Episode Schizophrenia Spectrum Disorders Research Articles

Cognitive Impairment in an Episode of Schizophrenia Spectrum Disorder.

Cognitive Impairment in an Episode of Schizophrenia Spectrum Disorder.

Increased violence and aggression levels during the SARS-Cov-2 pandemic; data from three London acute psychiatric inpatient facilities.

IntroductionThe COVID-19 pandemic has significantly impacted mental health services, with the literature reporting an increase in the incidence of psychiatric admissions.ObjectivesThe aim of this study was to assess the impact of the pandemic on clinical presentations, characteristics of admission and incidents occurring in three acute inpatient mental health facilities in the UK.MethodsThis was a retrospective study comparing data from the first and third UK lockdown to the five years prior to the pandemic. Data was acquired from electronic clinical records and addressed two acute psychiatric inpatient wards and one psychiatric intensive care unit. Key outcomes of comparison were clinical presentations, number of admissions, length of hospital stay, number of incidents and characteristics of incidents.ResultsCompared to the previous 5 years, a higher number of incidents characterized by violence and aggression were reported during the first (56.8% vs 44.3%, x2=16.56, df=1, p<0.001) and third lockdown (100.0% vs 86.2%, x2=36.40, df=1, p<0.001). An increase in non-psychotic disorders was observed in the first lockdown (20.0% vs 13.1%, x2=4.76, df=1, p=0.029), whilst increased first episode psychosis (19.7% vs 11.3%, x2=8.1, df=1, p=0.004) and schizophrenia spectrum disorders (74.4% vs 57.2%, x2= 7.6, df=1, p=0.006) were diagnosed during the third lockdown. There were no significant changes in the diagnosis of mood disorders in both lockdowns compared to previously. The median length of inpatient stay significantly reduced during the first lockdown (28 days vs 36 days, x2= 7.66, df=1, p=0.006).ConclusionsIncreased inpatient incidents may be explained by the impact of the pandemic on staffing levels and resources, combined with increased emotional distress amongst patients in the face of uncertainty. The pandemic may have increased substance misuse potentially linked with the increased incidence of first episode psychosis.Disclosure of InterestS. Bonaccorso: None Declared, O. Ajnakina: None Declared, A. Ricciardi: None Declared, S. Ouabbou: None Declared, J. Wilson: None Declared, C. Theleritis: None Declared, M. Badhan: None Declared, A. Metastasio: None Declared, N. Stewart: None Declared, M. Barczyck: None Declared, F. Johansson: None Declared, T. Tharmaraja: None Declared, F. Schifano Speakers bureau of: Prof. Fabrizio Schifano is a member of the European Medical Agency

Differences in white matter microstructure in first-episode schizophrenia spectrum disorders vs healthy volunteers and their association with cognition

Objective: Both cognitive impairment and alterations in white matter tissue microstructure are well recognised in schizophrenia. We investigated whether differences in white matter microstructure underpin cognitive impairments in patients with first-episode schizophrenia spectrum disorders when controlling for multiple confounding factors. Methods: We employed a cross-sectional study design and compared fractional anisotropy (FA) between individuals diagnosed with first- episode schizophrenia spectrum disorders (FES) (n = 68) and matched healthy controls (n = 120). We conducted multiple analyses of covariance (ANCOVAs) to compare the mean FA values for patients and controls across 27 white matter tracts. We conducted exploratory correlation analyses to determine if white matter tract differences were associated with global cognitive impairment as well as deficits across seven cognitive domains. Results: We found widespread reductions in FA in patients compared to controls, after controlling for confounding variables, such as age, biological sex, education, substances, and childhood adversities. We found a significant positive correlation between the attention/vigilance domain and the splenium of the corpus collosum and external capsule after correction for multiple comparisons. In the control group we found no significant correlations between FA and cognition. Conclusion: Our findings provide a neurobiological basis for attentional cognitive deficits in schizophrenia, highlighting a potential role for the splenium of the corpus collosum and external capsule.

Universal healthcare coverage for first episode of schizophrenia-spectrum disorders in Chile: analysis of the administrative database

Aim of the study was to analyse the Ministry of Health's (MINSAL) administrative database of the Universal Health Coverage (UHC) program for First Episode of Schizophrenia Spectrum Disorders (FEP-SSD). The database included every case registered in the program between 2004 and 2017. According to the timeframes established for permanence in the program, cases were defined as Suspected, FEP in diagnostic observation and FEP-SSD. Only first registers were analysed. We compared gender, age at entry, level of care and region where the case was registered. Denominator data for estimation of incidence rates were obtained from the last census. We adjusted incidence rate ratios by age, gender, and region. During the studied period, 33.207 suspected cases were registered. 27.006 (81%) were confirmed as FEP and after 6-month follow-up, 22.701 (68%) were confirmed as FEP-SSD. The median age at entry was 24years, males entering at younger age. Male proportion was higher than female in all groups. 46.9% of all cases were detected in primary care. FEP-SSD cases were six years younger and had a higher proportion of males than discarded cases (62.6 vs 53.2%). During 169.4 million person-years at risk, crude incidence for suspected cases was 19.58 per 100.000 person-years; for FEP, 15.92 per 100.000 person-years and for FEP-SSD, 13.38 per 100.000 person-years. Chile has lower incidence of FEP-SSD compared to current world estimations but gender proportions are comparable. This UHC program has allowed early access through the integration of mental health to the health network at all levels of care.

Episode detection based on personalized intensity of care thresholds: a schizophrenia case study.

Schizophrenia Spectrum Disorder (SSD) is characterized by its chronic, episodic nature. The clear definition of such episodes is essential for various clinical and research purposes. Most current definitions of episodes in SSD are based on either hospitalizations or on symptom scales. Both have drawbacks; symptom scales are measured infrequently, while hospitalization rates are often affected by policy. This study presents an approach for defining episodes in healthcare data that does not suffer such drawbacks. Healthcare use of 13,155 SSD patients in the Northern Netherlands with up to 12 years of follow-up was available. Patient-level structural changes in the trend of healthcare use costs were determined using Exponentially Weighted Moving Average (EWMA) control charts. Control charts restart with updated parameters after a detected structural change. Episodes were defined using these structural changes. The resulting episodes were validated by investigating their association with the Global Assessment of Functioning (GAF) scale. The mean number of episodes was 0.61 (sd: 0.60) per patient per year. For the sub-group without hospitalizations this was 0.51 (sd: 0.71). Average episode duration of the sub-group (147 days, sd: 309.4) was similar to that of the full sample (150 days, sd: 305.5). A significant inverse association was identified between GAF scores and the episode-state indicator. The repeated application of EWMA control charts based on healthcare-intensity is a feasible and promising tool for quantifying patient-level healthcare episodes. The validation using GAF scores indicates that our episode indicator is associated with lower levels of global functioning. Results for individuals without hospitalizations indicate that the method is robust with regard to changes in healthcare policy.

Glucose Metabolism, Thyroid Function, and Prolactin Level in Adolescent Patients With First Episode of Schizophrenia and Affective Disorders.

Schizophrenia and affective spectrum disorders (ASD) typically begin in adolescence or early adulthood. The pathophysiological mechanisms underlying these disorders are still not fully understood, and recent studies have suggested an involvement of dysfunctions in cardiometabolic and neuroendocrine systems at the onset of both disorders. In this context, we aimed to assess thyroid function, prolactin level, glucose metabolism, and lipid profile in drug naive adolescents, comparing patients with first episode of schizophrenia spectrum disorders (SSD) and patients with ASD. We performed a retrospective chart review from inpatients aged from ten to eighteen years, referred to Child and Adolescent Psychiatric Unit of University of Bari “Aldo Moro” over a period of 4 years, with diagnosis of SSD (n=30) or ASD (n=22), according to Diagnostic and Statistical Manual for Mental Disorders-fifth edition (DSM-5) criteria. Data on serum prolactin, glucose, insulin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, free triiodothyronin, and free thyroxin were collected, and the insulin resistance (IR) indexes “HOMA1-IR“ and “HOMA2-IR” were calculated. The multivariable linear regression models, adjusting for potential confounding factors (age, sex, and BMI), showed HOMA1-IR (p=0.001), HOMA2-IR (p=0.002), glucose (p=0.004), insulin (p=0.004) and free thyroxin (p<0.001) values higher in the SSD group than in ASD. No others significant differences were found. Our findings suggest the need for a metabolic and endocrine screening at the onset of SSD and ASD, particularly for indexes of IR, that is a testable and treatable risk factor for cardiometabolic diseases. Further studies are required to better understand the role of endocrinological and metabolic dysfunctions at the onset of severe mental illness also considering influencing factors as age, gender, and BMI.

Patterns of drug prescribing in inpatients withfirst episode of schizophrenia spectrum disorder: The role of guidelines .

The great discrepancy between clinical guidelines and the routine psychiatric practice in the treatment of schizophrenia is a subject of intensive research, with the aim to promote the rational prescribing of antipsychotics. The aim of this study was to analyze the pattern of drug prescribing in the treatment of inpatients with the first episode of schizophrenia spectrum disorders and the impact of the implementation of the Serbian National Guideline for the Diagnosis and Treatment of Schizophrenia. This cross-sectional study was conducted at the Clinic for Mental Disorders "Dr Laza Lazarević" in Belgrade and included a consecutive sample of 675 previously drug-naïve patients with the first episode of schizophrenia spectrum disorders. The data were obtained from the patients' medical records. The analysis of therapy prescribed at discharge included antipsychotics and non-antipsychotic adjuvant therapy. Descriptive statistical methods and methods for testing statistical hypotheses were used to analyze the primary data. The prescribing of second-generation antipsychotics has increased both within antipsychotic monotherapy and within antipsychotic polypharmacy during the period of the study. The use of adjuvant non-antipsychotic pharmacotherapy was very common, but use of benzodiazepines, carbamazepine, and anticholinergic drugs significantly decreased. Long-acting forms of antipsychotics have been rarely used (9.3%). Clozapine was in general underprescribed (10.4%). The National Guideline for the Diagnosis and Treatment of Schizophrenia most likely contributed to some positive changes in prescribing patterns during the treatment of the first psychotic episode in daily clinical practice in Serbia. However, antipsychotic polypharmacy and irrational use of adjuvant therapy was still prevalent.

S209. DRUG-NAïVE FIRST-EPISODE SCHIZOPHRENIA SPECTRUM DISORDERS: PHARMACOLOGICAL TREATMENT PRACTICES IN INPATIENT UNITS IN HUNAN PROVINCE, CHINA

BackgroundAntipsychotics represent the core of treatment for first-episode schizophrenia (FES). The choice of the first antipsychotic in drug-naïve FES patients is delicate, as it could influence both adherence to medications and the course of the illness. In China, mental health care for schizophrenia is mainly provided by psychiatric hospitals, due to the limited resources in outpatient community care. Psychiatrists and nurses are the main providers of mental health care, and medication is becoming the primary intervention for mental illness. In 2015, the second edition of China’s Guidelines for Schizophrenia was released. The use of a minimum effective dose of a single antipsychotic has been indicated for FES, consistent with multiple international guidelines. Since the current treatment practice for FES in China is unknown, this study aimed to describe antipsychotic prescription patterns for drug-naïve FES inpatients, and factors associated with practices deviating from China’s current guidelines.MethodsThis was a retrospective study. Participants included all inpatients, ages 7 to 45 years, experiencing a first episode of schizophrenia-spectrum disorder with a duration of untreated illness (interval between onset of psychotic symptoms and first antipsychotic prescription) less than 18 months, admitted between Aug 1st,2016 and Aug 1st,2017 to one of eight hospitals in Hunan Province. Demographics, clinical characteristics, and prescriptions at discharge were collected from electronic medical records. Descriptive analysis was used to describe prescription patterns. Logistic regression and random forest methods were used to model relationships between factors and deviations from China’s guidelines.ResultsOf the 602 inpatients included in the study, 598(99.3%) were prescribed antipsychotics at discharge, mostly risperidone (41.8%) and olanzapine (41.0%). Polytherapy (being prescribed more than one antipsychotic) was present in 121 (20.2%) participants. The prescription rate of high-dose antipsychotics among adults was 32.9%, and of off-label antipsychotics among minors was 23.2%. Adults (OR=1.95, 95% CI: 1.14–3.34, compared to minors) and patients with longer length of stay (OR=1.09, 95% CI: 1.03–1.14) were more likely to receive polytherapy. Younger age (OR= 0.96, 95% CI 0.93–0.99), having non-tertiary hospitalization (OR=0.38, 95% CI 0.24–0.59, compared to tertiary hospitalization), and being prescribed polytherapy (OR= 3.56, 95% CI 2.17–5.86, compared to monotherapy) were associated with high-dose antipsychotics prescription. Participants younger than 13 were more likely to receive off-label antipsychotics. Clozapine was prescribed to 45 (7.5%) patients, and more frequently to those hospitalized in non-tertiary facilities (χ2= 8.606, P=0.003) and receiving polytherapy (χ2= 81.488, P<0.001). Patients receiving clozapine had longer length of stay than those who did not (mean (SD): 8.02(4.93) vs 4.35(4.18) weeks, P<0.001).DiscussionOur study showed that most of the FES inpatients were prescribed antipsychotic in monotherapy, in compliance with current guidelines. Deviations from guidelines were found in younger patients with schizophrenia, and in clozapine prescriptions. Different practices were observed between tertiary and non-tertiary hospitals, suggesting possible challenges in delivering mental health care in those facilities where disproportionate distribution of resources might happen. Given the ongoing implementation of the National Mental Health Working Plan, these results provide a useful representation of the current practice in China and could help decision-makers on resource allocation in order to promote the best treatment for first-episode psychosis.

Retinal structural alterations in chronic versus first episode schizophrenia spectrum disorders

Recent studies have found evidence of retinal thinning in schizophrenia spectrum disorder patients; however, it is not known whether retinal thinning is present at the first episode of psychosis or whether it is a result of the progression of the disease or related factors (e.g., emergence of medical comorbidities). We hypothesized that first episode patients (FEP) would not differ on any retinal variables when compared to age matched controls, while chronically ill patients would show evidence of retinal thinning compared to age matched controls. 15 first episode patients, 20 control subjects age-matched to the FEP group, 18 chronically ill patients, and 18 control subjects age-matched to the chronically ill group participated in Spectral Domain OCT scans. We collected data on retinal nerve fiber layer (RNFL) thickness, macula thickness and volume, and ganglion cell-inner plexiform layer (GCL-IPL) thickness as well as cup-to-disc ratio at the optic nerve head. No evidence of retinal structural change was found in the first episode group. In contrast, chronic schizophrenia and schizoaffective disorder patients were characterized by GCL-IPL thinning and overall macula thinning and volume reduction. No evidence of RNFL thinning was observed in the chronic group, however. These data suggest that retinal structure is unaffected very early in the course of schizophrenia spectrum disorders but that thinning is an aspect of illness progression, medical comorbidity, and/or long-term antipsychotic medication use in schizophrenia spectrum disorders. Among retinal indices, macula thickness and volume appear to be the most sensitive to the changes associated with illness chronicity.

Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort - CORRIGENDUM.

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Dissecting the functional outcomes of first episode schizophrenia spectrum disorders: a 10-year follow-up study in the PAFIP cohort.

The aim of the current study was to examine the heterogeneity of functional outcomes in first episode psychosis (FEP) patients and related clinical, neurocognitive and sociodemographic factors using a cluster analytic approach. A large sample of FEP patients (N = 209) was functionally reassessed 10 years after the first contact with an early intervention service. Multiple baseline, 3-year and 10-year follow-up variables were explored. The cluster analysis emphasized the existence of six independent clusters of functioning: one cluster was normal overall (42.16%), two clusters showed moderate interpersonal (9.63%) or instrumental (12.65%) deficits, two clusters showed more severe interpersonal (12.05%) or interpersonal and instrumental (13.85%) deficits and there was a significantly overall impaired cluster (9.63%). Cluster comparisons showed that several baseline and follow-up factors were differentially involved in functional outcomes. The current study demonstrated that distinct clusters of functioning in FEP patients can be identified. The fact that a variety of profiles was observed contributes to a better understanding of the nature of the heterogeneity characterizing FEP patients and has clinical implications for developing individualized treatment plans.

PMH49 PERSONALIZED HEALTHCARE EPISODE IDENTIFICATION IN SCHIZOPHRENIA SPECTRUM DISORDER USING HEALTHCARE CONSUMPTION TRAJECTORIES

Background: Schizophrenia Spectrum Disorder (SSD) patients have repeated symptomatic relapses during their life course. A clear definition of such episodes is required to enable building patient level models describing episode patterns. In current literature, the definitions of relapse and episodes in SSD are mostly based on hospitalisation and occasionally on symptom scales. Hospitalisation rates are affected by deinstitutionalization, hence definitions of episodes should rather depend on healthcare intensity. We present a method for grouping healthcare consumption trajectories into episodes based on individual patterns of healthcare use. Methods: Administrative data describing the daily healthcare consumption of 13155 SSD patients in the Northern Netherlands is available for research. Data was collected between the years 2000 and 2012. Healthcare use costs are calculated using unit costs from a costing manual. We use Exponentially Weighted Moving Average (EWMA) control charts to distinguish two states of healthcare consumption based on intensity. Daily healthcare use weighted by cost is used as healthcare intensity. State transitions are determined on a patient level. The chart is restarted after a detected structural change. The approach is validated by determining the association between the Global Assessment of Functioning (GAF) scale and the episode state. Results: The mean number of episodes was 0.63 per patient per year. For the subsample without hospitalisations this was also 0.63. Average episode durations were similar with 235 and 245 days for the full- and subsample respectively. GAF scores have an inverse relationship with the episode state indicator. Conclusions: The Repeated Exponentially Weighted Moving Average Control Chart (REWMACC), using a daily healthcare intensity signal, is a feasible and promising tool in quantifying patient level SSD healthcare episodes, useful in health economic models to support prevention based healthcare. The results in the subgroup without hospitalizations show that the method is robust towards changes in health care policy.

Factors associated with adherence to guidelines of good clinical practice during hospital treatment of patients with the first episode of schizophrenia spectrum disorders

Background/Aim. Adherence to the guidelines of Good Clinical Practice (GCP) during the treatment of specific disorders is considered a guarantee of the implementation of a uniform, evidence-based clinical practice in psychiatry. The aim of this study was to analyze the concordance of prescribing patterns of antipsychotic drugs with the recommendations of good clinical practice in Serbia and an insight into the effects that introduction of the National Guideline for the Diagnosis and Treatment of Schizophrenia had on the prescribing practice in this area. Methods. Noninterventional, observational study was conducted at the Clinic for Mental Disorders ?Dr Laza Lazarevic? in Belgrade. It included a consecutive sample of 675 previously untreated patients, hospitalized from January 1st, 2012 to December 31st, 2015, dismissed with a discharge diagnosis of any of schizophrenia spectrum disorders. The data about demographic and clinical characteristics of patients, characteristics of prescribers and prescribed antipsychotics were obtained retrospectively, from the patients? medical records. For the analysis of primary data, the descriptive statistical methods and methods for testing statistical hypotheses were used. A method of logistic regression was used to identify the factors associated with adherence to the GCP recommendations. Results. Totaly, 446 (66.1%) of subjects were treated with antipsychotic monotherapy. After the introduction of National Guideline for the Diagnosis and Treatment of Schizophrenia prescribing of second generation antipsychotic monotherapy (78.41% vs. 63.5%, respectively; p &lt; 0.001) increased significantly compared to the previous period. The factors independently associated with adherence to the recommendations of the GCP were the year of hospitalization, the age of the prescriber, and the age and education of the patient. Conclusion. After the introduction of the National Guide to Good Clinical Practice for the Diagnosis and Treatment of Schizophrenia there have been significant, but insufficient changes in the prescribing patterns of antipsychotics during the treatment of the first psychotic episode in Serbia.

Machine learning classification of first-episode schizophrenia spectrum disorders and controls using whole brain white matter fractional anisotropy

BackgroundEarly diagnosis of schizophrenia could improve the outcome of the illness. Unlike classical between-group comparisons, machine learning can identify subtle disease patterns on a single subject level, which could help realize the potential of MRI in establishing a psychiatric diagnosis. Machine learning has previously been predominantly tested on gray-matter structural or functional MRI data. In this paper we used a machine learning classifier to differentiate patients with a first episode of schizophrenia-spectrum disorder (FES) from healthy controls using diffusion tensor imaging.MethodsWe applied linear support-vector machine (SVM) and traditional tract based spatial statistics between group analyses to brain fractional anisotropy (FA) data from 77 FES and 77 age and sex matched healthy controls. We also evaluated the effects of medication and symptoms on the SVM classification.ResultsThe SVM distinguished between patients and controls with significant accuracy of 62.34% (p = 0.005). Participants with FES showed widespread FA reductions relative to controls in a large cluster (N = 56,647 voxels, corrected p = 0.002). The white matter regions, which contributed to the correct identification of participants with FES, overlapped with the regions, which showed lower FA in patients relative to controls. There was no association between the classification performance and medication or symptoms.ConclusionsOur results provide a proof of concept that SVM might help differentiate FES patients early in the course of illness from healthy controls using white-matter fractional anisotropy. As there was no effect of medications or symptoms, the SVM classification seemed to be based on trait rather than state markers and appeared to capture the lower FA in FES participants relative to controls.

T233. Obesity and Brain Age in First Episode of Schizophrenia-Spectrum Disorders – Effects of Antipsychotic Medications

T233. Obesity and Brain Age in First Episode of Schizophrenia-Spectrum Disorders – Effects of Antipsychotic Medications

O11.2. CHANGES IN PSYCHOPATHOLOGY PREDICT CHANGES IN WORKING ALLIANCE IN FIRST EPISODE PSYCHOSIS

BackgroundThe cooperative and dynamic relationship between patients and therapist known as Working Alliance, has in two meta-analysis shown to be an important factor for positive outcome in psychotherapy regardless the modality of therapy. Studies investigating the association between working alliance and outcome conducted in cohorts of patients with mental illness treated in a case manager setting has reported an association between a strong working alliance and reduced symptom severity, better social function, adherence to psycho-social treatment.For this study, we used data from a trial testing the effect of five years of specialized early intervention (SEI) compared to two years of SEI for patients diagnosed with first episode of schizophrenia spectrum disorder. We aimed to study the effect of the intervention on the working alliance and the change in working alliance as a dynamic factor in the two treatment conditions from baseline to follow-up.When extending specialized early intervention from two to five years’ vs transferring to treatment as usual, we hypothesized a change in working alliance and psychopathology favoring the patient in the extended SEI group.MethodsParticipants were recruited from SEI teams (OPUS) in Denmark. All newly diagnosed within the schizophrenia spectrum (ICD-10, F2), age between 18 and 35. Participants were included 1 ½ year after initiation of SEI treatment (baseline) and followed up 5 years after initiation of treatment. At both assessments participants were examined with a comprehensive assessment battery including working alliance, psychopathology, social function, cognitive function, adherence to medication and client satisfaction. Assessors were blind to treatment allocation. The primary outcome, working alliance inventory (WAI), was assessed by self-assessment.A change score was calculated by subtracting the baseline score from the follow-up score. Multivariable linear regression analyses were conducted, corrected for the baseline value of the independent and dependent variable.ResultsOf the 289 participants who attended the follow-up interview 258 (89%) had completed the WAI at baseline and follow-up. Participants who were randomized to prolonged SEI had a stable WA from baseline to follow-up, while participants who were randomized to TAU had a mean drop in WA over the same period.Change in WA was associated with change in negative-, psychotic-, and disorganized symptoms dimension, and social function in the extended OPUS group. In the TAU group, we found that change in WA were negatively associated with change in cognitive function measured with BACS. In both groups, there were an association between the change in WA and change in client satisfaction.DiscussionThis indicates that those participants’ who continued the extended SEI treatment maintained their experiences of a strong WA with their case manager, while those participants who were transferred to TAU experiences a lower degree of WA with their case manager compared to their time in SEI treatment. Furthermore, the participants who increased on their cognitive functioning were less likely to assess WA positively if they were transferred to TAU.

Prospective Relationships Between Motivation and Functioning in Recovery After a First Episode of Schizophrenia

Diminished motivation is associated with robust impairment in psychosocial functioning in schizophrenia (SZ). Little is known about the reciprocal relationships between motivation and functioning, particularly following a first episode of psychosis. We tested bidirectional associations between motivation and social and occupational functioning in the year following a first episode of SZ spectrum disorder among patients in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study. Four hundred four individuals (aged 15-40) who presented with a first episode of SZ spectrum disorder (eg, SZ, schizoaffective or schizophreniform disorder, psychotic disorder not otherwise specified) completed assessments of work and school functioning, social functioning, and motivation at 6- and 12-month follow-up, controlling for assessments at study entry. Controlling for cognition, and psychotic and depressive symptoms measured at each time point, motivation at 6 months was associated with work and school participation at 12 months, but work and school participation at 6 months was not associated with motivation at 12 months. Conversely, social functioning at 6 months was associated with motivation at 12 months, but motivation at 6 months was not associated with social functioning at 12 months. Findings suggest that motivation is associated with later occupational, but not social, functioning in the first year following an initial episode of psychosis. Social functioning, on the other hand, is associated with later motivation. Future intervention trials focused on improving occupational functioning in this population may benefit from targeting patient motivation directly (eg, through motivational interviewing), or indirectly by improving relationships and support networks.

Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: a machine-learning study.

Early diagnosis of schizophrenia could improve the outcomes and limit the negative effects of untreated illness. Although participants with schizophrenia show aberrant functional connectivity in brain networks, these between-group differences have a limited diagnostic utility. Novel methods of magnetic resonance imaging (MRI) analyses, such as machine learning (ML), may help bring neuroimaging from the bench to the bedside. Here, we used ML to differentiate participants with a first episode of schizophrenia-spectrum disorder (FES) from healthy controls based on resting-state functional connectivity (rsFC). We acquired resting-state functional MRI data from 63 patients with FES who were individually matched by age and sex to 63 healthy controls. We applied linear kernel support vector machines (SVM) to rsFC within the default mode network, the salience network and the central executive network. The SVM applied to the rsFC within the salience network distinguished the FES from the control participants with an accuracy of 73.0% (p = 0.001), specificity of 71.4% and sensitivity of 74.6%. The classification accuracy was not significantly affected by medication dose, or by the presence of psychotic symptoms. The functional connectivity within the default mode or the central executive networks did not yield classification accuracies above chance level. Seed-based functional connectivity maps can be utilized for diagnostic classification, even early in the course of schizophrenia. The classification was probably based on trait rather than state markers, as symptoms or medications were not significantly associated with classification accuracy. Our results support the role of the anterior insula/salience network in the pathophysiology of FES.

Social cognition across stages and forms of schizophrenia

IntroductionSocial cognition is considered as a main predictor of functional outcomes and a candidate for endophenotype of schizophrenia. We hypothesize that social cognition capacities follow the course of schizophrenia as a progredient disorder.ObjectiveTo investigate social cognition across different groups of patients with schizophrenia and schizophrenia spectrum disorders.AimsTo evaluate social cognitive impairments in patients with first episode psychoses (FEP), chronic schizophrenia (CS) and schizophrenia-spectrum disorders (SSD).MethodsIn a cross-sectional study, 71 patients with FEP, CS and SSD were assessed with a battery of clinical and social cognitive tests. Three key social cognitive domains were assessed: emotion perception, Theory of Mind and attributional style.ResultsPatients with schizoaffective disorder and schizotypal disorder showed better scores in Hinting task (mean ranks: 47.0 and 39.9 respectively) than patients with less favourable forms of schizophrenia (mean ranks: 24.7 and 30.2 respectively) (P = 0.003). Patients with FEP showed better results in Hinting task (18.1 ± 2.4) versus CS patients (17.4 ± 2.0) (P &lt; 0.05). No differences in emotion perception (Ekman-60 task) among FEP and CS patients were detected. Patients with schizoaffective disorder showed better scores in emotional processing comparing to all forms of schizophrenia patients (mean ranks 49.1 vs. 30.1, 34.5, 28.0, P &lt; 0.05). No significant differences in attributional style were registered.ConclusionsEmotion perception and Theory of Mind domains show different level of impairment across FEP and CS patients and across forms of schizophrenia. Further longitudinal studies to establish how social cognition domains mirror the course and severity of schizophrenia and SSD are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparison of Visuospatial and Verbal Abilities in First Psychotic Episode of Schizophrenia Spectrum Disorder: Impact on Global Functioning and Quality of Life.

Objectives: Deficit in visuospatial functions can influence both simple and complex daily life activities. Despite the fact that visuospatial deficit was reported in schizophrenia, research on visuospatial functions as an independent entity is limited. Our study aims to elucidate the impact of visuospatial deficit in comparison with verbal deficit on global functioning and quality of life in the first psychotic episode of schizophrenia spectrum disorder (FES). The significance of clinical symptoms and antipsychotic medication was also studied.Methods: Thirty-six FES patients and a matched group of healthy controls (HC group) were assessed with a neuropsychological battery focused on visuospatial (VIS) and verbal (VERB) functions. Using multiple regression analysis, we evaluated the cumulative effect of VERB and VIS functions, psychiatric symptoms (PANSS) and antipsychotic medication on global functioning (GAF) and quality of life (WHOQOL-BREF) in the FES group.Results: The FES group demonstrated significant impairment both in VIS and VERB cognitive abilities compared to the HC group. Antipsychotic medication did not significantly affect either VIS or VERB functioning. PANSS was not related to cognitive functioning, apart from the Trail Making Test B. In the FES group, the GAF score was significantly affected by the severity of positive symptoms and VERB functioning, explaining together 60% of GAF variability. The severity of negative and positive symptoms affected only the Physical health domain of WHOQOL-BREF. The degree of VERB deficit was associated with both Physical and Psychological health. Although we did not find any relation between VIS functioning, GAF, and WHOQOL-BREF, a paradoxical finding emerged in the Environment quality domain, where a worse quality of the environment was associated with better VIS functioning.Conclusions: Our results suggest that the deficit in VIS functions is an integral part of cognitive deficit in schizophrenia spectrum disorders, rather than a side effect of symptomatology or antipsychotic medication. Moreover, VERB functioning was a better predictor of GAF and WHOQOL-BREF than VIS functioning. Given the findings of negative or missing effect of VIS deficit on WHOQOL-BREF and GAF, the accuracy of these measures in evaluating the impact of global cognitive deficit on everyday life in schizophrenia could be questioned.