First-episode Psychotic Disorder Research Articles

The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study.

Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.

Additive effects of a family history of schizophrenia spectrum disorders and an environmental risk score for the outcome of patients with non-affective first-episode psychosis.

First-episode psychotic disorders comprise a heterogeneous phenotype with a complex etiology involving numerous common small-effect genetic variations and a wide range of environmental exposures. We examined whether a family of schizophrenia spectrum disorder (FH-Sz) interacts with an environmental risk score (ERS-Sz) regarding the outcome of patients with non-affective first episode psychosis (NAFEP). We included 288 patients with NAFEP who were evaluated after discharge from an intensive 2-year program. We evaluated three outcome measures: symptomatic remission, psychosocial functioning, and personal recovery. We analyzed the main and joint associations of a FH-Sz and the ERS-Sz on the outcomes by using the relative excess risk due to interaction (RERI) approach. A FH-Sz showed a significant association with poor symptomatic remission and psychosocial functioning outcomes, although there was no significant interaction between a FH-Sz and the ERS-Sz on these outcomes. The ERS-Sz did not show a significant association with poor symptomatic remission and psychosocial functioning outcomes, even though the magnitude of the interaction between ERS-Sz and FH-Sz with the later outcome was moderate (RERI = 6.89, 95% confidence interval -16.03 to 29.81). There was no association between a FH-Sz and the ERS-Sz and personal recovery. Our results provide further empirical support regarding the contribution of FH-Sz to poor symptomatic remission and poor psychosocial functioning outcomes in patients with NAFEP.

Characteristics of incident substance-induced psychosis compared to first-episode psychotic disorders: A nationwide register-linkage study from Sweden

BackgroundThere is no previous research comparing preceding characteristics between incident substance-induced psychosis (SIP) and first-episode psychotic disorders (FEPD). AimsTo compare work-related factors and psychiatric morbidity preceding the incident psychotic episode between persons with SIP to persons with FEPD (ICD-10 F20–F29). MethodsIncident SIP aged 16–65 years (n = 7320, 79.4 % male) were identified from the Swedish National Patient Register (NPR) during the years 2006–2016, matched 1:1 (age, sex, year) with FEPD. Information on work-related factors and preceding psychiatric morbidity was collected from national registers. Comparisons between SIP vs FEPD were made using logistic regression analysis, adjusted (aOR) with education level, family situation, living area, country of origin, and Charlson Comorbidity Index. ResultsPrevious self-harm (22.9 % vs 11.3 %; aOR 2.4, 95%CI 2.2–2.6), ADHD (14.4 % vs 8.9 %; aOR 1.8, 95%CI 1.6–2.0), and SUD (68.3 % vs 22.3 %; aOR 7.2, 95%CI 6.6–7.9) were more prevalent among SIP, while all other psychiatric disorders were less common compared to FEPD. Also, persons with SIP were more often unemployed (24.6 % vs 18.6 %; aOR 1.2, 95%CI 1.1–1.3), had less any income from work (29.3 % vs 31.1 %; aOR 0.9, 95%CI 0.8–0.98), but were also less often on a sickness absence (8.6 % vs 9.9 %; aOR 0.8, 95%CI 0.7–0.95) or on a disability pension (18.6 % vs 26.3 %; aOR 0.6, 95%CI 0.5–0.7) compared to FEPD. ConclusionsPersons with SIP have less premorbid psychiatric morbidity than those with FEPD, apart from self-harm, ADHD, and SUD. Also, there is a higher likelihood of labour market marginalisation among persons with incident SIP than persons FEPD.

Neuroticism and Extraversion are modifiable by treatment in individuals at-risk for psychosis or with first-episode psychotic disorder

Meta-analytic work suggests that Neuroticism and Extraversion levels are modifiable by treatment, but it is unknown whether this holds for individuals with subclinical or clinical psychosis. The current study aimed to examine whether 1) Neuroticism and Extraversion change through intervention in individuals at clinical high risk for psychosis (CHR) or first-episode psychosis (FEP), and 2) Acceptance and Commitment Therapy in Daily Life (ACT-DL) is more successful in this regard compared to treatment as usual (TAU). Data pertain to the INTERACT study, a randomized controlled trial on the efficacy of ACT-DL in individuals with CHR or FEP. Assessments were at baseline, 8 week post-intervention and 6 and 12-month follow-up. Our sample consisted of 142 participants (ACT-DL: 67 and TAU: 75). Mixed model analyses showed a reduction in Neuroticism at post-intervention and both follow-up. Extraversion increased at 6 month follow-up. There was no difference between ACT-DL and TAU in personality change. Analyses were controlled for clinical group status (CHR vs. FEP), gender, age, IQ, baseline personality levels and baseline symptom levels. Our findings suggest that among help-seeking people at-risk for psychosis or with first-episode psychosis, treatment may have a fast and persistent impact on particularly Neuroticism. Potential mechanisms are discussed.

Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial

The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/; ACTRN12607000608460).

Sex differences in the clinical presentation of early psychosis in a primary care setting.

Primary care is an important part of the help-seeking pathway for young people experiencing early psychosis, but sex differences in clinical presentation in these settings are unexplored. We aimed to identify sex differences in clinical presentation to primary care services in the 1-year period prior to a first diagnosis of psychotic disorder. We identified first-onset cases of non-affective psychotic disorder over a 10-year period (2005-2015) using health administrative data linked with electronic medical records (EMRs) from primary care (n = 465). Detailed information on encounters in the year prior to first diagnosis was abstracted, including psychiatric symptoms, other relevant behaviours, and diagnoses recorded by the family physician (FP). We used modified Poisson regression models to examine sex differences in the signs, symptoms, and diagnoses recorded by the FP, adjusting for various clinical and sociodemographic factors. Positive symptoms (PR = 0.76, 95%CI: 0.58, 0.98) and substance use (PR = 0.54, 95%CI: 0.40, 0.72) were less prevalent in the medical records of women. Visits by women were more likely to be assigned a diagnosis of depression or anxiety (PR = 1.18, 95%CI: 1.00, 1.38), personality disorder (PR = 5.49, 95%CI: 1.22, 24.62), psychological distress (PR = 11.29, 95%CI: 1.23, 103.91), and other mental or behavioral disorders (PR = 3.49, 95%CI: 1.14, 10.66) and less likely to be assigned a diagnosis of addiction (PR = 0.33, 95%CI: 0.13, 0.87). We identified evidence of sex differences in the clinical presentation of early psychosis and recorded diagnoses in the primary care EMR. Further research is needed to better understand sex differences in clinical presentation in the primary care context, which can facilitate better understanding, detection, and intervention for first-episode psychotic disorders.

Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022.

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports.

Since the onset of COVID-19 pandemic, many case reports and case series dealt with new-onset psychotic disorders in patients either infected with SARS-CoV-2 or thematically linked to the pandemic, but without an infection. Our aim was to provide a comprehensive collection of these reports to illustrate the nature of these psychoses. We conducted a literature search in MEDLINE, Embase, PsycINFO, using search terms regarding first-episode psychotic disorders in the context of corona. 96 case reports or case series covering 146 patients (62 without and 84 with SARS-CoV-2 infection) were found. Compared to patients without infection, patients with infection showed significantly more often visual hallucinations (28.6% vs 8.1%), confusion (36.9% vs 11.3%), an acute onset of illness (88.5% vs 59.6%) and less often depression (13.1% vs 35.5%) and a delusional content related to the pandemic (29.5% vs 78.3%). Both groups had an equally favourable outcome with a duration of psychosis ≤2 weeks in half and full remission in two-thirds of patients. In patients with infection, signs of inflammation were reported in 78.3% and increased CRP in 58.6%. While reports on patients with infection are continuously published, no report about patients without infection was found after July 2020. Cases without infection were considered reactive and originated all from the first wave of the corona pandemic. In cases with infection, inflammation was considered as the main pathogenetic factor but was not found in all patients. Diagnosis was impeded by the overlap of psychosis with delirium.

Risk of first-episode psychosis in migrants to the Republic of Ireland.

Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. We included all presentations of first-episode psychosis over 8.5 years to the DETECT Early Intervention for psychosis service in the Republic of Ireland (573 individuals aged 18-65, of whom 22% were first-generation migrants). Psychotic disorder diagnosis relied on SCID. The at-risk population was calculated using census data, and negative binomial regression was used to estimate incidence rate ratios. The annual crude incidence rate for a first-episode psychotic disorder in the total cohort was 25.62 per 100000 population at risk. Migrants from Africa had a nearly twofold increased risk for developing a psychotic disorder compared to those born in the Republic of Ireland (IRR = 1.83, 95% CI 1.11-3.02, p = 0.02). In contrast, migrants from certain Asian countries had a reduced risk, specifically those from China, India, Philippines, Pakistan, Malaysia, Bangladesh and Hong Kong (aIRR = 0.36, 95% CI 0.16-0.81, p = 0.01). Further research into the reasons for this inflated risk in specific migrant groups could produce insights into the aetiology of psychotic disorders. This information should also be used, alongside other data on environmental risk factors that can be determined from census data, to predict the incidence of psychotic disorders and thereby resource services appropriately.

Neighborhood-level predictors of age at onset and duration of untreated psychosis in first-episode psychotic disorders

ObjectiveRecent years have witnessed growing interest in the role of the social environment in the development and outcomes of schizophrenia. We investigated whether neighborhood characteristics are associated with two important prognostic factors in early-course psychosis, age at onset of psychosis (AOP) and duration of untreated psychosis (DUP). MethodsData were collected from patients admitted to the hospital for first-episode schizophrenia-spectrum disorder. We collected data on perceived neighborhood disorder during childhood/adolescence and extracted data on 13 neighborhood characteristics from the American Community Survey based upon individual addresses. Four neighborhood-level factors were derived from factor analysis. Multiple logistic regression analyses assessed the association between specific neighborhood characteristics and the two prognostic factors (earlier AOP and longer DUP) in early-course psychosis. Results143 participants had valid addresses geo-coded. Neighborhood-level residential instability was associated with an earlier AOP (OR = 1.760; p = 0.022) even after controlling for known risk factors (OR = 2.026; p = 0.020) and also after controlling for individual-level residential instability (OR = 1.917; p = 0.037). The general socioeconomic status neighborhood factor (OR = 1.119; p = 0.019) and perceived neighborhood disorder (OR = 1.075; p = 0.005) were associated with a longer DUP. But only perceived neighborhood disorder (OR = 1.146; p = 0.011) remained significant, and general socioeconomic status was close to significant (OR = 1.215; p = 0.062), after controlling for individual-level predictors and socioeconomic status. ConclusionsThis study found evidence that neighborhood-level characteristics (in this case, residential instability) may be associated with earlier AOP, and perceptions of neighborhood disorder are associated with a longer treatment delay. Socioenvironmental factors should be more consistently considered going forward in research on early psychotic disorders.

Duration of untreated psychosis of first-episode psychotic disorders in Yogyakarta, Indonesia

Introduction: Duration of untreated psychosis (DUP) is an important predictor for prognosis in first episode of psychotic disorders. Caregivers often seek help from alternative healers first and health professional later. These would delay proper treatments for the patients, resulting in more severe symptoms and lower functioning on their visit to medical facility. The present study aims to find the association between DUP, symptoms severity, and global functioning in patients with first-episode psychotic disorders. Methods: We identified 100 patients with first episode of psychotic disorders and their caregivers. The instruments used were Brief Psychotic Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Premorbid Schizoid-Schizotypal Traits (PSST), and Global Assessment of Functioning (GAF). Results: There were no significant association between BPRS, PANSS, PSST, and GAF scores and DUP in our subjects. Nevertheless, we found that men had significantly longer DUP compared to women. Conclusion: We found significant association between sex and DUP in this study. Longer DUP leads to delayed treatments and poorer prognosis. Further study is required to confirm our finding.

Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study

Background: ‘Acute and transient psychotic disorder’ (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system.Aims: (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study.Methods: This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990–2000.Results: Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions.Conclusions: ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.

Symptom Profile of Substance-induced Psychosis Versus Primary Psychosis in a Sample of Egyptian Patients: A Preliminary Study

Introduction: There is an extensive literature on the link between psychosis and substance use. The nature of this association has been a matter of controversy for the last 2 decades, especially the possible cause effect relationship that may be involved in this association. The differential diagnosis of substance-induced psychotic disorder and primary psychotic disorder is particularly challenging during an acute admission when psychotic symptoms are the most severe and the identification of possible markers of these disorders could simplify their recognition and treatment. Objectives: The main objective of the current study was to compare the clinical picture between a sample of patients with substance-induced psychosis (SIP) and patients with primary psychosis, as regards the phenomenological aspects and to study the different correlates affecting their clinical picture. Materials and Methods: A comparative cross-sectional study including 22 patients with first-episode psychotic disorder recruited from the inpatient wards of the Institute of Psychiatry Ain-Shams University. All patients were interviewed between 1 week and 1 month of onset of symptoms using Structured Clinical Interview for DSM-IV (SCID-I) and Positive and Negative Syndrome Scale (PANSS). Patients were labeled into 2 groups according to diagnosis, group I: patients fulfilling criteria of brief psychotic episode. Group II: patients fulfilling criteria of substance-induced psychotic disorder. Results: No statistical difference between the 2 studied groups as regard PANSS score positive, negative, and general psychopathology, as well as the severity of symptoms. However, further analysis of the PANSS score components showed SIP group to have significantly higher P4 (excitement) score (P=0.02), G10 (disorientation) score (P=0.03), and G11 (poor attention) score (P=0.004). Conclusions: This study adds to a growing body of literature highlighting the differences between SIP and primary psychosis. It provides set of variables that distinguish the substance-induced and primary psychosis groups from one another, which should be an area for further studies.

The Relative Importance of Family History, Gender, Mode of Onset, and Age at Onsetin Predicting Clinical Features of First-Episode Psychotic Disorders.

Family history of psychosis, gender, mode of onset, and age at onset are considered prognostic factors important to clinicians evaluating first-episode psychosis; yet, clinicians have little guidance as to how these four factors differentially predict early-course substance abuse, symptomatology, and functioning. We conducted a "head-to-head comparison" of these four factors regarding their associations with key clinical features at initial hospitalization. We also assessed potential interactions between gender and family history with regard to age at onset of psychosis and symptom severity. Consecutively admitted first-episode patients (n=334) were evaluated in two studies that rigorously assessed a number of early-course variables. Associations among variables of interest were examined using Pearson correlations, χ2 tests, Student's t-tests, and 2×2 factorial analyses of variance. Substance (nicotine, alcohol, and cannabis) abuse and positive symptom severity were predicted only by male gender. Negative symptom severity and global functioning impairments were predicted by earlier age at onset of psychosis. General psychopathology symptom severity was predicted by both mode of onset and age at onset. Interaction effects were not observed with regard to gender and family history in predicting age at onset or symptom severity. The four prognostic features have differential associations with substance abuse, domains of symptom severity, and global functioning. Gender and age at onset of psychosis appear to be more predictive of clinical features at the time of initial evaluation (and thus presumably longer term outcomes) than the presence of a family history of psychosis and a more gradual mode of onset.

Capgras' Syndrome in First-Episode Psychotic Disorders

Background: Misidentification phenomena, including the delusion of ‘imposters' named after Joseph Capgras, occur in various major psychiatric and neurological disorders but have rarely been studied systematically in broad samples of modern patients. This study investigated the prevalence and correlated clinical factors of Capgras' phenomenon in a broad sample of patient-subjects with first-lifetime episodes of psychotic affective and nonaffective disorders. Methods: We evaluated 517 initially hospitalized, first-episode psychotic-disorder patients for the prevalence of Capgras' phenomenon and its association with DSM-IV-TR diagnoses including schizophreniform, brief psychotic, unspecified psychotic, delusional, and schizoaffective disorders, schizophrenia, bipolar-I disorder and major depression with psychotic features, and with characteristics of interest including antecedent psychiatric and neurological morbidity, onset type and presenting psychopathological phenomena, using standard bivariate and multivariate statistical methods. Results: Capgras' syndrome was identified in 73/517 (14.1%) patients (8.2-50% across diagnoses). Risk was greatest with acute or brief psychotic disorders (schizophreniform psychoses 50%, brief psychoses 34.8%, or unspecified psychoses 23.9%), intermediate in major depression (15%), schizophrenia (11.4%) and delusional disorder (11.1%), and lowest in bipolar-I (10.3%) and schizoaffective disorders (8.2%). Associated were somatosensory, olfactory and tactile hallucinations, Schneiderian (especially delusional perception), and cycloid features including polymorphous psychotic phenomena, rapidly shifting psychomotor and affective symptoms, pananxiety, ecstasy, overconcern with death, and perplexity or confusion, as well as rapid onset, but not sex, age, abuse history, dissociative features, or indications of neurological disorders. Conclusions: Capgras' syndrome was prevalent across a broad spectrum of first-episode psychotic disorders, most often in acute psychoses of rapid onset.

Diagnostic Stability of First-Episode Psychotic Disorders and Persistence of Comorbid Psychiatric Disorders over 1 Year

Diagnostic stability is an important indicator of the reliability and validity of psychiatric diagnoses and has implications in clinical practice and research. While several studies have investigated the diagnostic stability of first-episode psychosis (FEP) disorders, less is known about psychiatric comorbidity in FEP and the persistence of such comorbid conditions over time. Our study aimed to confirm the diagnostic stability of FEP disorders and determine the variation in persistence of comorbid substance use disorders (SUDs), mood disorders, and anxiety disorders over 1 year. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition was conducted at first presentation and repeated after 1 year (or reconstructed) for 214 FEP patients at the Prevention and Early Intervention Program for Psychoses-Montreal. Psychotic disorder diagnoses were retained by 76.2% of patients at 1 year, schizophrenia being the most stable diagnosis (92.1%). Most diagnostic shifts were to schizophrenia and schizophrenia spectrum disorders. Comorbid SUDs, anxiety disorders, and mood disorders persisted for 50.7%, 64.0%, and 16.7% of patients, respectively. Many new cases of each of these disorders also emerged at 1-year follow-up. These findings demonstrate the stability of primary psychotic disorder diagnoses and greater fluidity of comorbid psychiatric diagnoses, with anxiety disorders persisting as comorbid conditions more than mood disorders and SUDs. These results highlight the importance of repeating a structured diagnostic assessment longitudinally, especially for consideration of comorbid conditions.

2894 – Effect of antipsychotic use disorder on metabolic parameters in patients with first-episode psychosis

Because of the different receptor profiles, atypical antipsychotics are known to cause metabolic changes such as increased weight gain, type 2 diabetes and hyperglycemia,. In this study, we aimed to observe metabolic side effects of drug use of patients receiving antipsychotic medication in first-episode psychotic disorder. 49 male patients who were hospitalized at Gulhane Military Medical Academy Psychiatry Department with a diagnosis of psychotic disorder according to DSM-IV criteria between May 2011–2012 were included in the study. Blood lipid profiles and liver and renal function tests of the patients before treatment and after 8 weeks of treatment were evaluated. Of the patients participating in the study of 16 were using olanzapine, 15 risperidone, 6 quetiapine, 5 aripiprazole and 7 haloperidol. There was no statistically significant difference between patients before and after treatment in terms of blood lipid profile, the liver and kidney functions. There was also no significant difference according to the antipsychotic drug used. In studies with long-term follow-up of 6 months or 1 year or a short-term follow-up as 1 month with atypical antipsychotics these values usually seems to have changed. As a result of 2-month follow-up at our study, patients that were being treated with atypical antipsychotics have not shown any changes in the metabolic values.

Negative Affective Features in 516 Cases of First Psychotic Disorder Episodes: Relationship to Suicidal Risk

Plausible candidates of psychopathological phenomena that may associate with or anticipate suicidal risk, include negative affects, including admixtures of dysphoria, depression and anxiety described mainly in nonpsychotic disorders. We ascertained the distribution of such affective features in various first-episode psychotic disorders and correlated these and other clinical and antecedent features with intake suicidal status. We evaluated 516 adult subjects in first-lifetime episodes of various DSM-IV-TR psychotic disorders. Blinded, protocol-guided, assessments of clinical features ascertained in SCID examinations, self- and family reports and clinical records supported analyses of associations of suicide attempts at first-psychotic episodes with antecedent and intake clinical characteristics, including negative affects and diagnoses, using standard bivariate and multivariate methods. Negative affective features in various combinations were prevalent (90%) and at >75% in both affective and nonaffective psychotic disorders; anxious depression was most common (22%). We identified antecedent and intake clinical factors preliminarily associated with suicide attempts. Factors remaining independently associated in multivariate logistic modelling (ranked by OR) were: (a) prior suicide attempt, (b) prior aggressive assault, (c) bipolar-mixed state or psychotic major depression diagnosis, (d) prior dysphoria, (e) intake dysphoric-anxiousdepression, (f) prior impulsivity, (g) previous affective instability, (h) previous nonpsychotic depression, (i) previous decline in vital drive, and (j) prior sleep disturbances. Various types and combinations of negative affective features (especially anxious depression with and without dysphoria) were prevalent across nonaffective as well as affective first psychotic episodes and strongly associated with suicide attempts. These findings extend previous observations in nonpsychotic disorders.

Poster #240 DIFFERENTIAL ASSOCIATIONS BETWEEN COGNITION AND OUTCOME IN EARLY PSYCHOSIS: A COHORT STUDY OF EARLY PSYCHOSIS PATIENTS IN THE NETHERLANDS

Background: Substantial research done in the last few decades indicates that various neurocognition (NC) and social cognition (SC) domains are strongly associated with functional outcome in psychotic disorders. However, many studies investigating these associations have not used fully comprehensive cognitive batteries and/or a limited variety in outcome measures. Differences in demographic characteristics and methodology make integration of these findings problematic. Subsequently, our understanding of the differential associations between cognition and functional outcome remains limited, especially concerning the early stages of these disorders. This comprehensive cross-sectional study aims to investigate differential associations between cognition and outcome in a naturalistic cohort of early psychosis patients. Methods: The cognitive test-battery comprised fifteen neuropsychological measures to assess (a) general cognition, (b) seven NC domains (Attention, Problem solving, Speed of processing, Verbal fluency, Verbal learning, Visual learning and Working memory) and (c) four SC domains (Facial affect perception, Theory of Mind, Social knowledge and Social cognitive biases). The following global and specific outcome domains were assessed: (1) global functioning (GAF), (2) global clinical impression (CGI), (3) global social functioning (GSF) (4) social useful activities, including study and work (SUA) (5) personal and social relationships (PSR), (6) self-care (SeC), (7) disturbing and/or aggressive behaviour (DAB), (8) perceived chronic stress (PCS), and (9) health perception (HP). Participants included 114 patients with a first-episode psychotic disorder, of which 105 completed neuropsychological assessment (92,1%; 74 males and 31 females). Bivariate correlations between cognitive domains and functional outcome variables will be examined. Results: Of the twelve cognitive domains, three were related to global outcome: Attention to CGI (r=0.33), Speed of processing to GAF/CGI/GSF (rmean=0.27), and Facial affect perception to GAF/CGI/GSF (rmean=0.33). Seven cognitive domains were related to specific outcome domains: Attention to SUA/HP (rmean=0.26), Verbal fluency to SeC (r=0.22), Verbal learning to SUA/HP (rmean=0.25), Visual learning to HP (r=0.29), Working memory to SUA (r=0.23), Facial affect perception to SUA/PSR/DAB/HP (rmean =0.29), and Social cognitive biases to PSR/DAB/PCS/HP (rmean=0.42). Of the twelve cognitive domains, only Attention and Facial affect perception were related to both global and specific functional outcome domains. The cognitive domains Problem solving, General cognition, Theory of mind and Social knowledge were unrelated to all functional outcome domains. Discussion: Findings suggest that both NC and SC are substantially but selectively associated with various functional outcome domains. The heterogeneous cognition-outcome relationship pattern in our data illustrates that specificity is crucial in order to identify viable cognitive treatment targets in early psychosis patients. Implications for early psychosis interventions and future research are discussed.

The Singapore Early Psychosis Intervention Programme (EPIP): A programme evaluation

The alarmingly long duration of untreated psychosis (DUP) in Singapore and probable severe consequences were the impetus for establishing the Early Psychosis Intervention Programme (EPIP) in 2001. In 2007, EPIP became a part of the National Mental Health Blueprint. Here, we report some of the programme's outcomes. MethodConsecutive patients accepted into EPIP from April 2007 to March 2011 were included. Programme inclusion criteria were: (1) age between 15 and 41 years, (2) first-episode psychotic disorder with no prior or minimal treatment, (3) no current history of substance abuse, and (4) no history of major medical or neurological illness. EPIP has incorporated an evaluation component to the clinical programme by administering regular structured assessments and generating operational statistics from our hospital's data systems. ResultsBetween April 2007 to March 2011, 815 patients had been accepted and 795 had baseline data. 50.8% (404/795) were males, with mean age of 27years (±6.5 years). Mean DUP (SD) was 14.6 (±25.2) months and median was 6months. At the end of two years, 71.1% (202/284) achieved symptomatic remission as defined by the Schizophrenia Working Group, 84.9% (241/284) scored 61 or more on Global Assessment of Functioning (GAF) disability and 76.5% (274/358) had returned back to school or were gainfully employed. ConclusionBeing a national programme, EPIP had articulated process and outcome indicators to our stakeholders, and a periodic report card on these outcomes makes us accountable to our funders, our patients and their families.