First-episode Psychosis Group Research Articles

Brain structural correlates of functional capacity in first-episode psychosis

Impaired functional capacity is a core feature of schizophrenia and presents even in first-episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is less clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor, but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in FEP using MRI and a reliable objective measure of functioning [University of California, San Diego Performance-Based Skills Assessment (UPSA)]. In a sample of FEP (n = 39) and a well-matched control group (n = 21), we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) within brain regions implicated by previous work. The FEP group had thinner cortex in various frontal regions and fusiform, and reduced FA in inferior longitudinal fasciculus (ILF). In FEP, poorer functional capacity correlated with reduced superior frontal volume and lower FA in left ILF. Importantly, frontal brain volumes and integrity of the ILF were identified as the structural correlates of functional capacity in FEP, controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.

Lower speech connectedness linked to incidence of psychosis in people at clinical high risk

BackgroundFormal thought disorder is a cardinal feature of psychotic disorders, and is also evident in subtle forms before psychosis onset in individuals at clinical high-risk for psychosis (CHR-P). Assessing speech output or assessing expressive language with speech as the medium at this stage may be particularly useful in predicting later transition to psychosis. MethodSpeech samples were acquired through administration of the Thought and Language Index (TLI) in 24 CHR-P participants, 16 people with first-episode psychosis (FEP) and 13 healthy controls. The CHR-P individuals were then followed clinically for a mean of 7 years (s.d. = 1.5) to determine if they transitioned to psychosis. Non-semantic speech graph analysis was used to assess the connectedness of transcribed speech in all groups. ResultsSpeech was significantly more disconnected in the FEP group than in both healthy controls (p < .01) and the CHR-P group (p < .05). Results remained significant when IQ was included as a covariate. Significant correlations were found between speech connectedness measures and scores on the TLI, a manual assessment of formal thought disorder. In the CHR-P group, lower scores on two measures of speech connectedness were associated with subsequent transition to psychosis (8 transitions, 16 non-transitions; p < .05). ConclusionThese findings support the utility and validity of speech graph analysis methods in characterizing speech connectedness in the early phases of psychosis. This approach has the potential to be developed into an automated, objective and time-efficient way of stratifying individuals at CHR-P according to level of psychosis risk.

A multimodal magnetoencephalography 7\u2009T fMRI and 7\u2009T proton MR spectroscopy study in first episode psychosis

We combined magnetoencephalography (MEG), 7 T proton magnetic resonance spectroscopy (MRS), and 7 T fMRI during performance of a task in a group of 23 first episode psychosis (FEP) patients and 26 matched healthy controls (HC). We recorded both the auditory evoked response to 40 Hz tone clicks and the resting state in MEG. Neurometabolite levels were obtained from the anterior cingulate cortex (ACC). The fMRI BOLD response was obtained during the Stroop inhibitory control task. FEP showed a significant increase in resting state low frequency theta activity (p < 0.05; Cohen d = 0.69), but no significant difference in the 40 Hz auditory evoked response compared to HC. An across-groups whole brain analysis of the fMRI BOLD response identified eight regions that were significantly activated during task performance (p < 0.01, FDR-corrected); the mean signal extracted from those regions was significantly different between the groups (p = 0.0006; d = 1.19). In the combined FEP and HC group, there was a significant correlation between the BOLD signal during task performance and MEG resting state low frequency activity (p < 0.05). In FEP, we report significant alteration in resting state low frequency MEG activity, but no alterations in auditory evoked gamma band response, suggesting that the former is a more robust biomarker of early psychosis. There were no correlations between gamma oscillations and GABA levels in either HC or FEP. Finally, in this study, each of the three imaging modalities differentiated FEP from HC; fMRI with good and MEG and MRS with moderate effect size.

Influence of BDNF and MTHFR polymorphisms on hippocampal volume in first-episode psychosis

BackgroundThe BDNF and MTHFR genes are independently linked to the pathogenesis of schizophrenia and its neuroimaging correlates. The aim of this study was to explore, for the first time, the individual and interactional effects of the Val66Met and C677T polymorphisms on hippocampal atrophy in first-episode psychosis (FEP). MethodMulti-site case-control study based on clinical, genetic (rs 6265, rs 1801133) and structural magnetic resonance imaging data from 98 non-affective FEP patients and 117 matched healthy controls (HC). Hippocampal volume was estimated using FreeSurfer software and this volume was compared between diagnostic (FEP vs HC) and genotype (Val66Met, C677T) groups. The BDNF Val66Met x MTHFR C677T effect on hippocampal volume was further evaluated through stratified analyses. ResultsAfter applying Bonferroni correction, diagnosis showed a significant effect for adjusted left and right hippocampal volume (FEP < HC). Stratified analyses showed that the interactive effect contributed to adjusted hippocampal size in both the HC (left and right hippocampus) and FEP groups (right hippocampus); among BDNF Met carriers, those with the CT-TT genotype exhibited decreased hippocampal volume compared to individuals with the homozygous normal CC genotype. ConclusionsOur results provide preliminary evidence indicating that the Val66Met x C677T interaction may be a potential genetic risk factor for reduced hippocampal size in both healthy controls and in patients with FEP. Further research in independent samples including different ethnic groups is warranted to confirm this new finding.

Brain-derived neurotrophic factor levels and psychopathology scores in drug-naïve first-episode psychosis.

Brain-derived neurotrophic factor (BDNF) is involved in the regulation of many neuronal processes, including neurogenesis. Therefore, it is thought to be closely associated with many psychopathologies with a neurodevelopmental basis, for example, schizophrenia. The patients admitted to the Psychiatry Department of the Faculty of Medicine with a diagnosis of non-affective drug-naïve first-episode psychosis (FEP) were included in the study. The relationship between laboratory and clinical findings and psychometric data (Positive and Negative Syndrome Scale) was examined. The study population consisted of 34 FEP and 34 healthy control (HC) volunteers. Mean BNDF levels of FEP and HC groups were 14.95 ± 6.13 and 17.89 ± 4.84 pg/ml, respectively. The difference between the groups was statistically significant (t = 2.197; p = .032). There was a negative correlation between mean BDNF levels and PANSS general psychopathology subscale scores (r = .358; p = .038), and total PANSS scores (r = .356; p = .039). There is a consensus on low serum BDNF levels both in FEP and in schizophrenia. However, it is still not clear which clinical findings are associated with lower serum BDNF levels. The relationship between BDNF levels and psychopathologies in schizophrenia has to be investigated.

Plasma prolidase levels are high in schizophrenia but not in first-episode psychosis.

An increasing number of studies have focussed on the neurobiology of schizophrenia (SCH), contributing to a better understanding of this disorder. Prolidase is a metalloprotease found in various tissues, which has been associated with the concentrations of proline, a neurotransmitter, in the brain. There is evidence to suggest that elevated proline levels play a role in SCH. The aim of the present study was to compare plasma proline levels in patients with drug-naive first-episode psychosis (FEP) and in those with SCH. Patients diagnosed with FEP (n = 26) and SCH (n = 26) were recruited for this study, in addition to healthy control volunteers (n = 26). Plasma prolidase levels were found to be elevated in the SCH group compared to drug-naive FEP and healthy control groups. This finding indicates that prolidase levels are higher in SCH patients, while levels in patients with drug-naive FEP are similar to those of healthy control. Follow-up studies are needed to provide a better understanding of prolidase in the etiopathogenesis of SCH.

Machine-learning classification using neuroimaging data in schizophrenia, autism, ultra-high risk and first-episode psychosis

Neuropsychiatric disorders are diagnosed based on behavioral criteria, which makes the diagnosis challenging. Objective biomarkers such as neuroimaging are needed, and when coupled with machine learning, can assist the diagnostic decision and increase its reliability. Sixty-four schizophrenia, 36 autism spectrum disorder (ASD), and 106 typically developing individuals were analyzed. FreeSurfer was used to obtain the data from the participant’s brain scans. Six classifiers were utilized to classify the subjects. Subsequently, 26 ultra-high risk for psychosis (UHR) and 17 first-episode psychosis (FEP) subjects were run through the trained classifiers. Lastly, the classifiers’ output of the patient groups was correlated with their clinical severity. All six classifiers performed relatively well to distinguish the subject groups, especially support vector machine (SVM) and Logistic regression (LR). Cortical thickness and subcortical volume feature groups were most useful for the classification. LR and SVM were highly consistent with clinical indices of ASD. When UHR and FEP groups were run with the trained classifiers, majority of the cases were classified as schizophrenia, none as ASD. Overall, SVM and LR were the best performing classifiers. Cortical thickness and subcortical volume were most useful for the classification, compared to surface area. LR, SVM, and DT’s output were clinically informative. The trained classifiers were able to help predict the diagnostic category of both UHR and FEP Individuals.

A study in first-episode psychosis patients: does angiotensin I-converting enzyme (ACE) activity associated with genotype predict symptoms severity reductions after treatment with the atypical antipsychotic risperidone?

BackgroundOur previous studies showed increased angiotensin I-converting enzyme (ACE) activity in chronic schizophrenia patients compared with healthy control (HC) volunteers, and the relevance of combining ACE genotype and activity for predicting schizophrenia was suggested.MethodsACE activity was measured in plasma of ACE insertion/deletion (I/D) genotyped HC volunteers (n = 53) and antipsychotic-naïve first-episode psychosis (FEP) patients (n = 45) assessed at baseline (FEB-B) and also after 2 months (FEP-2M) of treatment with the atypical antipsychotic risperidone.ResultsACE activity measurements showed significant differences among HC, FEP-B, and FEP-2M groups (F = 5.356, df = 2, P = .005) as well as between HC and FEP-2M (post-hoc Tukey’s multiple comparisons test, P = .004). No correlation was observed for ACE activity increases and symptom severity reductions in FEP as assessed by total Positive and Negative Syndrome Scale (r = −0.131, P = .434). FEP subgrouped by ACE I/D genotype showed significant ACE activity increases, mainly in the DD genotype subgroup. No correlation between ACE activity and age was observed in FEP or HC groups separately (r = 0.210, P = .392), but ACE activity level differences observed between these groups were influenced by age.ConclusionsThe importance of measuring the ACE activity in blood plasma, associated with ACE I/D genotyping to support the follow-up of FEP patients, did not show correlation with general symptom amelioration in the present study. However, new insights into the influence of age and I/D genotype for ACE activity changes in FEP individuals upon treatment was demonstrated.

Progressive Impairment of Mismatch Negativity Is Reflective of Underlying Pathophysiological Changes in Patients With First-Episode Psychosis.

BackgroundAlthough mismatch negativity (MMN) is associated with the pathophysiology of schizophrenia, whether MMN progressively worsens during the initial years of psychotic disorder has not yet been sufficiently studied. We aimed to investigate whether longitudinal reduction of MMN occurs in patients with first-episode psychosis (FEP) and whether it is reflective of change in cognitive functioning or clinical status.MethodsMMN and the clinical status of 25 patients with FEP were measured and the Trail Making Test (TMT) was administered at baseline and reassessed after 1 year of usual treatment. The MMN of 25 matched healthy controls (HCs) was measured at baseline. Repeated-measures analysis of variance was used to compare MMNs at baseline among the groups, and paired t-test was utilized to compare the baseline and 1-year MMN amplitudes of FEP patients. To identify the association between changes in MMN and changes in cognitive, symptomatic, or functional status over 1 year, multiple regression analysis was used to control for other possible confounders.ResultsMMN amplitudes at baseline were significantly attenuated in FEP patients compared to those in HC. The 1-year follow-up MMN amplitude decreased significantly at the Fz electrode site in the FEP group. Additionally, the decreased MMN amplitude significantly correlated with worsened TMT part B (TMT-B) performance over 1 year but did not correlate with symptomatic or functional improvement.ConclusionsFEP patients with an MMN amplitude reduction showed worsening of cognitive functioning, which might reflect pathophysiological progression during the early years of a psychotic episode.

Clinical and cognitive correlates of childhood attention-deficit/hyperactivity disorder in first-episode psychosis: A controlled study

The relationship between childhood attention-deficit/hyperactivity disorder (c-ADHD) and psychosis has been understudied. Cognitive dysfunction is a core feature of both disorders, but no previous study has investigated whether first-episode psychosis (FEP) with c-ADHD (FEP-ADHD+) presents a different cognitive profile than FEP without c-ADHD (FEP-ADHD−). One hundred and thirty-three FEP outpatients were screened for c-ADHD through a diagnostic interview and underwent a comprehensive clinical and cognitive assessment with the MATRICS Consensus Cognitive Battery (MCCB). Cognitive differences among FEP groups, and a group of 65 healthy controls (HCs) were analysed by multivariate analysis of covariance. Nearly 25% of FEP fulfilled criteria for c-ADHD. Both FEP groups performed worse than HCs in speed processing, executive function and social cognition, but only the FEP-ADHD+group was significantly more impaired than the HC group in attention (F = 4.35; p = 0.04). Only the Trail Making Test A (TMT-A) (F = 6.99; p = 0.01) within the domain of processing speed and the Neuropsychological Assessment Battery (NAB) (F = 6.46; p = 0.01) within the domain of executive function reliably differentiated the two clinical groups. The FEP groups did not differ in the severity of psychopathology, but the FEP-ADHD+reported fewer years of education than the FEP-ADHD− and were more likely to use tobacco and cannabis and to require higher doses of antipsychotics to achieve a clinical response. In conclusion, we found a gradient of severity in cognitive performance between groups, with FEP-ADHD+ having the greatest cognitive impairment. Our results suggest that FEP-ADHD+ represents a subgroup with a worse prognosis than FEP-ADHD−.

M175. BRAIN STRUCTURAL CORRELATES OF FUNCTIONAL CAPACITY IN FIRST-EPISODE PSYCHOSIS

BackgroundImpaired functional capacity is a core feature of schizophrenia and present even in first episode psychosis (FEP) patients. Impairments in daily functioning tend to persist despite antipsychotic therapy but their neural basis is not clear. Previous studies suggest that volume loss in frontal cortex might be an important contributor but findings are inconsistent. We aimed to comprehensively investigate the brain structural correlates of functional capacity in first episode psychosis using MRI and a reliable objective measure of functioning (University of California, San Diego Performance-Based Skills Assessment (UPSA))MethodsIn FEP and a well-matched control group, we measured cortical thickness, gray matter volume, and white matter tract integrity (fractional anisotropy, FA) in specific regions implicated by previous work. Between-group differences in these parameters were assessed first. We then examined correlations between MRI measures and UPSA scores in the FEP group while controlling for negative symptomology and medication use.ResultsThe FEP group had thinner cortex in various frontal regions, fusiform, and insula, and reduced FA in inferior longitudinal fasciculus. In FEP, poorer functioning (UPSA) correlated with reduced superior frontal volume and lower FA in inferior longitudinal fasciculus.DiscussionIn accordance with previous findings, FEP exhibited widespread brain structural differences compared to controls. Importantly, frontal brain volumes and integrity of the inferior longitudinal fasciculus were identified as the structural correlates of functional capacity in FEP, after controlling for other relevant factors. These findings enhance mechanistic understanding of functional capacity deficits in schizophrenia by specifying the underlying neural correlates. In future, this could help inform intervention strategies.

S46. IMPAIRED ERROR-PROCESSING IN PATIENTS WITH FIRST-EPISODE PSYCHOSIS: AN EVENT-RELATED POTENTIAL STUDY

BackgroundImpaired error/conflict monitoring as reflected in the event-related potentials (ERPs) has consistently reported in patients with schizophrenia. However, whether this impairment exist from the early phase of psychosis such as first-episode psychosis (FEP) is not yet been clearly reported. To investigate the presence of error/conflict monitoring deficit in early psychosis, we examined the error-related negativity (ERN), error-related positivity (Pe), and correct-response negativity (CRN) during the Go/Nogo task in the patients with FEP.Methods25 patients with and 25 age, sex matched healthy controls (HCs) were participated in electroencephalographic recording during the Go/Nogo task. Trials with error response was analyzed to define ERN at Fz electrode site and Pe at Pz electrode site. Trials with correct response was used for CRN analysis at Fz electrode site. Independent samples t-test was used to compare the amplitudes of ERP components between FEP and HC groups. Pearson’s correlation analysis was performed to reveal the relationship of altered ERP component with symptomatic severity in patients with schizophrenia.ResultsFEP patients showed significantly smaller ERN amplitude at Fz electrode site compared to HCs (t=-3.294, p=0.002). However, there was no difference of CRN (t=0.017, p=0.986) and Pe (t=1.806, p=0.077) amplitudes between FEP and HC groups. There was no significant correlation of symptomatic severity and ERN amplitude at Fz electrode site in FEP patients.DiscussionThese findings suggest that impairments in error/conflict monitoring as reflected by ERN amplitude exist from the early course of psychotic disorder. Future study with larger sample size and subjects at earlier phase such as clinical high risk for psychosis would be needed to confirm the findings of current study.

M134. MISMATCH NEGATIVITY IS REFLECTIVE OF DISEASE PROGRESSION RATHER THAN SYMPTOMATIC RECOVERY IN FIRST-EPISODE PSYCHOSIS

BackgroundWhether mismatch negativity (MMN) is associated with clinical status or reflects the disease progression in first-episode psychosis (FEP) patients has not been established. We aimed to investigate whether the change in MMN impairment fluctuates with the change in clinical status during 1-year.MethodsMMN and the clinical status of 25 patients with FEP were measured at baseline and reassessed after 1 year. MMN of 25 matched healthy controls (HCs) were measured at baseline. Repeated-measures analysis of variance (ANOVA) was used to compare MMN at baseline among the groups, and paired t-tests were utilized to compare baseline and 1-year MMN amplitude of FEP. To identify the association between MMN impairment change and symptomatic, cognitive or functional change during 1-year, this study used multiple regression analysis controlling possible confounders.ResultsMMN amplitudes at baseline were significantly attenuated in FEP patients compared to HC. One-year follow-up MMN amplitude decreased significantly at Fz electrode site in FEP group. Also, the change in MMN amplitudes significantly correlated with the worsened TMT-B but did not with the symptomatic or functional recovery.DiscussionThese results suggest that MMN impairment may be more closely related to cognitive deficits reflecting disease progression than the currently apparent symptoms and functional status during the beginning of a psychotic episode. Future studies are needed to elucidate the relationship with the disease pathophysiology of psychosis and MMN.

Association of Magnetoencephalographically Measured High-Frequency Oscillations in Visual Cortex With Circuit Dysfunctions in Local and Large-scale Networks During Emerging Psychosis

Psychotic disorders are characterized by impairments in neural oscillations, but the nature of the deficit, the trajectory across illness stages, and functional relevance remain unclear. To examine whether changes in spectral power, phase locking, and functional connectivity in visual cortex are present during emerging psychosis and whether these abnormalities are associated with clinical outcomes. In this cross-sectional study, participants meeting clinical high-risk criteria for psychosis, participants with first-episode psychosis, participants with affective disorders and substance abuse, and a group of control participants were recruited. Participants underwent measurements with magnetoencephalography and magnetic resonance imaging. Data analysis was carried out between 2018 and 2019. Magnetoencephalographical activity was examined in the 1- to 90-Hz frequency range in combination with source reconstruction during a visual grating task. Event-related fields, power modulation, intertrial phase consistency, and connectivity measures in visual and frontal cortices were associated with neuropsychological scores, psychosocial functioning, and clinical symptoms as well as persistence of subthreshold psychotic symptoms at 12 months. The study participants included those meeting clinical high-risk criteria for psychosis (n = 119; mean [SD] age, 22 [4.4] years; 32 men), 26 patients with first-episode psychosis (mean [SD] age, 24 [4.2] years; 16 men), 38 participants with affective disorders and substance abuse (mean [SD] age, 23 [4.7] years; 11 men), and 49 control participants (mean age [SD], 23 [3.6] years; 16 men). Clinical high-risk participants and patients with first-episode psychosis were characterized by reduced phase consistency of β/γ-band oscillations in visual cortex (d = 0.63/d = 0.93). Moreover, the first-episode psychosis group was also characterized by reduced occipital γ-band power (d = 1.14) and altered visual cortex connectivity (d = 0.74-0.84). Impaired fronto-occipital connectivity was present in both clinical high-risk participants (d = 0.54) and patients with first-episode psychosis (d = 0.84). Importantly, reductions in intertrial phase coherence predicted persistence of subthreshold psychosis in clinical high-risk participants (receiver operating characteristic area under curve = 0.728; 95% CI, 0.612-0.841; P = .001). High-frequency oscillations are impaired in the visual cortex during emerging psychosis and may be linked to behavioral and clinical impairments. Impaired phase consistency of γ-band oscillations was also associated with the persistence of subthreshold psychosis, suggesting that magnetoencephalographical measured neural oscillations could constitute a biomarker for clinical staging of emerging psychosis.

Anhedonia in young people with first episode psychosis: a longitudinal study

Aim: Previous research observed deficits in pleasure experience in chronic schizophrenia, but little is known about anhedonia in early psychosis. Aim of this study is: (1) to examine anhedonia in distinct help-seeking subgroups of young people identified through the First Episode Psychosis (FEP) criteria, (2) to investigate its correlations with psychopathology in the FEP sample, and (3) to monitor longitudinally its stability in the FEP group along 1-year follow-up period.Materials and methods: All participants (137 FEP and 95 nonpsychotic psychiatric controls [i.e. non-FEP]), aged 13–35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Schizotypal Personality Questionnaire – Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life – Brief version (WHOQOL-BREF). We used two different indexes of anhedonia: CAARMS ‘Anhedonia’ item 4.3 and BOL ‘Introvertive Anhedonia’ subscale scores.Results: In comparison with non-FEP, FEP patients showed higher baseline anhedonia scores. After 1-year follow-up period, FEP individuals had a significant decrease in severity of anhedonia scores. In the FEP group, anhedonia showed significant, enduring (over time) correlations with impaired role functioning, negative symptoms, comorbid depression, poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits).Conclusions: Anhedonia is relevant in the early phase of psychosis and its severity is associated with functioning deterioration and a bad quality of life.

Plasma monoamines change under dopamine supersensitivity psychosis in patients with schizophrenia: A comparison with first-episode psychosis.

Patients with first-episode psychosis respond well to initial antipsychotic treatment, but among patients experiencing a relapse of psychosis, the response rate falls to approximately 30%. The mechanism of this discrepancy has not been clarified, but the development of dopamine supersensitivity psychosis with the underlying up-regulation of post-synaptic dopamine D2 receptors could be involved in this lesser response. It is uncertain whether elevated dopamine synthesis and release occurs in patients with dopamine supersensitivity psychosis, in contrast to those with first-episode psychosis. We examined a first-episode psychosis group (n=6) and a chronic schizophrenia group, i.e. patients experiencing relapse (n=23) including those who relapsed due to dopamine supersensitivity psychosis (n=18). Following the initiation of treatment, we measured the patients' blood concentrations of homovanillic acid and 3-methoxy-4-hydroxyphenylglycol at two weeks and four weeks after the baseline measurements. The first-episode psychosis group tended to show decreased homovanillic acid, accompanied by an improvement of symptoms. The chronic schizophrenia group showed no alteration of homovanillic acid or 3-methoxy-4-hydroxyphenylglycol over the treatment period. These results were the same in the dopamine supersensitivity psychosis patients alone. Our findings suggest that unlike first-episode psychosis, the release of dopamine from presynaptic neurons did not increase in relapse episodes in the patients with dopamine supersensitivity psychosis. This indirectly indicates that the development of supersensitivity of post-synapse dopamine D2 receptor is involved in relapse in dopamine supersensitivity psychosis patients.

Alterations in methionine to homocysteine ratio in individuals with first-episode psychosis and those with at-risk mental state

BackgroundDisturbance of the methionine (Met) cycle, which produces Met from homocysteine (Hcy), is suggested to be involved in several diseases, including psychiatric disorders. This study was aimed to investigate both levels of Met and Hcy in serum from individuals with first-episode psychosis (FEP) and individuals with at-risk mental state (ARMS). MethodWe measured serum Met and Hcy levels in individuals with FEP (n = 13) and ARMS (n = 30) using HPLC with fluorescence detection and LC-ESI-MS/MS. Met and Hcy levels in healthy controls (n = 41) were also measured. Differences between the 3 groups were analyzed by one-way analysis of variance (ANOVA) with Bonferroni correction. ResultsSerum Met levels were decreased (p = 0.038) and Hcy levels were increased (p = 0.017) in the FEP group. Hcy levels were also significantly increased compared to the ARMS group (p = 0.016), while Met levels were not significantly different between the FEP and ARMS groups. A significant decrease in the Met to Hcy ratio (Met/Hcy) was observed in the FEP group compared to both the control (p = 4.58 × 10−4) and ARMS (p = 8.07 × 10−3) groups. Furthermore, Met/Hcy ratio was correlated with Positive and Negative Syndrome Scale, especially positive scores (p = 5.90 × 10−5). ConclusionTaken together, these data indicate that a decrease in the serum Met/Hcy ratio may be a risk factor for developing psychosis during the transition from ARMS to FEP, and may prove to be a useful marker of the phase between ARMS and FEP.

Is cognitive performance associated with anxiety and depression in first-episode psychosis?

BackgroundIn first-episode psychosis (FEP), symptoms of anxiety and depression are common. We examined whether cognitive performance is associated with these clinical measures in FEP during a one-year follow-up. MethodsYoung adults with non-affective FEP (n = 52) were assessed two months after their first psychiatric contact for psychosis. Matched controls (n = 62) were administered a baseline assessment. 32 FEP subjects and 44 controls were assessed again at a one-year follow-up. In both assessments, a broad neuropsychological test battery was administered. Clinical evaluation was done with the Brief Psychiatric Rating Scale. Cross-sectional correlations were calculated at both time points. Cognitive test scores were used as independent variables in regression models, predicting both baseline and follow-up symptom levels. ResultsAt baseline, better performance especially in verbal memory and executive functioning was associated with elevated anxiety symptoms in FEP. In addition, better performance especially in verbal working memory was associated with depression. A year later, better cognitive performance was no longer associated with affective symptoms. LimitationsSmall sample sizes are a limitation. ConclusionsIn the FEP group, higher cognitive performance associated with affective symptoms. Right after getting severely ill, anxiety and depression may be a part of normal adaptive reactions to the situation and markers of an intact cognitive performance. This association seems to cease during the year following the FEP.

Self-Awareness of Psychopathology and Brain Volume in Patients With First Episode Psychosis.

Memory impairment, excessive rumination, and increased interpersonal sensitivity are major characteristics of high psychosis risk or first episode psychosis (FEP). Herein, we investigated the relationship between brain volume and self-awareness of psychopathology in patients with FEP. All participants (FEP: 34 and HCs: 34) completed clinical assessments and the following self-reported psychopathology evaluations: prospective and retrospective memory questionnaire (PRMQ), ruminative response scale (RRS), and interpersonal sensitivity measure (IPSM). Structural magnetic resonance imaging was then conducted. The PRMQ, RRS, and IPSM scores were significantly higher in the FEP group than in the healthy controls (HCs). The volumes of the amygdala, hippocampus, and superior temporal gyrus (STG) were significantly lower in the FEP group than in the HCs. There was a significant group-dependent moderation effect between self-awareness of psychopathology (PRMQ, RRS, and IPSM scores) and right STG (rSTG) volume. In the FEP group, self-awareness of psychopathology was positively associated with rSTG volume, while in the HCs, this correlation was negative. Our results indicate that self-awareness of psychopathology impacts rSTG volume in the opposite direction between patients with FEP and HCs. In patients with FEP, awareness of impairment may induce increases in rSTG brain volume. However, HCs showed decreased rSTG volume when they were aware of impairment.

The relation of basic self‐disturbance to self‐harm, eating disorder symptomatology and other clinical features: Exploration in an early psychosis sample

The notion of basic self-disturbance has been proposed as a core feature of schizophrenia-spectrum disorders and as an indicator of future transition to psychosis in high-risk populations. However, the relation of this notion to many clinical characteristics has not been explored. The aim of this study was: (a) to investigate the distribution of self-disturbance and other symptoms dimensions in ultra-high risk (UHR), first-episode psychosis (FEP) and healthy control groups; and (b) to explore the association of self-disturbance with a history of self-harm, suicidal attempt, eating disorder symptomatology, school bullying victimization and sexual or physical abuse. Patients with UHR status (n = 38) or FEP (n = 26) and healthy controls (n = 33) were assessed with the Examination of Anomalous Self-Experience (EASE) and the Comprehensive Assessment of at Risk Mental States (CAARMS). The clinical-historical variables were assessed through medical records. The FEP group scored significantly higher on the EASE than the UHR group, which scored significantly higher than the healthy control group, which had a very low score. Multivariate logistic regression analyses revealed that higher EASE score was significantly associated with a history of self-harm, disordered eating and bullying victimization (but not with suicide attempts or sexual/physical abuse) after controlling for positive, negative and depressive symptoms. These novel findings suggest that self-disturbance may be related to a history of school bullying victimization, self-harm and eating disorder symptomatology in patients with or at-risk of psychosis. If further confirmed, these findings are potentially relevant to clinical risk assessment and therapy.