DEPRESSIVE FEATURES IN INDIVIDUALS WITH FIRST EPISODE PSYCHOSIS: PSYCHOPATHOLOGICAL AND TREATMENT CONSIDERATIONS FROM A 2-YEAR FOLLOW-UP STUDY

Objective: Comorbid depression is quite common in early psychosis and specifically related to suicidal behavior and poor long-term outcomes. However, Depressive Symptoms (DS) are often neglected in both research and treatment, especially at the psychosis onset. The goals of this investigation were: (a) to longitudinally explore DS levels in patients with First Episode Psychosis (FEP) during 24 months of follow-up, and (b) to investigate the associations of DS with psychopathology and intervention components of an “Early Intervention in Psychosis” (EIP) program across the follow-up period. Method: The Global Assessment of Functioning (GAF) and the Positive And Negative Syndrome Scale (PANSS) were completed by 266 FEP subjects. A linear regression analysis with DS as the dependent parameter and psychopathological and treatment characteristics as independent variables was performed (both at baseline and across the follow-up period). Results: DS had enduring associations with PANSS “Positive Symptoms” and “Negative Symptoms” subscores. During the investigation, FEP subjects significantly improved their DS severity levels. This was related to the number of individual psychotherapy meetings supplied within the EIP protocol, as well as to a higher antidepressant dose and a lower antipsychotic dose prescribed during the follow-up. Conclusions: DS are quite prominent in FEP, even at the recruitment time in EIP services. Nevertheless, DS severity tends to diminish overtime, especially with the provision of specialized EIP treatments

Is depressed mood clinically relevant at the onset of schizophrenia? A longitudinal study.

Aim: Depressed mood (DM) in schizophrenia is often associated with suicide risk and poor outcomes. However, it is generally overlooked in clinical practice, especially in First Episode Schizophrenia (FES). The aims of this investigation were: (1) to calculate baseline prevalence of FES patients with relevant DM, (2) to longitudinally monitor DM severity levels over a 12-month follow-up, and (3) to investigate their associations with clinical data and the specific treatment components of an “Early Intervention in Psychosis” (EIP) program. Material and Methods: The Positive and Negative Syndrome Scale (PANSS) was completed by all FES participant. Individuals with a baseline PANSS “Depression” item subscore of ≥ 5 were classified as having relevant depressed mood (FES/DM+). Chi-square and Mann-Whitney tests were used for inter-group comparisons. A linear regression analysis was also performed. Results: Fifty-three (33.3%) participants were in the FES/DM+ subgroup. Relevant DM at baseline was associated with female gender and a higher PANSS “Positive Symptoms” score. Across the follow-up, FES individuals improved their DM severity levels. This was significantly related to a longitudinal decrease in PANSS “Positive Symptoms” levels. Conclusions: DM is relatively frequent in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs

Short‑term disengagement from early intervention service for first‑episode psychosis: findings from the “Parma Early Psychosis” program.

tors of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess the most relevant predictors of disengagement in the first year of treatment. Methods All participants were young FEP help-seeking patients, aged 12–35 years, enrolled within the “Parma Early Psychosis” (Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were used. Results 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence, living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry. Conclusion About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the option for low-intensity support and monitoring, also via remote technology

ANHEDONIA IN THE PSYCHOSIS RISK SYNDROME: STATE AND TRAIT CHARACTERISTICS

Background: Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. Subjects and methods: All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS “Anhedonia” item 4.3 and BOL “Introvertive Anhedonia” subscale scores. Results: In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL “Introvertive Anhedonia” subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. Conclusions: In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients

Anhedonia and suicidal ideation in young people with early psychosis: Further findings from the 2-year follow-up of the ReARMS program.

Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Ninty-six UHR and 146 FEP, aged 13–35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II “Anhedonia” subscale score to assess anhedonia and the CAARMS “Depression” item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime

Urban development and identity between modernity and tradition in the global oil city of Doha, Qatar

Today, Doha is a cosmopolitan city of about two million inhabitants with more than a hundred different nationalities within its borders. However, the speed and intensity of this urban development have favoured a model of 'fragmented' city, characterized by a low population density, social polarization, and based on the use of the car. From a spatial point of view, Doha presents advanced infrastructures and spectacular architecture, but, also, enormous corridors that fragment its urban fabric into 'islands'. Also, due to the rapid urbanization, many historic buildings have been demolished to give way to new residential towers and shopping centres causing the loss of important historical roots. A permanent conflict, thus, afflicts the growth direction of the city: on the one hand the formation of a new postmodern identity and international status, represented by spectacular mega-projects and state-of-the-art architectures; on the other, the need for a redevelopment of the ancient urban fabric and its historical architecture, in an attempt to establish new connections with local culture and traditions. In the debate between innovation and tradition, this article presents some urban projects recently concluded and highlighted essential issues regarding the processes that affect the urban development of Doha

Towards new directions for public spaces in the globalising Middle East

While cities are growing, public spaces are shrinking and declining world-wide. Nevertheless, public spaces have enormous potential, strategically supportingcities’ economic, environmental, and social agendas. Research on the impact ofurbanisation in the globalising Middle East is growing. Recent studies have beenbroadly discussing the speed and intensity of urban growth in this geographicalarea, specifically in the Arabian Gulf region where an unprecedented urbanisationprocess has taken place in the last few decades. Nevertheless, while hybrid typolo-gies of public spaces other than the traditional piazza, square, or street are material-ising, their form, use, and social value are still poorly understood. Investigating theseemerging urban directions raises the question of improving the quality of the builtenvironment to facilitate and promote liveable public spaces that, in turn, promotehigher living standards. Accordingly, this work’s fundamental objective is to explore,investigate, and demystify contemporary urban challenges faced by the globalisingMiddle Eastern cities and their urban spaces, discussing theories and design prin-ciples, supported by case studies, that influence and affect the urban growth andtransformations of these cities, and it discusses the social value of their public spaces

Urban Challenges in the Globalizing Middle-East: social value of public spaces

This publication aims to investigate the nature of social life in public and urban spaces in the cities of the Middle East, considering the value of environmental approaches. It aims to develop a better understanding of the patterns of social interactions and activities in public places, which have been influenced by cultural heritage values. Sustainable and livable open spaces can help in improving living conditions in cities. Public spaces are relevant as they satisfy many human needs. In public spaces, people interact and meet; people with different cultures and social backgrounds can communicate and learn from each other in social and spontaneous ways. However, decision-makers tend to forget the value of public spaces, especially in the absence of a national regulatory framework in emerging globalized cities. The book provides a multi-disciplinary approach in reading the characteristics and values of public spaces in the emerging cities of the Middle East

Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2‐year follow‐up of the Pr‐EP program.

Service disengagement is a major concern for “Early Intervention in Psychosis” (EIP). Indeed, understanding predictors of engagement is important for the efectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with frst episode psychosis (FEP). No specifc European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12–18 years) enrolled in the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS “Disorganization” factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the frst 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology