 0.04). There were significant differences in the timing of first SA after FEP between multiple and single suicide attempters. ConclusionsTheory of mind impairments along with more severe symptoms during the first contact with mental health services for psychotic symptoms appeared to be important predictors of mSA. On the other hand, multiple suicide attempters tend to make a first SA after FEP earlier than single suicide attempters. These results could contribute to the implementation of preventive suicidal programs, however they must be confirmed by additional research.

Differential gene expression analysis in blood of first episode psychosis patients

BackgroundPsychosis is a condition influenced by an interaction of environmental and genetic factors. Gene expression studies can capture these interactions; however, studies are usually performed in patients who are in remission. This study uses blood of first episode psychosis patients, in order to characterise deregulated pathways associated with psychosis symptom dimensions. MethodsPeripheral blood from 149 healthy controls and 131 first episode psychosis patients was profiled using Illumina HT-12 microarrays. A case/control differential expression analysis was performed, followed by correlation of gene expression with positive and negative syndrome scale (PANSS) scores. Enrichment analyses were performed on the associated gene lists. We test for pathway differences between first episode psychosis patients who qualify for a Schizophrenia diagnosis against those who do not. ResultsA total of 978 genes were differentially expressed and enriched for pathways associated to immune function and the mitochondria. Using PANSS scores we found that positive symptom severity was correlated with immune function, while negative symptoms correlated with mitochondrial pathways. ConclusionsOur results identified gene expression changes correlated with symptom severity and showed that key pathways are modulated by positive and negative symptom dimensions.

A longitudinal study of event related potentials and correlations with psychosocial functioning and clinical features in first episode psychosis patients

BackgroundDeficits in auditory event-related potentials (ERPs), brain responses to stimuli indexing different cognitive processes, have been demonstrated widely in chronic schizophrenia (SZ) patients though much less is known about these responses across the early course of psychosis. The present study examined multiple ERP components in first episode psychosis (FEP) patients longitudinally and investigated the relationships between ERPs, psychosocial functioning, and clinical features over time. MethodsN1, P2, P3a, and P3b ERPs were elicited using a three-stimulus (novelty) auditory oddball paradigm. FEP patients included SZ-spectrum and psychotic bipolar disorder (BD) diagnoses. Data were collected from 41 patients at baseline, 20 patients at 12-month follow-up, 14 at 24-month follow-up, and 29 healthy control subjects. ResultsN1 and P2 ERPs were intact across the early stages of psychosis. Baseline P2 was significantly larger in BD than SZ patients. Reduced P3a and P3b ERPs were found in patients followed longitudinally and are stable over time. ERPs tracked distinct aspects of symptomology and medication, though specific associations were inconsistent across time. Baseline P3a amplitude predicted later psychosocial functioning. The pattern of correlations between ERP components in patients differed from controls. DiscussionBaseline P3a ERP, and PANSS general score were significant and independent predictors of later MCAS functioning at 12-month. Overall, individuals with worse functioning and greater symptomology produced smaller amplitudes. Our results highlight the heterogeneity within the FEP population. Correlation patterns among ERPs are similar between patients and controls. P3a and P3b amplitudes appear to link with higher-order cognitive and psychosocial functioning.

Gender differences of patients at-risk for psychosis regarding symptomatology, drug use, comorbidity and functioning – Results from the EU-GEI study

BackgroundGender differences in symptomatology in chronic schizophrenia and first episode psychosis patients have often been reported. However, little is known about gender differences in those at risk of psychotic disorders. This study investigated gender differences in symptomatology, drug use, comorbidity (i.e. substance use, affective and anxiety disorders) and global functioning in patients with an at-risk mental state (ARMS) for psychosis. MethodsThe sample consisted of 336 ARMS patients (159 women) from the prodromal work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI; 11 centers). Clinical symptoms, drug use, comorbidity and functioning were assessed at first presentation to an early detection center using structured interviews. ResultsIn unadjusted analyses, men were found to have significantly higher rates of negative symptoms and current cannabis use while women showed higher rates of general psychopathology and more often displayed comorbid affective and anxiety disorders. No gender differences were found for global functioning. The results generally did not change when corrected for possible cofounders (e.g. cannabis use). However, most differences did not withstand correction for multiple testing. ConclusionsFindings indicate that gender differences in symptomatology and comorbidity in ARMS are similar to those seen in overt psychosis and in healthy controls. However, observed differences are small and would only be reliably detected in studies with high statistical power. Moreover, such small effects would likely not be clinically meaningful.

Verbal memory and voxel based morphometry in first episode non-affective psychosis: A process oriented approach.

The present study aimed to comprehensively study the specific neurocognitive constructs underlying verbal memory deficits and their neuroanatomical correlates in first episode psychosis (FEP) patients. A total of 218 FEP patients and 145 healthy participants were examined with the Rey Auditory Verbal Learning Test (a widely used verbal memory measure that provides a range of performance indexes to evaluate memory) and voxel-based morphometry (a neuroimaging analysis technique that allows investigation of focal differences in brain anatomy). The analyses showed that the FEP group presented significantly lower scores on acquisition/learning, F(1, 566) = 40.7; p < .001, and delayed recall, F(1, 570) = 74.12; p < .001, as well as higher rates of forgetting, F(1, 566) = 20.03; p < .001. They also exhibited a significant sensitivity to retroactive, F(1, 554) = 8.74; p = .003, but not to proactive interference. Neuroimaging analyses found significant interactions between bilateral frontal lobe morphometry and proactive interference (ρFWE = 0.023). Rate of forgetting also significantly interacted with right occipital cortex morphometry (ρFWE = 0.033). Patients with higher rates of forgetting, proactive and retroactive interference demonstrated further gray matter reductions in frontal and occipital cortical areas. These findings emphasize the anterior orbitofrontal cortex as the brain region that contributes to verbal memory deficits in FEP patients, and suggest specific relationships between different neuroanatomical structures and discrete verbal memory processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Improvement in verbal learning over the first year of antipsychotic treatment is associated with serum HDL levels in a cohort of first episode psychosis patients

To investigate whether changes in serum lipids are associated with cognitive performance in first episode psychosis (FEP) patients during their first year of antipsychotic drug treatment. One hundred and thirty-two antipsychotic-treated FEP patients were included through the TOP study along with 83 age- and gender-matched healthy controls (HC). Information regarding cognitive performance, psychotic symptoms, lifestyle, body mass index, serum lipids [total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and triglycerides] and antipsychotic treatment was obtained at baseline and after 1 year. The cognitive test battery is comprised of assessments for verbal learning, processing speed, working memory, verbal fluency, and inhibition. Mixed-effects models were used to study the relationship between changes over time in serum lipids and cognitive domains, controlling for potential confounders. There was a significant group by HDL interaction effect for verbal learning (F = 11.12, p = 0.001), where an increase in HDL levels was associated with improvement in verbal learning in FEP patients but not in HC. Practice effects, lifestyle, and psychotic symptoms did not significantly affect this relationship. Antipsychotic-treated FEP patients who increased in HDL levels during the first year of follow-up exhibited better verbal learning capacity. Further investigations are needed to clarify the underlying mechanisms.

12.4 THE BODILY SELF IN PSYCHOSIS: SENSORIMOTOR INDUCTION OF AUDITORY MISATTRIBUTION IN PSYCHOSIS IS LINKED TO NEURAL DISCONNECTIVITY

Abstract Background Psychosis is often depicted as a disruption of the self-model. Patients suffering from psychosis report many symptoms relating to deficiencies in the minimal self, including loss of the sense of control over their actions (Sense of Agency) as well as numerous disturbances of body representation (e.g. Body Ownership). Positive symptoms of psychosis such as passivity symptoms and auditory hallucinations (termed first-rank symptoms) are characterized by a diminished demarcation of self-other boundaries, causing misattribution of self-generated actions to external sources. It has been suggested that this deficiency in self-monitoring in schizophrenia is due to abnormal sensorimotor prediction mechanisms, causing a loss of agency for actions and thoughts. While the neurobiological underpinnings of schizophrenia are yet unclear, many studies have reported aberrant neural connectivity in schizophrenia patients which may impact sensorimotor prediction and integration. Methods Recently, we have shown that introducing sensorimotor conflict (SMC) can induce psychosis like symptoms in healthy patients. Employing a master-slave robotic system we induced a conflict by introducing a delay between the participants’ movements and the haptic feedback. The SMC caused a feeling of a Presence (FoP) which is a first rank symptom of psychosis. The FoP is also found in neurological patients with lesions in cortical regions of the temporoparietal cortex, insular cortex and fronto-parietal cortex related to abnormal bodily self-representation. Here, we tested if SMC may cause misattribution of auditory stimuli and if this is related to neural connectivity. We tested first episode psychosis patients (N=31) with and without first rank symptoms (related to the sense of control over actions and thoughts) as well as healthy participants (N=20) on an auditory attribution task while inducing conflict with the master-slave robot. Results We found that when a SMC was introduced patients with first rank symptoms showed a decrease in their ability to judge if the auditory stimuli were in their own voice or the voice of another person. Resting state functional connectivity analysis indicated that the first rank patients had reduced connectivity in the network related to the SMC, but not in other control regions. Furthermore, the reduced functional connectivity correlated with the rates of auditory misattribution. Conclusions Our results show that induction of SMC can cause auditory misattributions, and that this is related to reduced cortical communication in regions related to sensorimotor body representation. These findings connect two influential theories of psychosis linking cognitive theories of sensorimotor prediction error in schizophrenia with systems level theories of neural disconnectivity. Understanding these neurocognitive mechanisms underlying the disruption of the self-model in psychosis may allow novel approaches in early diagnosis and treatment of these conditions.

O5.7. THE FIRST EPISODE PSYCHOSIS OUTCOME STUDY: PRELIMINARY 15 YEAR PHYSICAL HEALTH OUTCOMES OF FIRST EPISODE PSYCHOSIS PATIENTS WHO WERE TREATED AT THE EARLY PSYCHOSIS PREVENTION AND INTERVENTION CENTRE BETWEEN 1998–2000

Abstract Background Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up skill patients and their families. While the immediate benefits of SEI are clear, and have been demonstrated, the long-term impact of SEI on illness course is less clear. The First Episode Outcome Study involves the long-term follow-up of a representative sample of first episode psychosis patients who were first treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. In this presentation the preliminary data on physical health outcomes are reported. Methods Between January 1998 and December 2000, 661 patients between the ages of 15–29 years were treated at the Early Psychosis Prevention and Intervention Centre, Melbourne Australia. The 18-month treatment characteristics of this cohort have been extensively examined in the First Episode Psychosis Outcome Study (FEPOS). The long-term outcomes of this cohort are now being examined in a new study (known as FEPOS15). Results The rates of self-report physical health problems in 100 participants 15 years after being treated for a first episode psychosis were significant for high cholesterol (41%), asthma (33.7%), chronic pain (25.3%), allergies (19.3%), respiratory problems (16.9%) anemia (12.2%), arthritis (12.0%), hepatitis C (10.8%) and diabetes (6.3%). Cardiovascular problems were also noted including heart attack (2.4%), other heart problems (8.4%), and stroke (3.6%). Sexual health problems are explored. Physical health findings pertaining to Coroners’ findings on those who had died will be also used to describe the long-term impacts of psychotic disorder. Discussion This follow-up study is one of the longest, largest and most comprehensive studies of the multidimensional outcomes of a SEI service for psychosis. The physical health outcomes of individuals 15-years after the first episode psychosis are poor. The importance of monitoring and managing physical health problems in those with psychotic disorder is highlighted.

Motivations to quit smoking and challenges faced during cessation among individuals with first episode psychosis in Singapore.

AimsThe prevalence of smoking has been noted to be higher among individuals with mental illness, particularly among those with schizophrenia and related psychosis than in the general population. The present paper sought to examine the motivations and challenges to quit smoking among first episode psychosis patients (N = 281) enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore.MethodsQuestionnaires were used to collect details on an individual's smoking status, cessation attempts, motivations to quit, and challenges to stop smoking. Using baseline data, multiple linear regressions were conducted to examine the socio‐demographic correlates of motivations and challenges of smoking cessation behaviour.ResultsOf the study sample, 59.4% reported to have never smoked while 39.9% were currently smoking or had attempted smoking. Health reasons and cost were the most highly endorsed motivations to stop smoking; whereas cravings, stress, and boredom were highly endorsed as challenges to stop smoking. Socio‐demographic factors such as age, educational level, and marital status were also found to be associated with the motivations to stop smoking and challenges faced during smoking cessation.ConclusionsThe present study highlights the most highly endorsed motivations and challenges reported among individuals with first episode psychosis (FEP) in an Asian population. Given that the literature examining motivations and challenges to quit smoking has predominantly focused on the general population, results from the current study have implications for the formulation of smoking cessation programmes targeted at individuals with mental illness, particularly those with FEP.

Hazardous alcohol use in a sample of first episode psychosis patients in Singapore

BackgroundHazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore.MethodsBaseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses.ResultsThe prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life.ConclusionsThe association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.

Psychiatric hospitalization following antipsychotic medication cessation in first episode psychosis.

There are questions about the risk-benefit balance of longer-term antipsychotic medication treatment following first episode psychosis, especially in relation to relapse because of dopamine supersensitivity following treatment cessation. The purpose of this study was to determine whether hospitalization rates in first episode psychosis patients are associated with length of initial oral antipsychotic medication exposure. We examined psychiatric hospitalization rates in patients experiencing first episode of psychosis from the total population of Sweden between 1 January 2007-31 December 2016 ( n=7043). We categorised patients by the length of first antipsychotic treatment (<6 months, 6 months to <1 year, 1 year to <2 years, 2 years to <5 years and ⩾5 years). Compared to those treated for <6 months, individuals receiving oral antipsychotic medications for ⩾5 years had less than half the cumulative incidence of hospitalization at all times between 1-4 years after treatment cessation. We found no evidence that hospitalization rates increased with increasing baseline antipsychotic exposure.

Gender and 5-years course of psychosis patients: focus on clinical and social variables.

Most studies on gender and psychosis have focused on gender differences at illness onset or on the long-term outcome, whereas little is known about the impact of gender on the first years after psychosis onset. A total of 185 first episode psychosis (FEP) patients were followed for 5years after psychosis onset, and gender differences were explored in psychopathology (PANSS), needs for care (CAN), and insight (SAI-E). Male patients showed more negative symptoms than females over time, whereas female patients showed higher levels of depressive symptoms than males throughout the study period. In addition, female patients presented more functioning unmet needs for care, but higher levels of insight into illness than males. Therapy and rehabilitative programs for FEP patients should be gender-targeted, as gender has proved to impact on psychopathology, needs for care, and insight in the very first years following psychosis onset.

The impact of gender and childhood abuse on age of psychosis onset, psychopathology and needs for care in psychosis patients

Gender is associated with several features of psychotic disorders, including age of illness onset, symptomatology, a higher prevalence of history of childhood sexual abuse (CSA) and needs for care. Childhood sexual abuse is associated with adverse mental health consequences but as there is a gender difference in stress reactivity, there may be a differential impact of CSA on psychopathology, age of psychosis onset and needs for care in First Episode Psychosis (FEP) patients. We hypothesized that a history of abuse would be associated with lowering of age of onset, increased symptomatology and more unmet needs in women but not men. A total of 444 FEP patients have been recruited within the context of the GET UP trial. Symptomatology has been assessed using the PANSS scale, needs for care with the CAN scale and childhood abuse with the CECA-Q scale. Childhood sexual abuse was more frequent among female patients [22.6% in women vs 11.6% in men (OR = 0.45, p < 0.01)], whereas there was no gender difference in the prevalence of childhood physical abuse (29.0% in women vs 31.7% in men). Childhood abuse was associated with higher levels of negative symptoms in both men and women, with a reduced age of onset in women only and little increase in needs for care in both men and women. Our results seem to suggest that childhood sexual abuse in female FEP patients may be linked to a more severe form of psychosis whose presentation is characterized by earlier age of onset and higher levels of negative symptoms and we can also speculate that gender-specific protective factors in women, but not in men, may be outweighed by the consequences of childhood abuse.

Increased peripheral levels of TARC/CCL17 in first episode psychosis patients

BackgroundEvidence for a link between the pathophysiology of schizophrenia and the immune system is mounting. Altered levels of chemokines in plasma have previously been reported in patients with schizophrenia under antipsychotic medication. Here we aimed to study both peripheral and central chemokine levels in drug-naïve or short-time medicated first episode psychosis (FEP) patients. MethodWe analyzed nine chemokines in plasma and CSF from 41 FEP patients and 22 healthy controls using electrochemiluminescence assay. ResultsIn plasma four chemokines; TARC/CCL17, eotaxin/CCL11, MDC/CCL22, IP-10/CXCL10 and in CSF one chemokine; IP-10/CXCL10 showed reliable detection in >50% of the cases. FEP patients displayed increased levels of TARC/CCL17 in plasma compared to healthy controls, 89.6 (IQR 66.2–125.8) pg/mL compared to 48.6 (IQR 28.0–71.7) pg/mL (p = 0.001). The difference was not attributed to confounding factors. Plasma TARC/CCL17 was not associated with PANSS, CGI or GAF scores, neither with cognitive functions. The chemokines eotaxin/CCL11, MDC/CCL22, IP-10/CXCL10 in plasma and IP-10/CXCL10 in CSF did not differ between FEP patients and controls. ConclusionIn line with a previous study showing that chronic patients with schizophrenia display increased plasma TARC/CCL17 levels, we here found an elevation in FEP patients suggesting a role of TARC/CCL17 in early stages of schizophrenia. The exact mechanism of this involvement is still unknown and future longitudinal studies as well as studies of central and peripheral chemokine levels would be of great interest.

Effectiveness of Cognitive Training in an Intensive Outpatient First Episode Psychosis Program.

Despite effective pharmacotherapy for positive symptoms of psychosis, cognitive deficits emerge early and are persistent. Efficacy studies have demonstrated cognitive training can produce improvement in cognition, symptoms, and functional outcomes for psychosis. A chart review of seventy-one first episode psychosis patients in a cognitive training program was designed to determine feasibility and effectiveness of the program in a non-research clinic setting. Cognitive testing data, symptom change, and re-hospitalization data were reviewed. The MATRICS Consensus Cognitive Battery (MCCB) was used to measure processing speed, attention, memory, verbal learning, visual learning, problem solving, and social cognition. Improvements in global cognition were found (p < .05), driven by changes in working memory and speed of processing. The expanded Brief Psychiatric Rating Scale (BPRS-E) was used to measure change in mental health symptoms. There were no significant changes in symptoms. Participants without comorbid diagnoses, who underwent cognitive training procedures, had lower re-hospitalization rates when compared to another comprehensive first episode program and routine practice. These findings indicate feasibility and effectiveness for implementing cognitive training for first episode patients in a day treatment setting.