Non-affective Psychosis Research Articles (Page 1)

Previous studies in non-affective psychosis (NAP) consistently found that patients' functioning is associated with social cognition and gender, with higher functioning in female patients. This study investigated the impact of social cognition on the relationship between gender and functioning, and examined psychometric properties of the Narrative Emotions Task (NET) as a measure of social cognition with high ecological validity. N = 95 outpatients with NAP were assessed regarding functioning, social cognition, and psychopathology. Correlations were computed and a potential indirect effect of gender on functioning, mediated by social cognition, was examined. Results showed a significant positive correlation between social cognition and functioning, with female patients exhibiting higher functioning. There were no gender differences in the total score of the NET, and the indirect effect of social cognition through gender on functioning could not be confirmed. Gender differences in social cognition were only evident for the NET emotion perception index. Moreover, there was some evidence of a potentially mediating effect of emotion perception concerning the relationship between gender and functioning, but this effect was not significant when covariates were added to the analysis. The NET showed high internal consistency and was correlated with an established instrument of metacognition (Metacognition Assessment Scale-Abbreviated). The findings equally broaden the picture and highlight the need for further investigation into gender differences in NAP, their underlying mechanisms, and their impact on functioning. The NET appears to be a feasible measure for assessing social cognition, going beyond laboratory tasks.

Microstructural alterations of the corpus callosum in affective and non-affective early psychosis: A diffusion magnetic resonance imaging study.

A two-year longitudinal investigation of insula subregional cortical thickness and surface area in early psychosis.

Compared to the general population, young adults with early psychosis are at increased risk of violent behavior. Existing research has found contextual similarities between violent behavior and suicidal behavior. Therefore, this study examines the drivers and consequences of violent ideation and behavior among young adults with early psychosis by applying frameworks developed for suicide prevention. This research was conducted at OnTrackNY, a network of early intervention services (EIS) that provides coordinated specialty care services to young adults with non-affective psychosis that began within the past two years. Qualitative interviews were conducted with 6 EIS participants and 12 EIS staff members. The interview guide applied the "suicide narrative" format from the Stanley-Brown Safety Planning Intervention by asking EIS staff and EIS participants detailed questions about a specific episode of violent ideation or behavior. Participant responses were then categorized using Fluid Vulnerability Theory (FVT). This study found that it was feasible to discuss information about a specific violence-related crisis for young adults with early psychosis and their treatment teams by eliciting violence narratives. In doing so, EIS participants and staff identified several risk factors from the FVT domains that previously sparked either violent ideation or behavior. In addition to identifying potential target mechanisms for future interventions, these narratives may lead to more compassionate and therapeutic understandings of violence for young adults with early psychosis. Future research is recommended to explore how best to incorporate violence narratives in the treatment of early psychosis.

BackgroundEarly intervention services (EIS) for first-episode psychosis (FEP) play a key role in shaping a better disease trajectory for both affective and non-affective psychosis. Psychotic disorders tend to present sex differences both from an epidemiological and clinical perspective.AimsThe primary aim of this study is to investigate sex-based differences in outcome of patients admitted to EIS for FEP, analysing clinical differences and recovery rates during a 24 months long follow-up.MethodsA longitudinal cohort study was conducted. Patients were those admitted to the EIS in Ferrara between 2012 and February 27th, 2025 who met the following enrolment criteria: (a) diagnosed with affective or non-affective FEP; (b) not being treated for more than 24 months; (c) absence of intellectual disability; (d) aged between 18 and 35 years; (e) absence of organic psychosis. Socio-demographic and clinical characteristics were collected at program admission. The HoNOS (Health of the Nation Outcome Scale) was administered at baseline and every 6 months for the 24 months follow-up to compare sex differences in terms of symptoms severity and clinical recovery (HoNOS total score <8). Outcomes over time were compared between groups using mixed effects models repeated measures analysis of variance (MMRM).ResultsA total of 174 patients were included in the study, most were males (74.1%), and most men vs. women were born in Italy (81.4% vs. 66.7%, p = 0.04). At admission, men had significantly higher rates of cannabis use (56.6% vs. 22.2%), tobacco use (62% vs. 28.9%), and alcohol misuse (51.2% vs. 15.5%) (p < 0.001). Men, compared to women, at 6 and 12 months showed significantly lower clinical severity than women (11.9 vs. 14.5, p = 0.03; 9.4 vs. 11.9, p = 0.05 respectively), and higher probability of being in recovery at 12 months (p = 0.04), indicating a faster clinical improvement. At 24-month, more men than women were NEET (Not in Education, Employment or Training) (26.3% vs. 8%, p = 0.04).ConclusionOverall, our study highlighted significant sex differences both at admission as well as in outcomes. Men tend to improve more rapidly than women, then reaching a plateau with no substantial differences between sexes at 24 months. Further studies should identify sex-specific outcome predictors that could help in early patients’ identification, thus leading to improve clinical trajectories and long-term prognosis.

Hippocampal volume in affective and non-affective psychosis.

The first aim of the study was to assess the validity of non-affective psychosis diagnoses, including schizophrenia, for migrants and Swedish-born to determine if the registered diagnoses were of sufficient quality for epidemiological research. If the validity was insufficient, the second aim was to find out what the non-valid cases have in common to see if there was a feasible way to handle these cases in future studies. We validated the register-diagnoses of 179 randomly selected patients aged 18-48 living in municipalities with a high proportion of migrants, diagnosed with non-affective psychotic disorder (F20-F29 according to ICD-10), drawn from the Region of Stockholm's medical records database by comparing them to their case notes to see if they fulfilled the DSM-5 criteria. We found acceptable validity for non-affective psychotic disorder for migrant men (70.5%), low for Swedish-born men (60.0%), and even lower for women (50.0% for Swedish-born and 40.0% for migrants). There was no statistically significant difference between Swedish-born and migrants. The case notes revealed that by excluding cases with an additional diagnosis equivalent of psychotic disorder due to psychoactive substance (ICD10: F11X.5 and F11X.7) the validity was good for both Swedish-born and migrant men. This study supports continued use of the register-diagnoses but only after taking appropriate measures to avoid that patients with additional psychotic disorder due to psychoactive substance are not violating the validity. It also suggests caution when studying non-affective psychosis diagnoses among migrant women as the validity is low, possibly due to difficulties in separating non-affective psychosis from symptoms of other disorders with psychotic features.

Bipolar disorder is a chronic disease that imposes a lifelong burden on those that suffer from it. Lithium is still considered both gold standard treatment and first-line maintenance treatment, and access to treatment with lithium is paramount to improving patient outcomes. However, access to adequate treatment is not only contingent on symptom recognition, accurate diagnosis, and individualization of treatment, but also affected by racial and ethnic disparities at each stage of patient experience. Individuals of African Ancestry with bipolar disorder are more frequently misdiagnosed with non-affective psychoses, less likely to receive minimally adequate treatment or be prescribed lithium, and more likely to be prescribed antipsychotics. To compare prescription patterns in the treatment of bipolar disorder between individuals of African and European Ancestry, we conducted a pooled meta-analysis of four cohorts spanning different clinical settings, recruitment periods, and ascertainment methods, followed by sex-stratified analyses. We found that, overall, individuals of African Ancestry with bipolar disorder were significantly less likely to be prescribed lithium, and more likely to be prescribed first and second-generation antipsychotics during their lifetime, than those of European Ancestry. Furthermore, both men and women of African Ancestry were independently less likely to be prescribed lithium and more likely to be prescribed second generation antipsychotics than men and women of European Ancestry. However, women appeared to be more burdened by the significantly increased likelihood of first-generation antipsychotic prescription than men, for whom the association was marginally non-significant. This continued underutilization of lithium likely stems from the complex interaction of multiple biases.

Background: Cognitive behavioral therapy (CBT) has shown consistent efficacy in individuals with psychosis, as supported by many trials. One classical distinction is that between affective and non-affective psychosis. Few studies have specifically examined the possible moderating role of substantial affective elements. In this systematic review and meta-regression analysis, we assess how CBT response differs across the affective spectrum in psychosis. Methods: We included studies assessing various CBT modalities, including third-wave therapies, administered in people with psychosis. The study protocol is published in the Open Science Framework. Meta-regression was conducted to assess whether the proportion of participants with affective psychosis (AP), as proxied by a documented diagnosis of schizoaffective (SZA) disorder, moderated CBT efficacy across positive, negative, and depressive symptom domains. Results: The literature search identified 4457 records, of which 39 studies were included. The median proportion of SZA disorder participants was 17%, with a total of 422 AP participants represented. Meta-regression showed a trend toward lower CBT efficacy for positive symptoms with a higher SZA disorder proportion (β = +0.10 SMD per 10% increase in AP; p = 0.12), though it was not statistically significant. No significant associations were found for negative (β = +0.05; p = 0.73) or depressive symptoms (β = -0.02; p = 0.78). Heterogeneity was substantial across all models (I2 ranging from 54% to 80%), and funnel plot asymmetry was observed in negative and depressive symptoms, indicating possible publication bias. Risk of bias assessment showed the anticipated inherent difficulty of psychotherapies in blinding and possibly dropout rates affecting some studies. Conclusions: Affective symptoms may reduce the effectiveness of CBT for positive symptoms in psychotic disorders, although the findings did not reach statistical significance. Other patient-level characteristics in psychosis could indicate which patients can benefit most from CBT modalities.

The use of community treatment orders (CTOs) has increased in many jurisdictions despite very limited evidence for their efficacy. In this context, it is important to investigate any differences in outcome by subgroup. To investigate the variables associated with CTO placement and the impact of CTOs on admissions and bed-days over the following 12 months, including differences by diagnosis. Cases and controls from a complete jurisdiction, the state of Queensland, Australia, were analysed. Administrative health data were matched by age, sex and time of hospital discharge (index date) with two controls per case subject to a CTO. Multivariate analyses were used to examine factors associated with CTOs, as well as the impact on admissions and bed-days over the 12 months after CTO placement. Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527). We identified 10 872 cases and 21 710 controls from January 2018 to December 2022 (total n = 32 582). CTO use was more likely in First Nations people (adjusted odds ratio = 1.14; 95% CI: 1.06-1.23), people from culturally diverse backgrounds (adjusted odds ratio = 1.45; 95% CI: 1.33-1.59) and those with a preferred language other than English (adjusted odds ratio = 1.21; 95% CI: 1.02-1.44). When all diagnostic groups were considered, there were no differences in subsequent admissions or bed-days between cases and controls. However, both re-admissions and bed-days were significantly reduced for CTO cases compared with controls in analyses restricted to non-affective psychoses (e.g. adjusted odds ratio = 0.77, 95% CI: 0.71-0.84 for re-admission). Queenslanders from culturally or linguistically diverse backgrounds and First Nations peoples are more likely to be placed on CTOs. Targeting CTO use to people with non-affective psychosis would both address rising CTO rates and mean that people placed on these orders derive possible benefit. This has implications for both clinical practice and policy.

Polygenic risk for schizophrenia predicting Big Five personality traits in individuals without non-affective psychosis.

Studies in animals and humans suggested that the tonic dopamine inhibition of prolactin release may be estimated by submaximal prolactin stimulation by thyrotropin-releasing hormone (TRH), the mini-TRH test. Because patients with schizophrenia may be more vulnerable to stress-induced elevations of prolactin, great care was taken to avoid stress-induced increases in prolactin, including applying local anaesthesia before blood extraction in our psychotic patients. Basal prolactin levels were in the reference range in all psychotic patients studied by us and were not higher in male patients than in normal men. Results of the mini-TRH test suggested that in acute patients with non-affective psychoses, everyday memory problems, non-paranoid delusions, and first-rank symptoms, but not other Comprehensive Psychopathological Rating Scale (CPRS) positive symptoms, could correlate with decreasing dopamine transmission in lactotrophs. In acute patients with first-episode schizophrenia, increasing negative disorganisation symptoms might correlate with increasing dopamine transmission. In first-episode patients, a hypersensitivity of the TRH response was detected, which could indicate that variability in the basal prolactin levels may confound the interpretation of the mini-TRH response. To avoid that, a smaller dose of TRH was recommended in first-episode patients. Studies using other estimates of basal dopamine release suggested that striatal dopamine transmission reflected delusions and hallucinations but not other Positive and Negative Symptom Scale (PANSS) positive symptoms. Including a wide range of symptoms in the PANSS positive scale may reduce its specificity for assessing basal dopamine transmission, although the scale remains useful for tracking treatment response.

Treatment and long-term outcome of mental disorders: The grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries.

This study evaluated the transition rates from schizotypal disorder to non-affective psychosis and schizophrenia in particular aiming to identify clinical and demographic factors associated with these transitions. We conducted a nationwide cohort study using data from the Swedish Patient Register and the Cause of Death Register, including patients aged 18 and older diagnosed with schizotypal disorder (ICD-10 F21) between 2006 and 2017. Cox proportional hazards regression was employed to assess the associations between baseline characteristics and transitions to schizophrenia (ICD-10 F20) and other non-affective psychotic disorders (ICD-10 F20-F29, excluding F21), with follow-up extending up to 12 years. Of the 667 patients included, 12.0 % transitioned to schizophrenia, and 22.5 % to other non-affective psychotic disorders. The estimated 10-year cumulative risks of transition were 24.6 % for schizophrenia and 43.5 % for non-affective psychotic disorders. Older age and diagnosis allocated during the study's early observation years were associated with a reduced risk of transition to schizophrenia, while pre-existing depression and anxiety disorders had protective effects. In contrast, substance use disorders other than alcohol were associated with an increased risk of transitioning to non-affective psychotic disorders. These findings highlight that a significant portion of individuals with schizotypal disorder progress to more severe psychotic disorders, underlining the need for careful monitoring, especially in those with comorbid substance use.

Aim Coercion in mental health care is under constant debate. Norway has been shown to have relatively high rates of involuntary admissions. The use of coercion in patients with first-episode psychosis (FEP) in Norway is sparsely described, thus limiting an informative debate. Method We registered involuntary admissions, involuntary treatment orders, community treatment orders and other coercive measures during the first two years of treatment for all patients diagnosed with a first-episode non-affective psychosis at St Olav’s University Hospital from 2012 to 2016. The hospital serves the Sør-Trøndelag County with 313,370 inhabitants in 2016. Results A total of 238 patients with FEP were included. 40% of the patients were involuntary admitted at first contact leading to the psychosis diagnose, and during the first two years of treatment 53% of the patients were involuntary admitted. Of the involuntarily admitted patients, 43% were discharged on a community treatment order, and 34% had involuntary treatment orders. Other coercive measures, such as short-term holding, mechanical restraint or short-acting medication, were used in 21% of patients receiving inpatient treatment. Conclusion Involuntary admission was relatively common in this cohort of FEP patients, although less used than in previous studies from Norway. Compared to studies from other countries, our findings, along with those from Finland, show among the highest rates of involuntary admissions and involuntary treatment orders published, and are higher than findings in other Nordic countries such as Denmark and Sweden.

Psychosis involves neuroinflammation and oxidative stress, both affecting the glymphatic system, the lymphatic-like, fluid-transport system in the brain. However, it is unclear whether early psychosis is related to impairments in glymphatic functions. In resting-state fMRI, it has been recently established in a number of neurodegenerative diseases that the coupling relationship between cortical blood-oxygen-level-dependent (BOLD) signal and ventricular cerebrospinal fluid (CSF) flow is associated with brain waste clearance, a key glymphatic function that has not been examined in psychosis or any other psychiatric populations. In a large dataset (total n = 137, age = 23.86 ± 4.16), we demonstrated that glymphatic clearance marked by BOLD-CSF coupling was weaker and more delayed in patients with early psychosis compared to healthy controls. BOLD-CSF coupling also varied between the non-affective and affective psychosis groups with group differences most prominent in high-order but not low-order cortical regions. Finally, reduced global BOLD-CSF coupling was associated with cognitive decline and more severe psychotic symptoms. We provided novel evidence highlighting dysregulated coupling between cortical activity and macroscopic CSF flow as a biomarker for early psychosis. Similar to recent observations in neurodegenerative disorders, the association between reduced BOLD-CSF coupling and psychotic symptoms suggested that waste clearance is disrupted in psychosis which shed light on the pathophysiology of this disease from a glymphatic point of view.

The picture for the long-term prediction of schizotypic individual difference features in relation to schizotypy assessed earlier in life remains opaque. Whereas schizotypy assessed earlier in life, typically during the late teen years, has been shown to predict nonaffective psychotic illness as well as the presence of nonaffective psychotic features (Chapman et al., 1994; Lenzenweger, 2021), the presence in midlife (mid-30s) of nonpsychotic schizotypic features in those assessed for schizotypy earlier in life remains to be demonstrated. The current study, which reports on a 17-year follow-up study, addresses this void in the schizotypy literature. Seventeen years after an initial psychometric assessment for schizotypy, in a sample of emerging adults (age = 18) with no prior history of psychotic illness, Perceptual Aberration Scale scores predicted elevated schizotypal personality features, increased schizophrenia-related personality disorder features (particularly schizotypal and paranoid), and elevated schizophrenia proneness scores at age 35. This pattern of associations was maintained even after the removal of participants with a diagnosis of nonaffective psychosis. The associations also remained largely unchanged net of state anxiety levels at initial and later assessments. These results support the emergence or maintenance of schizotypic psychopathology features consistent with a model that views schizotypy as the underlying liability for schizotypic psychopathology phenotypes. The results also provide additional support for both the construct validity of the initial psychometric schizotypy measure (Perceptual Aberration Scale) as well as the validity of the psychometric high-risk paradigm. Longitudinal research remains an illuminating and informative approach to understanding the nature of schizophrenia-related psychopathology by utilizing time as an essential scientific lever. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BackgroundHaving a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.AimsTo assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment.MethodsThe trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital).ResultsDuring the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse.ConclusionsOur data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.

Background: Psychosis, particularly schizophrenia (SZ), is influenced by genetic and environmental factors. The neurodevelopmental hypothesis suggests that genetic factors affect neuronal circuit connectivity during perinatal periods, hence causing the onset of the diseases. In this study, we performed a genome-wide association study (GWAS) in a sample of the first episode of psychosis (FEP). Methods: A sample of 147 individuals diagnosed with non-affective psychosis and 102 controls were recruited and assessed. After venous blood and DNA extraction, the samples were genotyped. Genetic data underwent quality controls, genotype imputation, and a case-control genome-wide association study (GWAS). After the GWAS, results were investigated using an in silico functional mapping and annotation approach. Results: Our GWAS showed the association of 27 variants across 13 chromosomes at genome-wide significance (p &lt; 1 × 10−7) and a total of 1976 candidate variants across 188 genes at suggestive significance (p &lt; 1 × 10−5), mostly mapping in non-coding or intergenic regions. Gene-based tests reported the association of the SUFU (p = 4.8 × 10−7) and NCAN (p = 1.6 × 10−5) genes. Gene-sets enrichment analyses showed associations in the early stages of life, spanning from 12 to 24 post-conception weeks (p &lt; 1.4 × 10−3) and in the late prenatal period (p = 1.4 × 10−3), in favor of the neurodevelopmental hypothesis. Moreover, several matches with the GWAS Catalog reported associations with strictly related traits, such as SZ, as well as with autism spectrum disorder, which shares some genetic overlap, and risk factors, such as neuroticism and alcohol dependence. Conclusions: The resulting genetic associations and the consequent functional analysis displayed common genetic liability between the non-affective psychosis, related traits, and risk factors. In sum, our investigation provided novel hints supporting the neurodevelopmental hypothesis in SZ and—in general—in non-affective psychoses.

It is not known if there are differences in antipsychotic initiation between migrants and native-born individuals diagnosed with non-affective psychotic disorder. This study aimed to determine (1) potential differences in initiation rate and type of first antipsychotic medication between refugees, non-refugee migrants, second-generation migrants, and Swedish-born young adults with incident non-affective psychosis and (2) which sociodemographic and clinical factors are associated with initiation. This register-based cohort included 12,960 adults aged 18-35 years, residing in Sweden during 2007-2018, with an incident diagnosis of a non-affective psychotic disorder in inpatient or specialised outpatient care. Sociodemographic and clinical factors associated with antipsychotic initiation were determined using modified Poisson regression models yielding Relative Risk, RRs, and 95% Confidence Intervals, CI. Initiation of antipsychotic use was slightly less common among refugees (65.6%) compared to non-refugee migrants (70.2%), second-generation migrants (71.0%), and Swedish-born individuals (71.1%). However, after adjustment for sociodemographic and clinical factors, there was no difference in initiation rates between refugees and Swedish-born individuals (adjusted RR 0.96; 95% CI 0.92-1.00). Olanzapine was most common initial antipsychotic in all groups. However, compared to the Swedish-born, refugees (1.47; 1.10-1.97), non-refugee migrants (1.70; 1.26-2.27) and second-generation migrants (1.43; 1.05-1.97) were more likely to initiate the use with long-acting injectable antipsychotics, and also with first-generation antipsychotics, particularly haloperidol. Sociodemographic factors associated with initiation were similar among refugees and Swedish-born individuals, including younger age, higher education and inpatient care. Our finding that migrants were more likely to initiate long-acting antipsychotics suggests that clinical teams anticipate medication non-adherence among migrants.