Onset Of Psychotic Disorders Research Articles

Environmental factors and the age at onset in first episode psychosis

ObjectiveFactors that influence the age at onset in psychotic disorders could provide valuable insights into precipitating or causative factors of the disorder. Despite being established risk factors, it is not yet known whether migration status, place of birth, social class at birth and season of birth influence the age at onset of psychotic disorders. This study aimed to determine whether these environmental factors, in addition to cannabis abuse and obstetric complications, influence the age at onset. Additionally, we investigated whether environmental factors could have a cumulative effect on the age at onset. MethodData was obtained from two first episode of psychosis (FEP) cohort studies. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses. ResultsThe age at onset was determined for 555 individuals with a FEP and the median age at onset was 27.3years. Individuals with a history of cannabis abuse had an earlier age at onset by nearly six years. There was a trend for a history of obstetric complications to be associated with a younger age at onset by 2.7years and this was significant in the subgroup with a family history of psychosis. Social class at birth, migration status, place of birth and season of birth were not associated with the age at onset. Exposure to a higher number of environmental factors was associated with an earlier age at onset. ConclusionsCannabis and obstetric complications are associated with an earlier age at onset and there appears to be a cumulative effect of exposure to multiple environmental factors.

Understanding the course of cognitive deficits over the onset of psychosis

ABSTRACT FROM: Bora E, Murray RM. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first episode psychosis: do the cognitive deficits progress over, or after, the onset of...

The Development of a Short Psychotic Symptoms Questionnaire Using Data of a Two-Wave Epidemiological Study

For use in epidemiological surveys, short self-report questionnaires measuring psychotic symptoms were not available in 1995, when we started a multi-wave epidemiological study. This paper presents such an instrument, using the epidemiological data of the 1996 and 2000 waves of a longitudinal study. Relevant items from the Dutch Abbreviated MMPI and the Symptom Checklist were combined into one questionnaire, which was completed by a regional Dutch population sample of 1528 subjects in 1996 and 525 in 2000, with a common cohort of 496. Data from a client sample were used (n = 113) for validation purposes. Principal component analyses resulted in one general psychosis factor with sufficient reliability. Validity research indicated that the instrument measured the psychotic symptoms. Positive correlations were found with schizotypal personality and experienced disability. Correlations indicating both convergent and divergent validity were found in the Rorschach test, the Dutch Abbreviated MMPI and the MMPI-2. The instrument measures the prevalence of psychotic symptoms in the general population and can be used as a short self-report screener in epidemiological surveys. Combined with a disability screener, the proportion of the population suffering disabilitating effects of psychotic symptoms can be estimated. Further research is recommended to investigate the predictive value of the instrument concerning the prognosis of experiencing psychotic symptoms or showing onset of psychotic disorder. This offers perspectives for future use in primary health care to identify persons with psychotic liability or who need support in coping with psychotic symptoms.

The effect of drug use on the age at onset of psychotic disorders in an Australian cohort

BackgroundWe aimed to examine the association between illicit substance use and age at onset in psychotic disorders in an Australian cohort. MethodsRetrospectively acquired information on substance use during the year prior to illness onset was collected from 1642 participants enrolled in the Australian National 2010 Survey of High Impact Psychosis study (SHIP), with an ICD-10 diagnosis of schizophrenia spectrum or affective psychosis. Latent class analysis was performed according to illicit substance use, using age as an active covariate; identified classes were subsequently validated. Cox regression was used to examine the independent contribution of the identified substance use classes and several confounding variables to the prediction of age at onset of psychosis. ResultsThree classes according to substance use were identified: non-users (n=803), cannabis predominant users (n=582), and polysubstance users (n=257). For participants with schizophrenia spectrum disorders, cannabis predominant users had a higher hazard of earlier age at onset than for non-users (adjusted HR=1.38, 95% CI=1.2–1.6); polysubstance users had an even higher hazard (adjusted HR=1.95, 95% CI=1.5–2.4). In contrast, for participants with affective psychosis, cannabis predominant users (adjusted HR=1.10, 95% CI=0.8–1.4) and polysubstance users (adjusted HR=0.87, 95% CI=0.6–1.3) did not have a higher hazard of earlier age at onset compared with non-users. ConclusionsIllicit substance use in the 12months prior to psychosis onset has a differential effect on age at onset in schizophrenia spectrum and affective psychotic disorders. Our findings are compatible with the notion that illicit drugs bring forward age at onset in schizophrenia spectrum disorders but not affective psychotic disorders.

Interplay Between Childhood Physical Abuse and Familial Risk in the Onset of Psychotic Disorders

Background: Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. Methods: Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. Results: Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09–17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06–12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03–115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22–8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. Conclusions: This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse.

Prevalence of bullying victimisation amongst first-episode psychosis patients and unaffected controls

BackgroundDespite increasing evidence suggesting that childhood maltreatment is significantly associated with psychosis, the specific role of bullying in the onset of psychotic disorders is still unclear. This study aimed to examine whether bullying was more prevalent amongst individuals presenting to services for the first time with a psychotic disorder than in unaffected community controls. MethodsData on exposure to bullying, psychotic symptoms, cannabis use and history of conduct disorder were collected cross-sectionally from 222 first-presentation psychosis cases and 215 geographically-matched controls. Bullying victimisation was assessed retrospectively as part of the Brief Life Events schedule. Logistic regression was used to examine associations between exposure to bullying and case–control status, while controlling for potential confounders. ResultsPsychosis cases were approximately twice as likely to report bullying victimisation when compared to controls. No significant interactions between bullying and either gender or cannabis use were found. Controls reporting being a victim of bullying were approximately twice as likely to also report at least one psychosis-like symptom. ConclusionsOur results extend previous research by suggesting that bullying victimisation may contribute to vulnerability to develop a psychotic disorder in some individuals.

Ten year neurocognitive trajectories in first-episode psychosis

Objective: Neurocognitive impairment is commonly reported at onset of psychotic disorders. However, the long-term neurocognitive course remains largely uninvestigated in first episode psychosis (FEP) and the relationship to clinically significant subgroups even more so. We report 10 year longitudinal neurocognitive development in a sample of FEP patients, and explore whether the trajectories of cognitive course are related to presence of relapse to psychosis, especially within the first year, with a focus on the course of verbal memory.Method: Forty-three FEP subjects (51% male, 28 ± 9 years) were followed-up neurocognitively over five assessments spanning 10 years. The test battery was divided into four neurocognitive indices; Executive Function, Verbal Learning, Motor Speed, and Verbal Fluency. The sample was grouped into those relapsing or not within the first, second and fifth year.Results: The four neurocognitive indices showed overall stability over the 10 year period. Significant relapse by index interactions were found for all indices except Executive Function. Follow-up analyses identified a larger significant decrease over time for the encoding measure within Verbal Memory for patients with psychotic relapse in the first year [F(4, 38) = 5.8, p = 0.001, η2 = 0.40].Conclusions: Main findings are long-term stability in neurocognitive functioning in FEP patients, with the exception of verbal memory in patients with psychotic relapse or non-remission early in the course of illness. We conclude that worsening of specific parts of cognitive function may be expected for patients with on-going psychosis, but that the majority of patients do not show significant change in cognitive performance during the first 10 years after being diagnosed.

Sensitive delusion of reference, rivisitation of a concept: clinical accounts on onset paranoid psychosis

In this work it is discussed whether and how Kretchmer's psychopathological reflections about sensitive delusion of reference can offer a relevant interpretative key for clinicians who face cases of acute persecutory psychosis. It is argued the utility and topicality of those psychopathological concepts that aren't commonly investigated, especially in the evaluation and management of onset paranoid psychosis in an emergency ward. We provide clinical vignettes of two young patients, admitted in the emergency psychiatry ward, who represent a concrete example of the dynamic-affective comprehension of delusional elaboration, through its embodiment in the individual biographical development. An interpretative key, based on this specific conceptual frame, seems to provide an integrated intervention tool that aims both to a causal comprehension and demolition of the delusional solution in onset psychotic cases. The rediscovery of classical psychopathological concepts appears to be a necessary process, especially in the clinical management of onset psychotic disorders. Further and more accurate researches are, in any case, needed.

Le traumatisme crânien comme facteur étiopathogénique de déclenchement d’une maladie schizophrénique. Illustrations des difficultés et intérêts théoriques et pratiques d’une telle conception

Schizophrenia and head trauma are two major public health problems. When schizophrenia is triggered or revealed by a head trauma in a predisposed subject due to genetic vulnerability, we talk of post-traumatic schizophrenia. However, very few studies can be found in the literature for adolescent psychiatry concerning this common clinical entity. After reviewing the criteria of the different post-traumatic psychotic syndromes, we illustrate this thematic of a clinical situation, which questions the role of the head trauma in the onset of psychotic disorders. We discuss more specifically the modern notions of progressive onset in schizophrenia and gene/environment interactions in view of the neurodevelopmental paradigm. This etiopathogenic model considers that schizophrenia is determined multifactorially. Clinical elements and deleterious medical history, such as childhood infections, can be very early risk factors in relation to the onset of schizophrenia, which will occur a few years or decades later. The latency period, sometimes long between exposure to the risk factor and the schizophrenic onset, is necessary for cerebral reorganisation which progressively evolves into a degenerative process. In subjects genetically vulnerable to schizophrenia, the head trauma is an environmental risk factor, which increases the probability of the onset of a psychotic disorder. Furthermore, patients from families predisposed to schizophrenia are more at risk from head traumas. Certain vulnerability genes also present a risk with head trauma and its deleterious effects by causing a synergetic effect of the risk factors in the onset of psychotic disorders.

Immigration, Social Environment and Onset of Psychotic Disorders

The recent decade has been characterized by a resurging interest for socio-environmental determinants of psychotic disorders, largely as a result of findings from studies of migration and psychotic disorders. This contribution reviews recent meta-analytic findings which confirm higher incidence rates of schizophrenia and related disorders among first- and second-generation immigrants than in non-immigrant populations, as well as substantial risk variation according to both ethnic minority groups and host society contexts. The relevance of social contexts in the onset of psychosis is also suggested by incidence variation according to the neighbourhood level ethnic density. While limited, an emerging literature suggests potential variations in psychotic-like experiences and at-risk mental states according to ethnic minority status. We then discuss the meaning of findings from migrant studies, as well as integrative models that attempt to account for ethnic variations in the incidence of psychosis and psychotic-like phenomena. In conclusion, there remain numerous gaps in our understanding of the relation between migration, ethnicity, social contexts and the onset of psychosis and we propose future research avenues to address these. In particular, there is a need for multilevel approaches integrating disciplines and methodologies across the psychosis continuum.

Risk, Disorder and Diagnosis

develop schizophrenia and is generally not longer than a few years, with an average duration of about one year [7]. Thus it has been seen as a legitimate target for detection and intervention, with the aim of prevention of onset, or at least amelioration or delay of onset [8]. This is the background to the ‘ prodromal intervention ’ fi eld. However, even apparent prodromal symptoms lack specifi city. Characteristic prodromal features include sleep disturbance, irritability, lowered mood, anxiety and decline in school or work performance [7,9]. This clinical picture could be the result of a number of conditions, such as major depression, substance abuse and physical illness, as well as a psychotic prodrome. Even attenuated or isolated psychotic symptoms may not necessarily progress to a frank psychotic disorder, as these are now known to be quite common in the general population [10 – 14]. There are two implications of this lack of specifi city. First, is the recognition that a prodrome cannot be diagnosed as such prospectively, and that the terms ‘ prodrome ’ and ‘ prodromal ’ should not be used to refer to this clinical picture or those apparently presenting with it. This is more than pure semantics. Adoption of the term ‘ prodromal ’ to refer to individuals implies that they are on the path to schizophrenia. It suggests that the ‘ process ’ has already begun. Instead, as McGorry [15] has pointed out, terminology such as ‘ at risk mental state ’ should be used, to highlight that a person presenting with apparent prodromal symptoms may be at increased risk of onset of psychotic disorder within a brief time frame (1 – 2 years), but that onset is not inevitable. The second implication is that there needs to be some narrowing of the defi nition of ‘ at risk ’ so that those so identifi ed truly have a high likelihood of onset of fi rst episode psychosis within a brief period of time. One strategy to achieve this aim has been the development of the ultra high risk (UHR) criteria. These have been described elsewhere [8,16,17]. Essentially, there are three groups identifi ed: (i) attenuated psychotic symptoms

S21-04 - Fatty acid metabolism and the onset of psychotic disorder

IntroductionPotentially chronic diseases often have a critical point in their course beyond which treatment becomes less effective. In support of this, early treatment in schizophrenia and other psychoses has been linked to better outcome.ObjectivesThe emergence of simultaneous brain volume changes in those ultra-high-risk individuals who develop psychosis indicate an active biological process, and underline the importance of pre-onset treatment. However, pre-psychotic intervention has also been questioned as, using current criteria, only 20–50% of individuals classified as prodromal develop a psychotic disorder within a 1–2 years period.AimsTreatment agents in the pre-psychotic phase should, therefore, not have major side effects. Bioactive lipids are molecules that have both intra- and intercellular roles, including mediation, modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression.MethodsLong-chain omega-3 polyunsaturated fatty acids (PUFAs) have been shown effective for both, mood and psychotic symptoms, and they have neuroprotective properties. Because of the controversy concerned with the extent to which an intervention may produce harm which outweighs its benefits, omega-3 PUFAs are prime candidates for evaluation in putatively prodromal individuals.ResultsWe report on the first randomized, placebo-controlled trial on the preventive use of omega-3 fatty acids in 81 ultra-high-risk individuals.ConclusionsSupplementation with long-chain omega-3 PUFAs reduces the risk of progression to psychotic disorder, and offers a safe and efficacious strategy for indicated prevention in individuals at ultra-high-risk of developing a psychotic illness.

Age at onset of psychotic disorder: Cannabis, BDNF Val66Met, and sex‐specific models of gene–environment interaction

Discovering modifiable predictors for age at onset may help to identify predictors of transition to psychotic disorder in the "at-risk mental state." Inconsistent effects of sex, BDNF Val66Met (rs6265), and cannabis use on age of onset were previously reported. BDNF Val66Met and cannabis use before illness onset were retrospectively assessed in a sample of 585 patients with schizophrenia and their association with age at onset was evaluated. Cannabis use was significantly associated with earlier age at onset of psychotic disorder (AOP; average difference 2.7 years, P < 0.001), showing dose-response effects with higher frequency and earlier age at first use. There was a weak association between BDNF Val66Met genotype and AOP (difference 1.2 years; P = 0.050). No evidence was found for BDNF × cannabis interaction (interaction χ(2) (1) = 0.65, P = 0.420). However, a significant BDNF × cannabis × sex interaction was found (interaction χ(2) (1) = 4.99, P = 0.026). In female patients, cannabis use was associated with earlier AOP in BDNF Met-carriers (difference 7 years), but not in Val/Val-genotypes. In male patients, cannabis use was associated with earlier AOP irrespective of BDNF Val66Met genotype (difference 1.3 years). BDNF Val66Met genotype in the absence of cannabis use did not influence AOP, neither in female or male patients with psychotic disorder. Complex interactions between cannabis and BDNF may shape age at onset in female individuals at risk of psychotic disorder. No compelling evidence was found that BDNF genotype is associated with age at onset of psychotic disorder in the absence of cannabis use.

Cannabis use and age at onset of psychosis: further evidence of interaction with COMT Val158Met polymorphism

To examine, in a sample of young psychiatric patients, (n = 157, mean age 17.01 years (SD = 3.6)) whether i) age at first cannabis use and age at emergence of psychiatric disorders are related and ii) such a relationship is modulated by the Val158Met polymorphism in the COMT gene. Cannabis use profiles and COMT Val158Met genotypes were obtained from 80 inpatients with schizophrenia-spectrum disorders and 77 inpatients with other non-psychotic disorders. First, age at first cannabis use correlates with age at onset in both schizophrenia-spectrum and other psychiatric disorder groups: those who started using cannabis earlier had an earlier age at onset of psychiatric disorders. Second, the distribution of the Val158Met genotypes was not different either between diagnosis groups or between cannabis users and non-users. Third, an interaction between Val158Met genotypes and cannabis use was observed specifically on age at emergence of psychotic disorders, with Val/Val genotype carriers showing an earlier age at onset than Met carriers. Our results suggest the importance of brain maturation timing in which exposure to cannabis occurs. The COMT Val158Met genotype seems to modulate the association between cannabis and age at onset of psychotic disorders. These results are consistent with previous studies.

Severe injuries in adolescence predict psychosis: A nested case control study of the Northern Finland 1966 Birth Cohort

Adolescents who later develop schizophrenia are likely to have problems with motor coordination and many adolescents with schizophrenia have self-injurious behaviour before treatment of first psychosis but association between injuries in adolescence and onset of psychotic disorder is unknown. The aim of this study was to describe what type of injuries psychotic individuals had during adolescence and in which age these injuries occurred. The study population consists of 155 members of the Northern Finland 1966 Birth Cohort with diagnosis of schizophrenia spectrum disease and 620 matched controls. All injuries which had occurred before onset of psychosis were extracted from Finnish Hospital Discharge Register. Individuals with psychotic disorder were more likely to have a history of severe injury. During the age 12–19, 11% of psychotic subjects and 5.3% of healthy controls had an injury (z=2.38; P=0.017) and the most common type of injury was fractures. Our findings suggest that severe injury in adolescence may be a predictor of psychosis.

Families' Experience With Seeking Treatment for Recent-Onset Psychosis

Families' Experience With Seeking Treatment for Recent-Onset Psychosis

The Role of Gender in Early and Very Early Onset of Psychotic Disorders

This study examines the impact of gender and very early onset on the prognosis of a psychotic disorder. Methods: Eighty-seven youths under 18 years of age, 36 (41%) female and 51 (59%) male, hospitalized with first-episode psychosis were investigated in a multi-site, longitudinal, retrospective follow-up cohort design. An exploratory examination of the subjects was undertaken to assess the impact of very early transition to psychosis on prognosis. Data at Time 1 (time of discharge) were retrospectively collected using a standardized questionnaire from patients' hospital records, and follow-up data at Time 2 (a minimum interval of two years post discharge) were obtained using a mailout questionnaire. Subjects were followed for at least two years (3.9±1.3 years). Results: Females with very early onset (<13 years) were more likely to have a poorer prognostic course and experience relapse resulting in hospital readmission than older females (13-18 years). Conversely, older males were more likely than younger ...

Relationships between schizotypy and subjective experiences in a sample of 399 university students

The high-risk approach based on the definition of schizotypy by Meehl (The American Psychologist 1962;17:827-38) and the basic symptom approach proposed by Huber (Fortschritte für Neurologie und Psychiatrie 1957;25:491-520) share many points in common. In particular, several studies have shown that high scores on psychosis proneness or subjective experiences (SE) scales were associated with the onset of psychotic disorders in nonpsychiatric or nonpsychotic subjects. However, the relationships between the 2 concepts have never been studied experimentally. The present study was therefore designed to investigate the relationships between the scores of the SE scale and several psychosis proneness scales evaluating the negative and positive components of schizotypy in a sample of 399 university students. Data were analyzed using multiple regression and principal components analyses. The results show that SE, as assessed by the Frankfurt Complaint Questionnaire, were significantly associated with the positive component of schizotypy but not with the negative component. Subjective experiences could constitute vulnerability traits for psychosis and the Frankfurt Complaint Questionnaire could be use instead of the positive psychosis proneness scales.

STRATEGIES FOR IMPROVING THE PREDICTION OF PSYCHOSIS

Introduction: Over the last fifteen years, valid and reliable criteria have been developed for identifying individuals at ‘ultra-high risk’ (UHR) of imminent onset of psychotic disorder. A number of randomized controlled trials (RCTs) have been conducted in the UHR population. These trials have demonstrated that psychotic disorder can at least be delayed in this population. However, it remains unclear what the most effective type, timing and duration of treatment is for this population is. There is evidence that benign treatments may be sufficient as a first step in the UHR population. Recent research also indicates a reduction in rate of transition to psychotic disorder in the UHR population. Together, these data suggests that a staged approach to treatment, starting with more benign interventions and progressing to more intensive treatments in the case of poor response or deterioration, may be appropriate for the UHR population. Another factor that has been a challenge in UHR intervent ion studies has been to recruit a sufficient number of participants to provide statistical power to address research questions. Methods: This background has provided the impetus for a new multisite RCT being developed in the UHR population. The RCT has a two-stage design. Stage 1 consists of participants being randomized to one of two conditions: cognitive-behavioural case management (CBCM) + placebo or CBCM + eico sapentanoic acid (EPA). Treatment will continue for 3 months. Participants who fail to respond to treatment in Stage 1 will be randomized at Stage 2 to either CBCM + low dose atypical anti-psychotic medication (quetiapine) or CBCM + placebo. Treatment will continue for 6 months. The study will be conducted across 9 international UHR clinics.

Substance Abuse in Early Onset Psychotic Disorders

ABSTRACT Objectives: To examine patterns of substance use in youths with schizophrenia or other early onset psychotic disorders. Methods: Youths with psychotic disorders (onset before age 18 years) were assessed annually over two years using standardized diagnostic and symptom rating measures, including the Structured Clinical Interview for DSM-IV (SCID). Subjects with psychosis solely due to substance use were excluded. Subjects were between the ages of 6 and 17 years at study entry, with a mean age of 14.8 ± 2.2 years. Results: Thirty-nine percent of the 69 subjects met criteria for schizophrenia. Forty-five percent of the subjects met criteria for substance use disorders (i.e., substance abuse or dependence), and another 7% tried illicit substances without meeting criteria for abuse or dependence. Substance use disorders (SUDs) were not significantly associated with the type of psychotic illness, gender, ethnicity, socioeconomic status, severity of positive or negative symptoms at baseline, or other hypothesized risk factors (e.g., disruptive behavior disorders, familial substance abuse, and maltreatment). Subjects with SUDs had a significantly older age of entry into the study (p < .001). Subjects with co-occurring schizophrenia and SUDs used substances prior to the onset of psychosis and had a significantly older age of onset of psychosis (p < .021). Only 26% of youths with SUDs had received specific chemical dependency treatment. Conclusions: Substance abuse is a very significant and under-treated problem in this sample of youths with early onset psychosis. Efforts to identify specific risk factors and effective intervention strategies are needed.