Trajectories of Symptom Dimensions in Short-Term Response to Antipsychotic Treatment in Patients with a First Episode of Non-Affective Psychosis

Background Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data. Method This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and negative) in order to identify the different response trajectories. Diagnosis, cannabis use, duration of untreated psychosis (DUP), smoking and antipsychotic class were examined as possible predictive variables. Results Patients were classified in five groups according to the positive dimension, three groups according to the disorganized dimension and five groups according to the negative dimension. Longer DUPs and cannabis use were associated with higher scores and poorer responses in the positive dimension. Cannabis use was associated with higher scores and poorer responses in the disorganized dimension. Only schizophrenia diagnosis was associated with higher scores and poorer responses in the negative dimension. Conclusions Our results illustrate the heterogeneity of short-term response to antipsychotics in patients with a first episode of psychosis and highlight markedly different patterns of response in the positive, disorganized and negative dimensions. DUP, cannabis use and diagnosis appeared to have a prognostic value in predicting treatment response with different implications for each dimension

Association of gene-enviroment and age of pre-onset cannabis use with age at onset of psychosis in frist-episode patients

Trabajo presentado a la 10ª Reunión anual de la Sociedad Española de Investigación sobre Cannabinoides celebrada en Santander del 26 al 28 de noviembre de 2009.Es conocida la influencia negativa del uso de cannabis sobre el curso y pronóstico de la esquizofrenia. El cannabis es, además, la sustancia de abuso más utilizada en pacientes con esquizofrenia (15%-65%). Sin embargo sólo una pequeña proporción de consumidores de cannabis desarrollan psicosis. Varios estudios han demostrado que el uso de cannabis precede al debut de la psicosis en varios años (entre 4 y 5 ). El inicio precoz del consumo de cannabis en la adolescencia, puede por tanto, estar asociado a un debut precoz de la psicosis, con el consiguiente pronóstico negativo de la enfermedad. Varios polimorfismos de nucleótidoúnico (SNPs) del gen que codifica el receptor CB1 (CNR1; rs806379, rs1535255, rs2023239 y rs1049353) han sido asociados al consumo de drogas o alcohol (Zhang et al., Molecular Psychiatry, 9, 916–931. 2004, Schmidtetal., 2002 Drug and Alcohol Dependence, 65, 221–224) Variaciones en el gen de la triptófano hidroxilasa se han asociado con un mayor riesgo de psicosis (LiD, HeL: Hum Genet 2006). Finalmente, algunos de los SNPs en los receptores de la serotonina se han asociado con diversos trastornos psiquiátricos como la esquizofrenia o la depresión, sin embargo, los resultados de estos estudios de asociación genética han mostrado resultados conflictivos.Peer Reviewe

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey

Aims: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. Methods: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. Results: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. Conclusions: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.Instituto de Salud Carlos III/ Ministerio de Ciencia e Innovación/ FEDER (J. A., grant number COV20/00711); Project “PI17/00521”, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union, PERIS, Health Dpt, Generaliat de Catalunya (I. A., grant number SLT017/20/000009); ISCIII-FSE+, Miguel Servet (P. M., grant number CP21/00078); ISCIII-FSE, Sara Borrell (P. M., grant number CD18/00049), Generalitat de Catalunya (2017SGR452). Additional partial funding was received from the Gerencia Regional de Salud de Castilla y León (SACYL) (J. M. P. T., grant number GRS COVID 32/A/20).S

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.This work was supported by grants from the Instituto de Salud Carlos III (ISCIII)/Ministerio de Ciencia e Innovación/FEDER, Spain (Jordi Alonso, grant number COV20/00711); ISCIII-FEDER, Spain (Jordi Alonso, grant number PI17/00521); ISCIII-FSE, Spain: Sara Borrell and Miguel Servet grants (Philippe Mortier, grant number CD18/00049 and CP21/00078); Generalitat de Catalunya, Spain (2017SGR452); and PERIS, Departament de Salut, Spain (Itxaso Alayo; SLT017/20/000009). Additional partial funding was received from the Gerencia Regional de Salud de Castilla y León (SACYL), Spain (José María Pelayo Terán, grant number GRS COVID 32/A/20).S

Age of onset and duration of untreated psychosis in first episode psychosis: Interaction effects between cannabis and comt

Trabajo presentado a la 10ª Reunión anual de la Sociedad Española de Investigación sobre Cannabinoides celebrada en Santander del 26 al 28 de noviembre de 2009.Introduction: Age of onset and duration of untreated Psychosis (DUP) have been proposed as key factors in the prognosis of psychosis. Whereas gender differences in age of onset have been established and there is an emerging evidence of the association between cannabis use and an earlier age of onset, the role of other variables remains unclear. The Val158Met polymorphism of Catechol-O-Methyltransferase (COMT) has shown differences in clinical variables between genotypes and a possible association with an earlier age of onset. Additionally, an interaction between COMT genotype and cannabis has been previously found in the modulation of risk of psychosis. The aim of this study was to examine the effects of COMT genotype, cannabis and their interaction in the age of onset and DUP in a representative group of first episode psychosis patients. Methods: Aged of onset, DUP and cannabis consumption (regular user vs. sporadic or non-user) were assessed in 169 caucasian drug-naïve patients with a first-episode of non-affective psychosis. COMT polymorphism was typed using PCR of the relevant region followed by digestion with NlaIII and electrophoresis. A multivariate ANCOVA was performed with DUP and Age of onset as dependent variables, cannabis and COMT genotype as fixed factors and gender as a covariate. Results: The MANCOVA was significant for age of onset and DUP. Cannabis users had a significant earlier age of onset (F=16.887; p<0.001). Age of onset was later in the Met homozygote group (non significant, F=2.348; p=0.099). The cannabis-COMT interaction showed a significant effect in both DUP and age of onset (F=3.816; p=0.024). Post hoc analyses showed that differences between genotypes were only present in the non-cannabis users group. Conclusions: Cannabis users had an earlier age of onset and shorter DUPs. Val carriers had an earlier age of onset and longer DUPs, but only in the non-cannabis user group. Cannabis seems to modulate the age of onset and DUP in first episode psychosis independently of gender and to moderate the effect of COMT Val158Met polymorphism.Peer Reviewe