First-episode Psychosis Cohort Research Articles

Recorded Rates of Trauma-Exposure in a Retrospective Epidemiologically Complete First-Episode Psychosis Cohort.

Trauma plays an important role in the development and maintenance of psychosis. However, it is still under-examined in daily clinical practice. The current study investigated the rates of recording of trauma-exposure in the clinical histories of a first-episode psychosis (FEP) cohort attending an early intervention psychosis service. This study used a retrospective chart review methodology in a 6-year epidemiologically complete FEP cohort attending an early intervention psychosis service. The Trauma and Life Events Checklist was used to define the rate and types of trauma-exposure reported in clinical histories. The relationships were examined between recorded trauma-exposure and positive and negative symptoms, depression and duration of untreated psychosis at first assessment. Trauma-exposure was frequently recorded within clinical histories. Childhood trauma-exposure was recorded in 47.4% of the sample, which is lower than may be expected. No significant relationships between the recorded trauma-exposure and symptom measures were found. A significant relationship was found between interpersonal stressors and positive symptoms, and work-related stress and negative symptoms, highlighting the importance of proximal stressful life events. This study found that clinicians were frequently recording trauma-exposure in daily practice. However, it was unclear whether the recording of trauma-exposure highlighted led to systematic diagnosis, assessment or treatment of trauma for people with psychosis. The importance of treatment and service planning to include information about trauma-exposure is discussed.

Long-term clinical recovery and treatment resistance in first-episode psychosis: a 10-year follow-up study

Illness trajectories in people with first-episode psychosis (FEP) vary significantly over time. Identifying early-course parameters predicting outcomes is essential, but long-term data still needs to be provided. We conducted a 10-year follow-up study of a comprehensive first-episode psychosis (FEP) cohort investigating the prevalence of clinical recovery (CR) and treatment resistance (TR) after ten years, as well as clinical, demographic, and pre-illness predictors of long-term outcomes. 102 participants with FEP DSM-IV Schizophrenia spectrum disorders were recruited within their first year of treatment. The Treatment Response and Resistance in Psychosis Working Group (TRRIP) and the Remission in Schizophrenia Working Group (RSWG) criteria were used to define TR and CR, respectively. At 10-year follow-up, 29 (29%) of the participants were classified as in CR, while 32 (31%) were classified as TR. We also identified a larger middle group (n = 41, 40%) consisting of participants in partial recovery. 7% of all participants had tried Clozapine at the 10-year follow-up. Logistic regression analyses identified insidious onset (OR = 4.16) and baseline disorganized symptoms (OR = 2.96) as significantly associated with an increased risk of developing TR. Good premorbid academic adjustment (OR = 1.60) and acute onset (OR = 3.40) were associated with an increased chance of CR. We identified three long-term outcome groups by using recent consensus definitions. We also identified the potential importance of assessing baseline disorganized symptoms and monitoring patients with insidious onset more closely. Further, the findings suggest that clinicians should pay close attention to early-course parameters and provide adequate treatment to improve long-term outcomes of FEP.

Plasma neurofilament light chain is not elevated in people with first-episode psychosis or those at ultra-high risk for psychosis

IntroductionNeurofilament light chain (NfL), a blood biomarker of neuronal injury, shows promise in distinguishing neurodegenerative disorders from psychiatric conditions. This is especially relevant in psychosis, given neurological conditions such as autoimmune encephalitis and Niemann Pick Type C disease (NPC) may initially present with psychotic symptoms. Whilst NfL levels have been studied in established schizophrenia cases, their levels in first-episode psychosis (FEP) and ultra-high risk (UHR) for psychosis individuals remain largely unexplored. This study aimed to compare plasma NfL in people with FEP or UHR with healthy controls, as well as explore its associations with clinical data. MethodWe retrospectively analysed plasma NfL in 63 participants, consisting of 29 individuals with FEP, 10 individuals with UHR, and 24 healthy controls. We used general linear models (GLM), which were bootstrapped, to compute bias-corrected and accelerated (BCa) 95 % confidence intervals (CIs). ResultsMean NfL levels were 5.2 pg/mL in FEP, 4.9 pg/mL in UHR, and 5.9 pg/mL in healthy controls. Compared to healthy controls, there were no significant differences in NfL levels in the FEP group (β = −0.22, 95 % CI [−0.86, 0.39], p = 0.516) nor UHR group (β = −0.37, 95 % CI [−0.90, 0.19], p = 0.182). There were no significant associations between NfL levels and clinical variables in the FEP group. DiscussionOur study is the first to demonstrate that plasma NfL levels are not significantly elevated in individuals at UHR for psychosis compared to healthy controls, a finding also observed in the FEP cohort. These findings bolster the potential diagnostic utility of NfL in differentiating between psychiatric and neurodegenerative disorders.

An exploratory study of psychosis risk factors in individuals who are referred but do not meet criteria for an early intervention in psychosis service.

The 'at-risk mental state' (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk. To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria. A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period. From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort. This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.

Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use

Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15–25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.

Exploration of cannabis use and polygenic risk scores on the psychotic symptom progression of a FEP cohort

Cannabis use is highly prevalent in first-episode psychosis (FEP) and plays a critical role in its onset and prognosis, but the genetic underpinnings promoting both conditions are poorly understood. Current treatment strategies for cannabis cessation in FEP are clearly inefficacious. Here, we aimed to characterize the association between cannabis-related polygenic risk scores (PRS) on cannabis use and clinical course after a FEP. A cohort of 249 FEP individuals were evaluated during 12 months. Symptom severity was measured with the Positive and Negative Severity Scale and cannabis use with the EuropASI scale. Individual PRS for lifetime cannabis initiation (PRSCI) and cannabis use disorder (PRSCUD) were constructed. Current cannabis use was associated with increased positive symptoms. Cannabis initiation at younger ages conditioned the 12-month symptom progression. FEP patients with higher cannabis PRSCUD reported increased baseline cannabis use. PRSCI was associated with the course of negative and general symptomatology over follow-up. Cannabis use and symptom progression after a FEP were modulated by cannabis PRS, suggesting that lifetime initiation and use disorders may have partially independent genetic factors. These exploratory results may be the first step to identify those FEP patients more vulnerable to cannabis use and worse outcomes to ultimately develop tailored treatments.

Blood–brain barrier dysfunction and folate and vitamin B12 levels in first-episode schizophrenia-spectrum psychosis: a retrospective chart review

Vitamin deficiency syndromes and blood–brain barrier (BBB) dysfunction are frequent phenomena in psychiatric conditions. We analysed the largest available first-episode schizophrenia-spectrum psychosis (FEP) cohort to date regarding routine cerebrospinal fluid (CSF) and blood parameters to investigate the association between vitamin deficiencies (vitamin B12 and folate) and BBB impairments in FEP. We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with an ICD-10 diagnosis of a first-episode F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture, blood-based vitamin status diagnostics and neuroimaging within the clinical routine. 222 FEP patients were included in our analyses. We report an increased CSF/serum albumin quotient (Qalb) as a sign of BBB dysfunction in 17.1% (38/222) of patients. White matter lesions (WML) were present in 29.3% of patients (62/212). 17.6% of patients (39/222) showed either decreased vitamin B12 levels or decreased folate levels. No statistically significant association was found between vitamin deficiencies and altered Qalb. This retrospective analysis contributes to the discussion on the impact of vitamin deficiency syndromes in FEP. Although decreased vitamin B12 or folate levels were found in approximately 17% of our cohort, we found no evidence for significant associations between BBB dysfunction and vitamin deficiencies. To strengthen the evidence regarding the clinical implications of vitamin deficiencies in FEP, prospective studies with standardized measurements of vitamin levels together with follow-up measurements and assessment of symptom severity in addition to CSF diagnostics are needed.

First episode psychosis during the Covid-19 pandemic in Milan, Italy: Diagnostic outcomes at 1-year follow-up

An influence of the Covid-19 pandemic on First Episode Psychosis (FEP) has been hypothesized. We previously reported an increase of FEP during the early stages of the pandemic in Milan, Italy. Here we report a 1-year follow-up of the same cohort and comparison with a FEP cohort from 2019. The higher proportion of non-chronic psychoses observed during the pandemic (58.62% in 2020 vs 43,75% in 2019) should be confirmed in larger cohorts over a longer follow-up period.

Polygenic risk scores enhance prediction of body mass index increase in individuals with a first episode of psychosis.

Individuals with a first episode of psychosis (FEP) show rapid weight gain during the first months of treatment, which is associated with a reduction in general physical health. Although genetics is assumed to be a significant contributor to weight gain, its exact role is unknown. We assembled a population-based FEP cohort of 381 individuals that was split into a Training (n=224) set and a Validation (n=157) set to calculate the polygenic risk score (PRS) in a two-step process. In parallel, we obtained reference genome-wide association studies for body mass index (BMI) and schizophrenia (SCZ) to examine the pleiotropic landscape between the two traits. BMI PRSs were added to linear models that included sociodemographic and clinical variables to predict BMI increase (∆BMI) in the Validation set. The results confirmed considerable shared genetic susceptibility for the two traits involving 449 near-independent genomic loci. The inclusion of BMI PRSs significantly improved the prediction of ∆BMI at 12months after the onset of antipsychotic treatment by 49.4% compared to a clinical model. In addition, we demonstrated that the PRS containing pleiotropic information between BMI and SCZ predicted ∆BMI better at 3 (12.2%) and 12months (53.2%). We prove for the first time that genetic factors play a key role in determining ∆BMI during the FEP. This finding has important clinical implications for the early identification of individuals most vulnerable to weight gain and highlights the importance of examining genetic pleiotropy in the context of medically important comorbidities for predicting future outcomes.

Need adapted use of medication in the open dialogue approach for psychosis: a descriptive longitudinal cohort study

ABSTRACT Background The open dialogue (OD) approach includes the need-adapted use of psychiatric medication in treating first-episode psychosis (FEP), but there is limited information on how psychiatric medications are actually used in OD-based services. This study aims to analyse long-term medication dispensing patterns among FEP cohort treated according to the OD. Methods The OD cohort consisted of people who received treatment for FEP in the Finnish Western Lapland catchment area at a time of OD implementation (n=61). The comparison group included people whose FEP treatment commenced outside the catchment area during the mid-1990s (n=1378). Data were gathered from national registers from onset to the end of the 10-year follow-up or death. A non-confirmatory descriptive comparison was performed to evaluate the usage patterns and cumulative exposure to psychiatric medication. Results Under OD, a smaller proportion had been dispensed benzodiazepines, antidepressants, and neuroleptics. Persons who had received these medications did not differ in cumulative exposure. In both groups, most of those who received neuroleptics in the first follow-up years continued using medication throughout follow-up. Discussion OD may assist in detecting FEP patients who can manage without neuroleptics, thus minimizing iatrogenic effects. Due to the observational design, further studies are required to confirm this hypothesis.

Co-occurring first-episode psychosis and borderline personality pathology in an early intervention for psychosis cohort.

Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under-recognized and under-researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP); (ii) demographic and clinical factors associated with FEP + BPP; (iii) the symptomatic and functional outcomes. This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30-month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM-IV Axis II Personality Questionnaire BPD criteria. In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian-born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self-harm throughout the follow-up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care. BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed.

Metabolic polygenic risk scores effect on antipsychotic-induced metabolic dysregulation: A longitudinal study in a first episode psychosis cohort

ObjectiveMetabolic syndrome is a health-threatening condition suffered by approximately one third of schizophrenia patients and largely attributed to antipsychotic medication. Previous evidence reports a common genetic background of psychotic and metabolic disorders. In this study, we aimed to assess the role of polygenic risk scores (PRSs) on the progression of the metabolic profile in a first-episode psychosis (FEP) cohort. MethodOf the 231 FEP individuals included in the study, 192–220 participants were included in basal analysis and 118–179 in longitudinal 6-month models. Eleven psychopathologic and metabolic PRSs were constructed. Basal and longitudinal PRSs association with metabolic measurements was assessed by statistical analyses. ResultsNo major association of psychopathological PRSs with the metabolic progression was found. However, high risk individuals for depression and cholesterol-related PRSs reported a higher increase of cholesterol levels during the follow-up (FDR ≤ 0.023 for all analyses). Their effect was comparable to other well-established pharmacological and environmental risk factors (explaining at least 1.2% of total variance). ConclusionOur findings provide new evidence of the effects of metabolic genetic risk on the development of metabolic dysregulation. The future establishment of genetic profiling tools in clinical procedures could enable practitioners to better personalize antipsychotic treatment selection and dosage.

The effects of childhood adversity on treatment delays and its components in first-episode psychosis

Apart from increasing risk for psychotic disorders, childhood adversity has been associated with worse outcomes. One way in which childhood adversity may worsen outcomes is by lengthening treatment delays, which are associated with negative impacts. We tested the influence of childhood trauma on treatment delays, measured as the duration of untreated psychosis (DUP), and its help-seeking and referral components, in a first-episode psychosis cohort (N = 203). We accounted for pertinent social (e.g., migrant status) and other determinants (i.e., age at onset, diagnosis, symptoms) of treatment delays. Multiple linear regression analyses revealed that for a one-unit increase in Childhood Trauma Questionnaire (CTQ) scores, average overall DUP increased by 25%. Higher CTQ scores also significantly predicted help-seeking and referral DUPs. Patients with schizophrenia-spectrum psychosis had longer help-seeking and total DUPs than those with affective psychosis. More severe positive symptoms predicted longer help-seeking DUPs, while more severe negative symptoms predicted longer referral DUPs. Indicators of social disadvantage did not affect DUP. Our results show that childhood trauma increases DUP by prolonging the help-seeking process and delaying access to mental healthcare even after help is sought. Early identification of psychosis among populations with trauma histories seems warranted and can likely positively impact outcomes.

Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables

ObjectiveTo study the prevalence and the type of childhood trauma (CT) in a first-episode psychosis (FEP) cohort and in a healthy control (HC) sample. To study which clinical and sociodemographic variables in the onset of the FEP are related to having suffered some traumatic experience in childhood. Method100 FEP patients and 94 HC participated in the study. The Childhood Traumatic Questionnaire (CTQ) was used to evaluate CT. The Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance (PSP), the Suicide Risk Scale of Plutchik (SRSP), and the Perceived Stress Scale (PSS) were also administered. Results61% of FEP patients and 17% of HC reported having experienced some kind of CT. FEP showed more CT than controls in all subscales, except in sexual abuse. The most frequent CT was emotional abuse. For the FEP group, younger age, more years of education, have a first-degree family history, more positive and negative symptoms, more perceived stress and more personal and social functioning were the variables more influenced by having suffered some kind of CT. ConclusionsThere is a high prevalence of CT in FEP patients. Having a first-degree family history of mental illness, more positive symptoms, and more perception of stress at the time of hospital admission were related to having suffered CT. More research is needed to find out the best way to detect CT and its role in psychosis to be able to implement interventions to improve the evolution of these patients.

Editors' Note: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis

In “Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis,” Guasp et al. and the Barcelona group reported that 21 of 105 patients with first-episode psychosis (FEP) met the criteria by Pollak et al. for possible or probable autoimmune psychosis (AP), none of whom had autoimmune antibodies or developed NMDAR encephalitis. In a separate cohort, 2 of 3 patients referred for a second opinion with FEP who had NMDA receptor antibodies did not meet the criteria by Pollak et al. for possible AP. They concluded that the criteria by Pollak et al. are overly dependent on neurologic features and propose their own algorithmic approach to screen for AP, which includes the performance of MRI, EEG, and testing for serum neuronal antibodies for all patients with FEP even in the absence of neurologic warning symptoms. Pollak et al. commented that all 3 patients in the one FEP cohort with autoimmune antibodies, in fact, met the criteria for possible AP because of the presence of a movement disorder and/or cognitive dysfunction. Furthermore, they questioned the recommendation by Guasp et al. to perform an extensive workup in the setting of FEP without neurologic symptoms because of concern that this is not only a poor use of resources but it is also not feasible in most psychiatric settings. Dalmau et al. and the Barcelona group respond that (1) although echolalia is one of the 12 features of catatonia, it can be present independently and (2) because there is a broad differential diagnosis for FEP, which includes systemic, neurologic, and psychiatric disorders, facilities that care for patients with FEP must be able to perform a thorough diagnostic evaluation themselves or transfer patients elsewhere. In “Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis,” Guasp et al. and the Barcelona group reported that 21 of 105 patients with first-episode psychosis (FEP) met the criteria by Pollak et al. for possible or probable autoimmune psychosis (AP), none of whom had autoimmune antibodies or developed NMDAR encephalitis. In a separate cohort, 2 of 3 patients referred for a second opinion with FEP who had NMDA receptor antibodies did not meet the criteria by Pollak et al. for possible AP. They concluded that the criteria by Pollak et al. are overly dependent on neurologic features and propose their own algorithmic approach to screen for AP, which includes the performance of MRI, EEG, and testing for serum neuronal antibodies for all patients with FEP even in the absence of neurologic warning symptoms. Pollak et al. commented that all 3 patients in the one FEP cohort with autoimmune antibodies, in fact, met the criteria for possible AP because of the presence of a movement disorder and/or cognitive dysfunction. Furthermore, they questioned the recommendation by Guasp et al. to perform an extensive workup in the setting of FEP without neurologic symptoms because of concern that this is not only a poor use of resources but it is also not feasible in most psychiatric settings. Dalmau et al. and the Barcelona group respond that (1) although echolalia is one of the 12 features of catatonia, it can be present independently and (2) because there is a broad differential diagnosis for FEP, which includes systemic, neurologic, and psychiatric disorders, facilities that care for patients with FEP must be able to perform a thorough diagnostic evaluation themselves or transfer patients elsewhere.

Metabolic parameters as possible diagnostic predictors in first-episode psychosis: An exploratory retrospective cohort study.

Patients in early phases of schizophrenia or mood disorders with psychotic symptoms have a wide array of metabolic abnormalities. We analysed the potential predictive value of uric acid (UA) levels and other metabolic parameters in first-episode psychosis patients to differentiate between non-affective and affective psychosis. Retrospective chart review of all patients referenced to a first-episode psychosis unit (n = 149), between 2012 and 2017, with available UA levels. Patients included (n= 37) were compared according to the follow-up diagnosis of schizophrenia or mood disorder. Mood disorder patients presented higher UA levels (p= .030) and lower fasting blood glucose levels (p= .020) compared with schizophrenia patients. The remaining variables did not show significant intergroup differences. Findings in this first-episode psychosis cohort support previous evidence suggesting higher UA levels as a predictor of affective psychosis and glucose dysfunction as predictive of schizophrenia. Further studies are needed to explore metabolic parameters as possible diagnostic predictors in first-episode psychosis.

Cerebrospinal Fluid Pathologies in Schizophrenia-Spectrum Disorder-A Retrospective Chart Review.

The role of inflammatory processes in the etiology of schizophrenia is increasingly being investigated. A link between psychosis and inflammation measured with different biomarkers has been reported in the literature and needs to be further explored. To investigate the presence of inflammatory biomarkers in first-episode psychosis (FEP) we analyzed the largest available FEP cohort to date regarding routine CSF and blood diagnostics. We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with a ICD-10 diagnosis of F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture. A total of n = 314 FEP patients were included in our sample. 42.7% patients (134/314) showed cerebrospinal fluid (CSF) alterations. Oligoclonal bands in the CSF were present in 21.8% of patients (67/307) with 12.4% (27/217) of patients presenting OCBs type 2 or 3. 15.8% (49/310) of our cohort revealed signs of blood-brain-barrier (BBB) dysfunction with increased albumin ratios. Mean serum CRP levels were 2.4 mg/l (SD = 9.5). CRP elevation was present in 116/280 cases (41.4%). This large retrospective analysis on FEP cohort greatly enriches the clinical data available on this population and contributes to the discussion around inflammation in psychosis. Of note, even though several inflammatory alterations were found both in CSF and in blood tests, we found no evidence for a significant relationship between peripheral inflammation and inflammatory CSF. Furthermore, no significant relationship between CSF alterations and peripheral inflammation measured with CRP could be established.

Clozapine prescribing during follow-up of a first-episode psychosis cohort

IntroductionOf those with schizophrenia, one third develop treatment-resistant illness. Nearly 60% of these benefit from clozapine- the only antipsychotic medication licensed in this group.ObjectivesAs treatment-resistant illness developed in the follow-up of a first-episode psychosis (FEP) cohort, clozapine was prescribed. This study retrospectively compared the clozapine prescribing patterns, within this cohort, to National Institute for Health and Care Excellence (NICE) guidelines. In addition, impact on hospitalisation, physical health monitoring and augmentation strategies employed following clozapine initiation were examined. Factors delaying initiation of clozapine treatment or contributing to its discontinuation were also explored.MethodsThe study included 339 individuals resident within an Irish community mental health team catchment area, referred with FEP from 1 January 2005 to 31 August 2016. Data were extracted from electronic medical records.ResultsWithin the cohort, clozapine was prescribed to 32 individuals (9.4%). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). Following initiation of clozapine, mean hospital admissions per year fell from 2.3 to 0.3 (p=0.00). Mean inpatient days pre- and post-clozapine also decreased (147 vs. 53; p=0.00). In all, 18 patients ceased use of clozapine, 5 temporarily and 13 permanently.ConclusionsPatients are being prescribed clozapine earlier than previously demonstrated. However, delayed treatment remains common, and many patients discontinue clozapine. Further research is necessary to describe and address factors which contribute to its discontinuation.DisclosureNo significant relationships.

Trajectories of suicidal ideation after first-episode psychosis: a growth mixture modeling approach.

The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. We identified three distinct trajectories: Non-SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow-up assessments. Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at-risk population.

Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis.

Being able to predict functional outcomes after First-Episode Psychosis (FEP) is a major goal in psychiatry. Thus, we aimed to identify trajectories of psychosocial functioning in a FEP cohort followed-up for 2 years in order to find premorbid/baseline predictors for each trajectory. Additionally, we explored diagnosis distribution within the different trajectories. A total of 261 adults with FEP were included. Latent class growth analysis identified four distinct trajectories: Mild impairment-Improving trajectory (Mi-I) (38.31% of the sample), Moderate impairment-Stable trajectory (Mo-S) (18.39%), Severe impairment-Improving trajectory (Se-I) (12.26%), and Severe impairment-Stable trajectory (Se-S) (31.03%). Participants in the Mi-I trajectory were more likely to have higher parental socioeconomic status, less severe baseline depressive and negative symptoms, and better premorbid adjustment than individuals in the Se-S trajectory. Participants in the Se-I trajectory were more likely to have better baseline verbal learning and memory and better premorbid adjustment than those in the Se-S trajectory. Lower baseline positive symptoms predicted a Mo-S trajectory vs. Se-S trajectory. Diagnoses of Bipolar disorder and Other psychoses were more prevalent among individuals falling into Mi-I trajectory. Our findings suggest four distinct trajectories of psychosocial functioning after FEP. We also identified social, clinical, and cognitive factors associated with more resilient trajectories, thus providing insights for early interventions targeting psychosocial functioning.