Brzina cerebralnoga protoka u bolesnika s prvom psihotičnom epizodom [Velocity of Cerebral Blood Flow in Patients with First Psychotic Episode]

Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. We recruited 46 patients with the first episode of psychosis and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Patients with first episode of psychosis had significantly lower blood flow velocity in left anterior cerebral artery during neurocognitive tetsing. Decreased blood flow velocity during the execution of neurocognitive tasks in patients with first episode of psychosis, compared to control subjects might indicate impaired hemodynamic function in the prefrontal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis

SIGNIFICANTLY LOWER RIGHT MIDDLE CEREBRAL ARTERY BLOOD FLOW VELOCITY IN THE FIRST EPISODE OF PSYCHOSIS DURING NEUROCOGNITIVE TESTING

Background: Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity (BFV) during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. Subjects and methods: We recruited 46 patients with the first episode of psychosis (FEP), admitted to the University Hospital Centre Zagreb during 2016-2017 and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Results: After the adjustment for age, sex and education by quantile regression, patients with FEP had significantly lower BFV in middle cerebral arteries during the 3rd

NEUROCOGNITIVE PROFILES OF PATIENTS WITH THE FIRST EPISODE OF PSYCHOSIS AND SCHIZOPHRENIA DO NOT DIFFER QUALITATIVELY: A NESTED CROSS-SECTIONAL STUDY

Background: The aim of study was to analyze neurocognitive profiles in patients with first-episode psychosis (FEP) and patients with schizophrenia (SCH), and their correlations with other clinical features. Subjects and methods: We performed a multicentric cross sectional study including 100 FEP and 100 SCH recruited from three Croatian hospitals during 2015-2017. Assessment included a set of neurocognitive tests, psychiatric scales and self-reporting questionnaires. The main analysis was done by multigroup latent profile analysis. Results: Multigroup latent profile analysis resulted in three structurally equivalent neurocognitive profiles ("Best", "Medium", "Worst"), with differences in the severity of neurocognitive deficits measured with successfulness in solving domain specific tasks. The "Best" profile was statistically significantly more prevalent in FEP and "Worst" profile in the SCH. Negative symptom score was the highest in patients with the "Worst" profile and the lowest among those with the "Best" profiles. Conclusions: Differences in neurocognitive profiles between FEP and SCH appear to be quantitative rather than qualitative nature, possibly reflecting a specific trait of illness that may progress over time. Defining neurocognitive profiles from the first episode of psychosis could help in tailoring individualized treatment options with focus on neurocognitive and negative symptoms and possible influence on patients\u27 overall clinical outcome

INTEGRATION OF COMPLEMENTARY BIOMARKERS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS: RESEARCH PROTOCOL OF A PROSPECTIVE FOLLOW UP STUDY

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis

Velocity of Cerebral Blood Flow in Patients with First Psychotic Episode

Niz istraživanja pokazuje promijenjenu cerebralnu hemodinamiku u pacijenata oboljelih od shizofrenije. Cilj našeg istraživanja bio je usporediti promjene brzine krvnog protoka za vrijeme neurokognitivne aktivacije kod pacijenata s prvom psihotičnom epizodom i kod zdravih sudionika. U istraživanje smo uključili 46 pacijenata s prvom psihotičnom epizodom i 41 zdravog sudionika. Učinili smo snimanje brzine krvnog protokau srednjim i prednjim moždanim arterijama za vrijeme neurokognitivnog testiranja u trajanju od 25 minuta testovima: Test verbalne fluentnosti, Trial making test B i Stroop test. Pronašli smo signifikantno nižu brzinu krvnog protoka u lijevoj prednjoj moždanoj arteriji za vrijeme riješavanja svih neurokognitivnih zadataka u pacijenata s prvom psihotičnom epizodom. Navedeni pronalazak snižene brzine krvnog protoka za vrijeme riješavanja neurokognitivnih zadataka upućuje na poremećenu hemodinamiku u prefrontalnom moždanim regijama te potencijalno objašnjava opservirane neurokognitivne deficite u pacijenata s prvom psihotičnom epizodom.Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. We recruited 46 patients with the first episode of psychosis and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Patients with first episode of psychosis had significantly lower blood flow velocity in left anterior cerebral artery during neurocognitive tetsing. Decreased blood flow velocity during the execution of neurocognitive tasks in patients with first episode of psychosis, compared to control subjects might indicate impaired hemodynamic function in the prefrontal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis

Velocity of Cerebral Blood Flow in Patients with First Psychotic Episode

Niz istraživanja pokazuje promijenjenu cerebralnu hemodinamiku u pacijenata oboljelih od shizofrenije. Cilj našeg istraživanja bio je usporediti promjene brzine krvnog protoka za vrijeme neurokognitivne aktivacije kod pacijenata s prvom psihotičnom epizodom i kod zdravih sudionika. U istraživanje smo uključili 46 pacijenata s prvom psihotičnom epizodom i 41 zdravog sudionika. Učinili smo snimanje brzine krvnog protokau srednjim i prednjim moždanim arterijama za vrijeme neurokognitivnog testiranja u trajanju od 25 minuta testovima: Test verbalne fluentnosti, Trial making test B i Stroop test. Pronašli smo signifikantno nižu brzinu krvnog protoka u lijevoj prednjoj moždanoj arteriji za vrijeme riješavanja svih neurokognitivnih zadataka u pacijenata s prvom psihotičnom epizodom. Navedeni pronalazak snižene brzine krvnog protoka za vrijeme riješavanja neurokognitivnih zadataka upućuje na poremećenu hemodinamiku u prefrontalnom moždanim regijama te potencijalno objašnjava opservirane neurokognitivne deficite u pacijenata s prvom psihotičnom epizodom.Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. We recruited 46 patients with the first episode of psychosis and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Patients with first episode of psychosis had significantly lower blood flow velocity in left anterior cerebral artery during neurocognitive tetsing. Decreased blood flow velocity during the execution of neurocognitive tasks in patients with first episode of psychosis, compared to control subjects might indicate impaired hemodynamic function in the prefrontal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis

Velocity of Cerebral Blood Flow in Patients with First Psychotic Episode

Niz istraživanja pokazuje promijenjenu cerebralnu hemodinamiku u pacijenata oboljelih od shizofrenije. Cilj našeg istraživanja bio je usporediti promjene brzine krvnog protoka za vrijeme neurokognitivne aktivacije kod pacijenata s prvom psihotičnom epizodom i kod zdravih sudionika. U istraživanje smo uključili 46 pacijenata s prvom psihotičnom epizodom i 41 zdravog sudionika. Učinili smo snimanje brzine krvnog protokau srednjim i prednjim moždanim arterijama za vrijeme neurokognitivnog testiranja u trajanju od 25 minuta testovima: Test verbalne fluentnosti, Trial making test B i Stroop test. Pronašli smo signifikantno nižu brzinu krvnog protoka u lijevoj prednjoj moždanoj arteriji za vrijeme riješavanja svih neurokognitivnih zadataka u pacijenata s prvom psihotičnom epizodom. Navedeni pronalazak snižene brzine krvnog protoka za vrijeme riješavanja neurokognitivnih zadataka upućuje na poremećenu hemodinamiku u prefrontalnom moždanim regijama te potencijalno objašnjava opservirane neurokognitivne deficite u pacijenata s prvom psihotičnom epizodom.Changes in cerebral hemodynamics have been reported in schizophrenia and proposed as underlying the cognitive deficits seen in patients. The objective of our study was to compare changes of the cerebral blood flow velocity during neurocognitive tasks between the patients with the first episode of psychosis and healthy controls. We recruited 46 patients with the first episode of psychosis and 41 control subjects. Transcranial Doppler ultrasonography monitoring of BFV in both middle cerebral arteries was recorded during 25-minute long neurocognitive assessment with Phonemic Verbal Fluency test, Trial Making Test B and Stroop test. Between every consecutive test resting periods were recorded. Patients with first episode of psychosis had significantly lower blood flow velocity in left anterior cerebral artery during neurocognitive tetsing. Decreased blood flow velocity during the execution of neurocognitive tasks in patients with first episode of psychosis, compared to control subjects might indicate impaired hemodynamic function in the prefrontal brain areas, and possibly provide an explanation of some of the observed neurocognitive deficits in patients with the first episode of psychosis

Interventions for prodromal stage of psychosis

Background: Psychosis is a serious mental condition characterised by a loss of contact with reality. There may be a prodromal period or stage of psychosis, where early signs of symptoms indicating onset of first episode psychosis (FEP) occur. A number of services, incorporating multimodal treatment approaches (pharmacotherapy, psychotherapy and psychosocial interventions), developed worldwide, now focus on this prodromal period with the aim of preventing psychosis in people at risk of developing FEP. ----- Objectives: The primary objective is to assess the safety and efficacy of early interventions for people in the prodromal stage of psychosis. The secondary objective is, if possible, to compare the effectiveness of the various different interventions. ----- Search methods: We searched Cochrane Schizophrenia's study-based Register of studies (including trials registers) on 8 June 2016 and 4 August 2017. ----- Selection criteria: All randomised controlled trials (RCTs) evaluating interventions for participants older than 12 years, who had developed a prodromal stage of psychosis. ----- Data collection and analysis: Review authors independently inspected citations, selected studies, extracted data, and assessed study quality. ----- Main results: We included 20 studies with 2151 participants. The studies analysed 13 different comparisons. Group A comparisons explored the absolute effects of the experimental intervention. Group B were comparisons within which we could not be clear whether differential interactive effects were also ongoing. Group C comparisons explored differential effects between clearly distinct treatments. A key outcome for this review was 'transition to psychosis'. For details of other main outcomes please see 'Summary of findings' tables. In Group A (comparisons of absolute effects) we found no clear difference between amino acids and placebo (risk ratio (RR) 0.48 95% confidence interval (CI) 0.08 to 2.98; 2 RCTs, 52 participants; very low-quality evidence). When omega-3 fatty acids were compared to placebo, fewer participants given the omega-3 (10%) transitioned to psychosis compared to the placebo group (33%) during long-term follow-up of seven years (RR 0.24 95% CI 0.09 to 0.67; 1 RCT, 81 participants; low-quality evidence). In Group B (comparisons where complex interactions are probable) and in the subgroup focusing on antipsychotic drugs added to specific care packages, the amisulpiride + needs-focused intervention (NFI) compared to NFI comparison (no reporting of transition to psychosis; 1 RCT, 102 participants; very low-quality evidence) and the olanzapine + supportive intervention compared to supportive intervention alone comparison (RR 0.58 95% CI 0.28 to 1.18; 1 RCT, 60 participants; very low-quality evidence) showed no clear differences between groups. In the second Group B subgroup (cognitive behavioural therapies (CBT)), when CBT + supportive therapy was compared with supportive therapy alone around 8% of participants allocated to the combination of CBT and supportive therapy group transitioned to psychosis during follow-up by 18 months, compared with double that percentage in the supportive therapy alone group (RR 0.45 95% CI 0.23 to 0.89; 2 RCTs, 252 participants; very low-quality evidence). The CBT + risperidone versus CBT + placebo comparison identified no clear difference between treatments (RR 1.02 95% CI 0.39 to 2.67; 1 RCT, 87 participants; very low-quality evidence) and this also applies to the CBT + needs-based intervention (NBI) + risperidone versus NBI comparison (RR 0.75 95% CI 0.39 to 1.46; 1 RCT, 59 participants; very low-quality evidence). Group C (differential effects) also involved six comparisons. The first compared CBT with supportive therapy. No clear difference was found for the 'transition to psychosis' outcome (RR 0.74 95% CI 0.28 to 1.98; 1 RCT, 72 participants; very low-quality evidence). The second subgroup compared CBT + supportive intervention was compared with a NBI + supportive intervention, again, data were equivocal, few and of very low quality (RR 6.32 95% CI 0.34 to 117.09; 1 RCT, 57 participants). In the CBT + risperidone versus supportive therapy comparison, again there was no clear difference between groups (RR 0.76 95% CI 0.28 to 2.03; 1 RCT, 71 participants; very low-quality evidence). The three other comparisons in Group C demonstrated no clear differences between treatment groups. When cognitive training was compared to active control (tablet games) (no reporting of transition to psychosis; 1 RCT, 62 participants; very low quality data), family treatment compared with enhanced care comparison (RR 0.54 95% CI 0.18 to 1.59; 2 RCTs, 229 participants; very low-quality evidence) and integrated treatment compared to standard treatment comparison (RR 0.57 95% CI 0.28 to 1.15; 1 RCT, 79 participants; very low-quality evidence) no effects of any of these approaches was evident. ----- Authors' conclusions: There has been considerable research effort in this area and several interventions have been trialled. The evidence available suggests that omega-3 fatty acids may prevent transition to psychosis but this evidence is low quality and more research is needed to confirm this finding. Other comparisons did not show any clear differences in effect for preventing transition to psychosis but again, the quality of this evidence is very low or low and not strong enough to make firm conclusions

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes

Salivary cortisol response to psychosocial stress in patients with first-episode psychosis

Aim To analyze the difference in the salivary cortisol response to psychosocial stress between the patients with the first episode of psychosis (FEP) and the control group. Methods We performed a cross-sectional analysis of the baseline measurements of a prospective cohort study conducted from 2015 to 2018 at two Croatian psychiatric hospitals. The study consecutively enrolled 53 patients diagnosed with FEP and 63 healthy controls. The primary outcome was the difference in the changes of salivary cortisol concentration during the stress test. The secondary outcome was the difference in the baseline levels of salivary cortisol between patients with FEP and controls. The tertiary outcome were the correlations of salivary cortisol levels with the results of the Positive and Negative Syndrome Scale for Schizophrenia, Rosenberg Self-Esteem Scale, and the International Personality Item Pool. Results Patients with FEP had significantly higher baseline salivary cortisol than controls, but their salivary cortisol increased significantly less during the stress test. Conclusion Patients with FEP respond differently to stressful stimuli than controls, as shown by the increased baseline salivary cortisol and blunted cortisol response, possibly indicating a greater vulnerability to psychosocial stress