Personality traits, theory of mind and their relationship with multiple suicide attempts in a sample of first episode psychosis patients: One-year follow-up study

BACKGROUND: High rates of suicidal behaviour (SB) have been found in first episode psychosis (FEP) patients. It has been suggested that the presence of multiple suicide attempts (mSA) increases the risk of later SA and the risk of eventual death by suicide. OBJECTIVE: Our main objective was to study the baseline factors associated with the presence of mSA during the first year after FEP. In addition, a second aim was to find out whether there were any differences between single and multiple suicide attempters in the timing of the first SA after FEP. METHOD: A total of 65 FEP patients were evaluated. The presence of SAs were recorded at two different times after FEP. Bivariate and multivariate analyses were performed to explore the relationship between SA with sociodemographic and clinical variables. RESULTS: Multiple linear regression showed that mSA was associated with the presence of increased symptom severity (B?=?0.35; t?=?3.67; p < 0.01) and errors in first-order false-belief task (B?=?0.48; t?=?2.11; p?=?0.04). There were significant differences in the timing of first SA after FEP between multiple and single suicide attempters. CONCLUSIONS: Theory of mind impairments along with more severe symptoms during the first contact with mental health services for psychotic symptoms appeared to be important predictors of mSA. On the other hand, multiple suicide attempters tend to make a first SA after FEP earlier than single suicide attempters. These results could contribute to the implementation of preventive suicidal programs, however they must be confirmed by additional research.Funding: This study was funded by Ministry of Science and Innovation grant ISC PI11/0233

Understanding the Influence of Personality Traits on Risk of Suicidal Behaviour in Schizophrenia Spectrum Disorders: A Systematic Review

Risk of suicidal behaviour (SB) in schizophrenia spectrum disorders (SSD) is a major concern, particularly in early stages of the illness, when suicide accounts for a high number of premature deaths. Although some risk factors for SB in SSD are well understood, the extent to which personality traits may affect this risk remains unclear, which may have implications for prevention. We conducted a systematic review of previous studies indexed in MEDLINE, PsycINFO and Embase examining the relationship between personality traits and SB in samples of patients with SSD. Seven studies fulfilled predetermined selection criteria. Harm avoidance, passive-dependent, schizoid and schizotypal personality traits increased the risk of SB, while self-directedness, cooperativeness, excluding persistence and self-transcendence acted as protective factors. Although only seven studies were retrieved from three major databases after applying predetermined selection criteria, we found some evidence to support that personality issues may contribute to SB in patients with SSD. Personality traits may therefore become part of routine suicide risk assessment and interventions targeting these personality-related factors may contribute to prevention of SB in SSD

Longitudinal trajectories in negative symptoms and changes in brain cortical thickness: 10-year follow-up study

Background Understanding the evolution of negative symptoms in first-episode psychosis (FEP) requires long-term longitudinal study designs that capture the progression of this condition and the associated brain changes. Aims To explore the factors underlying negative symptoms and their association with long-term abnormal brain trajectories. Method We followed up 357 people with FEP over a 10-year period. Factor analyses were conducted to explore negative symptom dimensionality. Latent growth mixture modelling (LGMM) was used to identify the latent classes. Analysis of variance (ANOVA) was conducted to investigate developmental trajectories of cortical thickness. Finally, the resulting ANOVA maps were correlated with a wide set of regional molecular profiles derived from public databases. Results Three trajectories (stable, decreasing and increasing) were found in each of the three factors (expressivity, experiential and attention) identified by the factor analyses. Patients with an increasing trajectory in the expressivity factor showed cortical thinning in caudal middle frontal, pars triangularis, rostral middle frontal and superior frontal regions from the third to the tenth year after the onset of the psychotic disorder. The F-statistic map of cortical thickness expressivity differences was associated with a receptor density map derived from positron emission tomography data. Conclusions Stable and decreasing were the most common trajectories. Additionally, cortical thickness abnormalities found at relatively late stages of FEP onset could be exploited as a biomarker of poor symptom outcome in the expressivity dimension. Finally, the brain areas with less density of receptors spatially overlap areas that discriminate the trajectories of the expressivity dimension.Funding: This work was supported by the Instituto de Salud Carlos III (PI14/00639 and PI14/00918) and Fundación Instituto de Investigación Marqués de Valdecilla (NCT0235832 and NCT02534363). M.C.-R. acknowledges funding support from the Consejería de Salud y Familias (Junta de Andalucía) 2020 grant, which covers his salary (RH-0081 2020). R.R.-G. is funded by the EMERGIA Junta de Andalucía programme (EMERGIA20_00139) and the Plan Propio of the University of Seville

Insight and risk of suicidal behaviour in two first-episode psychosis cohorts: effects of previous suicide attempts and depression

ABSTRACT Background: The role of insight dimensions – illness recognition (IR), symptoms relabelling (SR), treatment compliance (TC) - in suicide risk in first-episode psychosis (FEP) remains unclear. Method: The AESOP (n=181) and GAP (n=112) FEP cohorts were followed-up over 10- and 5 years. Survival analysis modelled time to first suicidal event in relation to baseline scores on the Schedule for the Assessment of Insight, whilst adjusting for demographic, clinical, psychopathological and neuropsychological variables.This work represents independent research which was supported by the UK Medical Research Council (grant number G0500817) and partly-funded by the UK Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to the South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry, Psychology and Neuroscience at Kings College London. JDLM was funded by the British Medical Association via the Margaret Temple Research Award for Schizophrenia. PBJ received funding support from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC), East of England. RMM was supported by the Medical Research Council and Lord Leverhulme Trust. CM is funded by grants from the Medical Research Council (grant number MR/P025927/1) and EU (grant number ERC Ref: 648837 REACH). RD is funded by a Clinician Scientist Fellowship awarded by the Academy of Medical Sciences in partnership with The Health Foundation. ASD is supported by National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and Kings College London

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study.

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women

Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis

Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide.IG thanks the support of the Spanish Ministry of Science and Innovation (MCIN) (PI19/00954, PI23/00822) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y confinanciado por la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement (2021 SGR 01358), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022).Peer reviewe

Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol

BackgroundMore than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children’s knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma.Materials and methodsA quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups.DiscussionThis will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers’ with psychosis and adolescents’ functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457]

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.This work has received support from the Fundación Alicia Koplowitz to realize the epigenetic wide association study and to the clinical assessment to the children. This work has also received public support from the Consejería de Salud y Familias para la financiación de la investigación, desarrollo e innovación (i + d + i) biomédica y en ciencias de la salud en Andalucía (CSyF 2021 - FEDER). Grant Grant number PECOVID- 0195-2020. Convocatoria financiada con Fondo Europeo de Desarrollo Regional (FEDER) al 80% dentro del Programa Operativo de Andalucía FEDER 2014-2020. Andalucía se mueve con Europa. NG-T received payment under Rio Hortega contract CM20-00015 with the Carlos III Health Institute.Peer reviewe

Efficacy of clozapine versus standard treatment in adult individuals with intellectual disability and treatment-resistant psychosis (CLOZAID): study protocol of a multicenter randomized clinical trial

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37

Factores de riesgo de suicidio en primeros episodios psicóticos

Existe una alta tasa de conductas suicidas tras un primer episodio psicótico, especialmente durante las primeras fases del trastorno. A pesar del importante volumen de investigaciones publicadas hasta la fecha, no se han identificado los factores de riesgo de la conducta suicida tras un primer episodio psicótico y las diferentes publicaciones han mostrado datos contradictorios. Los principales objetivos de la tesis fueron analizar el patrón temporal de las primeras conductas suicidas tras un primer episodio psicótico a lo largo del año posterior al debut del trastorno. También la tesis estudió la posible relación de los rasgos de personalidad, así como de fallos en la cognición social con las conductas autolíticas posteriores al primer episodio psicótico. Finalmente, la última de las publicaciones que conforma la tesis trató de comprobar la posible influencia de las conductas autolíticas sobre el funcionamiento psicosocial al año de haber sufrido un primer episodio psicótico. Sesenta y cinco participantes fueron evaluados durante primer contacto con los servicios de salud mental por la presencia de un primer episodio psicótico. Fueron reevaluados a los 6 y 12 meses después del primer episodio psicótico. Datos de carácter sociodemográfico, psicopatológico y medidas de tipo clínicas fueron obtenidas durante el primer contacto con los servicios de salud mental. La información relacionada con la presencia de conductas autolíticas, así como el funcionamiento psicosocial fueron obtenidas durante el período de seguimiento. Los resultados de los estudios mostraron como la gran mayoría de las primeras conductas autolíticas tras el primer episodio psicótico tuvieron lugar durante los primeros seis meses tras el debut del trastorno. Diferentes rasgos de la personalidad incluidos en el estudio se relacionaron con las conductas autolíticas. Específicamente, los rasgos pasivo-dependientes fueron asociados con los primeros intentos autolíticos tras el primer episodio psicótico realizados en los siguientes seis meses tras el debut del trastorno psicótico, mientras que los rasgos esquizoides se relacionaron con las conductas suicidas ocurridas a lo largo del primer año tras el primer episodio psicótico. Por otro lado, dificultades en las tareas de falsa creencia de primer orden en las tareas de teoría de la mente predijeron las conductas autolíticas ocurridas durante el año posterior al primer episodio psicótico. Finalmente, descubrimos que la presencia de conductas autolíticas tras el primer episodio psicótico se relacionaba con un peor funcionamiento en el cuidado personas al año de haberse producido el debut del trastorno psicótico. En conclusión, rasgos de personalidad, así como fallos en cognición social son importantes predictores de las conductas autolíticas tras un primer episodio psicótico. Los resultados de estos estudios pueden contribuir a la implementación de programas de prevención de la conducta autolítica en primeros episodios psicóticos. Además, estrategias terapéuticas que se focalicen en la prevención de la conducta suicida tras un primer episodio psicótico pueden contribuir a alcanzar un mejor nivel funcionamiento psicosocial.High suicide attempt rates have been reported in first episode psychosis patients, especially during the first stages of the disorder. Despite the huge number of studies that have analysed suicide risk factors, controversial results have been reported. The objectives of this thesis were to analyse the time pattern of first suicide attempts after first episode of psychosis and test the association between personality traits and social cognition with suicide-related behaviours. It also analysed the possible influence of suicide-related behaviours and personality traits on psychosocial functioning after first episode of psychosis. Sixty-five patients were evaluated at first contact with mental health services for psychotic symptoms and followed up for one year after the onset of the disorder. Sociodemographic, psychopathological and clinical assessments were done at first contact. Information about suicide-related behaviours and psychosocial functioning was acquired during the follow-up period. We found that the majority of first suicide attempts took place during the first six months after the onset of the psychotic disorder. Personality traits were related to suicide-related behaviours. Specifically, passive-dependent personality traits were associated with first suicide attempts made over the first six months of the disorder, while schizoid personality traits were related to the presence of suicide-related behaviour during a 12-month follow-up. On the other hand, impairments in first-order false belief tasks predicted postpsychotic suicide attempts. There is also a relationship between attempting suicide and poorer personal care. Finally, the results showed the influence of personality traits, such as sociopathy and schizotypy, on personal care and occupational disability, respectively. In the light of our findings, premorbid personality traits as well as social cognition impairments are important predictors of suicide-related behaviours. These results can contribute to the implementation of suicide prevention programmes. In addition, treatment strategies focusing on personality traits and the prevention of suicide could lead to functional recovery