The Athens Multifamily Therapy Project (A- MFTP) aims to provide systemic multifamily group therapy to youths who experienced a first psychotic episode (FEP) and their families

Since 2017, we run five groups of five-four families, with a duration of ten months and frequency every two weeks. Participants were recruited from the longitudinal study, Athens FEP Project, which aimed to investigate the involvement of genetic and environmental determinants on psychosis risk.

During the Covid-19 pandemic, the provision of therapy to the current groups continued through online sessions. Participants were asked to answer qualitative questions on the perceived effectiveness of the therapy on their life as well as on the presenting problem(s) at three time points: middle, end of therapy and 6-month follow-up.

All members highlighted the significance of the reciprocity in the group communication. They mentioned that “sharing” and “exchanging” experiences helped them listen to others and felt heard by them. They moved from feeling fear and embarrassment when discussing the diagnosis and the aftermath, to feeling safety and comfort talking about their difficulties. Qualitative analysis showed no difference in participants’ perception of multifamily therapy as helpful between live therapy and online therapy.

Results suggest that MFT can be a viable way to provide early intervention in FEP even in at online modality.

No significant relationships.

Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.

204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.

Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.

Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.

Approximately, 15- 26% of patients with first-episode psychosis, including schizophrenia, are likely to have attempted suicide by their first treatment contact. Studies of suicidal behavior outside of schizophrenia have indicated grey matter volume loss in the prefrontal and orbitofrontal cortex, and aberrant brain activity in relation to emotional recognition and dysfunction.

This study aimed to investigate the functional neural correlates of suicidal behavior in early schizophrenia.

fMRI faces task was conducted (fearful face versus neutral face) in 8 participants with first-episode schizophrenia together with standardised scales including PANSS and SBQ-R. fMRI activation was compared using a two-sample t-test in participants with low and high suicidal behavior. Extent threshold is 0 voxels and significance level p<0.001 (FWE corrected). Processing of images was carried out using SPM12 and Matlab.

8 participants were recruited; 5 males and 3 females, mean age of 26.5. Results suggest that participants with higher suicidal behaviour showed reduced activation on the anterior-cingulate gyrus and medial frontal gyrus, which are parts of PFC, (p= .005). There was also a significant difference in task response accuracy, where, participants with high suicidal behaviour made more accurate responses compared to low group (t (3) = 3.65, p = .035).

This is an exploratory study, investigated the differences in brain activity in patients with schizophrenia who are at risk of completed suicide and, therefore might provide new insights into the underlying mechanisms. Further work should address how PFC activity changes with risk over time and its potential utility as a biomarker in suicide.

Recent studies reported very high cumulative risk for a patient who had cannabis-induced psychosis to be diagnosed with a schizophrenia spectrum disorder.

We aim to compare sociodemographic and clinical characteristics, treatment and discharge plan in cannabis-induced first psychosis episode (CI-FEP) vs. multiple cannabis-induced psychotic episodes (CI-MEP) inpatients.

Retrospective observational study of inpatient episodes with a discharge diagnosis of cannabis-induced psychosis between January 1st, 2018 and December 31st, 2019 in the Psychiatry Service of CHUSJ. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 61 inpatients, 19 (31.1%) with CI-FEP and 42 (68.9%) with CI-MEP. CI-MEP group had a median of 1±0,234 previous hospital admissions. CI-MEP group has 10,0 higher odds of being discharged in outpatient compulsory treatment (CI 95% 1,21-82,50, p=0,013) and 6.0 odds of being treated with long-acting injectable antipsychotics (LAIAP) (CI 95% 1,79-20,31, p=0,002) when compared to CI-FEP group. Having multiple cannabis-induced psychotic episodes was associated with future admissions to psychiatry unit (OR 4,85 (95% CI 1,23-19,15, p=0,018). We found no statistically significant differences regarding the sociodemographic and clinical characteristics, use habits and discharge plan between the two groups.

Patients with multiple psychotic episodes due to cannabis use are more likely to have a LAIAP prescription, be discharged in compulsory outpatient regimen and be readmitted in to psychiatric inpatient unit. Considering the prevalence of CI-MEP and the risk of chronicity, we need integrative treatment programs to address the specificities of these patients.

The Athens multifamily therapy project (A- MFTP) provides systemic multifamily group therapy to youths who experienced a first psychotic episode (FEP) and their families.

The participants were recruited from the ongoing longitudinal Early Psychosis Intervention Study –ELPIS, Athens FEP Project, which aims to investigate the involvement of genetic and environmental determinants on psychosis risk.

A group of five families with a child who had experience FEP, attended two multifamily group sessions per month, in the time period from September 2017 to Jun 2018. Parents and offspring participated to the sessions, which were conducted by two co-therapists. Assessment of patients’ psychopathology was based on PANSS at baseline, end of therapy and 6-month follow-up. All participants fulfilled an instrument assessing family factors (SCORE-15) and the Reflective Functioning Questionnaire (RFQ) at the same three time points. Furthermore, participants were asked to give written opinions regarding the therapeutic process at the middle phase, the end of therapy and six months follow - up.

A qualitative analysis identified the emerging themes and patterns, focusing on the language and the meaning constitutes. Communication techniques, emotional processing and problem solving were the main learnings for the members of the group. They highlighted the impact of the group processes on family communication and individual understanding, while the development of a “new family” emerged from the group relationships.

A- MFTP seems to be a promising service aiming to improve mental health and wellbeing of participants, to contrast chronicity and to contribute to early intervention services for psychoses in Greece.

This is a presentation of the FEP of a 23 y.o. patient. The patient had a Duration of Untreated Psychosis (DUP) of 6 months and Duration of Untreated Illness (DUI) of six years. The therapeutic response and the adverse effects of Paliperidone are being described.

To investigate the tolerance of Paliperidone in a patient with FEP.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments and investigations took place.

Upon admission the patient appeared guarded. She also presented with weight loss and dehydration. Initial PANSS score was 173, positive subscale 41. The patient was initially treated with monotherapy 6mg of Paliperidone. However, the heart rate was around 100 bpm culminating as high as 156 bpm. The ECG indicated sinus tachycardia. The patient presented with serious EPSs and diarrhea. Simpson-Angus Scale score 10. Metoprolol 25mg was prescribed twice a day. The clinical team proceeded in cross titration replacing Paliperidone with Olanzapine. A brain CT scan was also performed, unremarkable. After 10 days of therapy the PANSS score reduced to 102, positive subscale 21.

Initial sinus tachycardia is a common adverse effect of Paliperidone. However in this case the tachycardia was refractory in time even after the 7th day, making an alternative SGA trial necessary.

No significant relationships.

Little is known about changes in brain functioning after first-episode psychosis (FEP). Such knowledge is important for predicting the course of disease and adapting interventions. Functional magnetic resonance imaging has become a promising tool for exploring brain function at the time of symptom onset and at follow-up.

A systematic review of longitudinal fMRI studies with FEP patients according to PRISMA guidelines. Resting-state and task-activated studies were considered together.

Eleven studies were included. These reported on a total of 236 FEP patients were evaluated by two fMRI scans and clinical assessments. Five studies found hypoactivation at baseline in prefrontal cortex areas, two studies found hypoactivation in the amygdala and hippocampus, and three others found hypoactivation in the basal ganglia. Other hypoactivated areas were the anterior cingulate cortex, thalamus and posterior cingulate cortex. Ten out of eleven studies reported (partial) normalization by increased activation after antipsychotic treatment. A minority of studies observed hyperactivation at baseline.

This review of longitudinal FEP samples studies reveals a pattern of predominantly hypoactivation in several brain areas at baseline that may normalize to a certain extent after treatment. The results should be interpreted with caution given the small number of studies and their methodological and clinical heterogeneity.

There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP).

Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case–control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded.

VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls.

This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.

Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined.

This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results.

The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: ‘sense of difference’, ‘characterizing difference negatively’, ‘negative reactions (anticipated and experienced)’, ‘strategies’, ‘lack of knowledge and understanding’, and ‘service-related factors’. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups.

Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.