Patients can respond differently to intervention in the early phase of psychosis. Diverse symptomatic and functional outcomes can be distinguished and achieving one outcome may mean achieving another, but not necessarily the other way round, which is difficult to disentangle with cross-sectional data. The present study's goal was to evaluate implicative relationships between diverse functional outcomes to better understand their reciprocal dependencies in a cross-sectional design, by using statistical implication analysis (SIA).

Early psychosis patients of an early intervention program were evaluated for different outcomes (symptomatic response, functional recovery, and working/living independently) after 36 months of treatment. To determine which positive outcomes implied other positive outcomes, SIA was conducted by using the Iota statistical implication index, a newly developed approach allowing to measure asymmetrical bidirectional relationships between outcomes.

Two hundred and nineteen recent onset patients with early psychosis were assessed. Results at the end of the three-years in TIPP showed that working independently statistically implied achieving all other outcomes. Symptomatic and functional recovery reciprocally implied one another. Living independently weakly implied symptomatic and functional recovery and did not imply independent working.

The concept of implication is an interesting way of evaluating dependencies between outcomes as it allows us to overcome the tendency to presume symmetrical relationships between them. We argue that a better understanding of reciprocal dependencies within psychopathology can provide an impetus to tailormade treatments and SIA is a useful tool to address this issue in cross-sectional designs.

Evidence suggests a possible relationship between exposure to childhood adversity (CA) and functional impairment in psychosis. However, the impact of CA on long-term outcomes of psychotic disorders remains poorly understood.

Two hundred and forty-three patients were assessed at their first episode of psychosis for CA and re-assessed after a mean of 21 years of follow-up for several outcome domains, including symptoms, functioning, quality of life, cognitive performance, neurological dysfunction, and comorbidity. The unique predictive ability of CA exposure for outcomes was examined using linear regression analysis controlling for relevant confounders, including socioeconomic status, family risk of schizophrenia, and obstetric complications.

There were 54% of the patients with a documented history of CA at mild or higher levels. CA experiences were more prevalent and severe in schizophrenia than in other psychotic disorders (p < 0.001). Large to very large effect sizes were observed for CA predicting most role functioning variables and negative symptoms (ΔR2 between 0.105 and 0.181). Moderate effect sizes were observed for positive symptoms, personal functioning, impaired social cognition, impaired immediate verbal learning, poor global cognition, internalized stigma, poor personal recovery, and drug abuse severity (ΔR2 between 0.040 and 0.066). A dose–response relationship was observed between levels of CA and severity of outcome domains.

Our results suggest a strong and widespread link between early adversity exposure and outcomes of psychotic disorders. Awareness of the serious long-term consequences of CA should encourage better identification of those at risk and the development of effective interventions.

Although diagnostic instability in first-episode psychosis (FEP) is of major concern, little is known about its determinants. This very long-term follow-up study aimed to examine the diagnostic stability of FEP diagnoses, the baseline predictors of diagnostic change and the timing of diagnostic change.

This was a longitudinal and naturalistic study of 243 subjects with FEP who were assessed at baseline and reassessed after a mean follow-up of 21 years. The diagnostic stability of DSM-5 psychotic disorders was examined using prospective and retrospective consistencies, logistic regression was used to establish the predictors of diagnostic change, and survival analysis was used to compare time to diagnostic change across diagnostic categories.

The overall diagnostic stability was 47.7%. Schizophrenia and bipolar disorder were the most stable diagnoses, with other categories having low stability. Predictors of diagnostic change to schizophrenia included a family history of schizophrenia, obstetric complications, developmental delay, poor premorbid functioning in several domains, long duration of untreated continuous psychosis, spontaneous dyskinesia, lack of psychosocial stressors, longer duration of index admission, and poor early treatment response. Most of these variables also predicted diagnostic change to bipolar disorder but in the opposite direction and with lesser effect sizes. There were no significant differences between specific diagnoses regarding time to diagnostic change. At 10-year follow-up, around 80% of the diagnoses had changed.

FEP diagnoses other than schizophrenia or bipolar disorder should be considered as provisional. Considering baseline predictors of diagnostic change may help to enhance diagnostic accuracy and guide therapeutic interventions.

Remitted psychotic depression (MDDPsy) has heterogeneity of outcome. The study's aims were to identify subgroups of persons with remitted MDDPsy with distinct trajectories of depression severity during continuation treatment and to detect predictors of membership to the worsening trajectory.

One hundred and twenty-six persons aged 18–85 years participated in a 36-week randomized placebo-controlled trial (RCT) that examined the clinical effects of continuing olanzapine once an episode of MDDPsy had remitted with sertraline plus olanzapine. Latent class mixed modeling was used to identify subgroups of participants with distinct trajectories of depression severity during the RCT. Machine learning was used to predict membership to the trajectories based on participant pre-trajectory characteristics.

Seventy-one (56.3%) participants belonged to a subgroup with a stable trajectory of depression scores and 55 (43.7%) belonged to a subgroup with a worsening trajectory. A random forest model with high prediction accuracy (AUC of 0.812) found that the strongest predictors of membership to the worsening subgroup were residual depression symptoms at onset of remission, followed by anxiety score at RCT baseline and age of onset of the first lifetime depressive episode. In a logistic regression model that examined depression score at onset of remission as the only predictor variable, the AUC (0.778) was close to that of the machine learning model.

Residual depression at onset of remission has high accuracy in predicting membership to worsening outcome of remitted MDDPsy. Research is needed to determine how best to optimize the outcome of psychotic MDDPsy with residual symptoms.

Parents of children with CHD face several barriers when trying to access the services needed to support their child’s development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada.

Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5–15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child’s developmental follow-up were conducted.

Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child’s development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent–child relationship and siblings.

The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent–child relationships.

Consistent evidence supports the involvement of genetic and environmental factors, and their interactions, in the etiology of psychosis. First-episode psychosis (FEP) comprises a group of disorders that show great clinical and long-term outcome heterogeneity, and the extent to which genetic, familial and environmental factors account for predicting the long-term outcome in FEP patients remains scarcely known.

The SEGPEPs is an inception cohort study of 243 first-admission patients with FEP who were followed-up for a mean of 20.9 years. FEP patients were thoroughly evaluated by standardized instruments, with 164 patients providing DNA. Aggregate scores estimated in large populations for polygenic risk score (PRS-Sz), exposome risk score (ERS-Sz) and familial load score for schizophrenia (FLS-Sz) were ascertained. Long-term functioning was assessed by means of the Social and Occupational Functioning Assessment Scale (SOFAS). The relative excess risk due to interaction (RERI) was used as a standard method to estimate the effect of interaction of risk factors.

Our results showed that a high FLS-Sz gave greater explanatory capacity for long-term outcome, followed by the ERS-Sz and then the PRS-Sz. The PRS-Sz did not discriminate significantly between recovered and non-recovered FEP patients in the long term. No significant interaction between the PRS-Sz, ERS-Sz or FLS-Sz regarding the long-term functioning of FEP patients was found.

Our results support an additive model of familial antecedents of schizophrenia, environmental risk factors and polygenic risk factors as contributors to a poor long-term functional outcome for FEP patients.

Late-life depression (LLD) is characterized by differences in resting state functional connectivity within and between intrinsic functional networks. This study examined whether clinical improvement to antidepressant medications is associated with pre-randomization functional connectivity in intrinsic brain networks.

Participants were 95 elders aged 60 years or older with major depressive disorder. After clinical assessments and baseline MRI, participants were randomized to escitalopram or placebo with a two-to-one allocation for 8 weeks. Non-remitting participants subsequently entered an 8-week trial of open-label bupropion. The main clinical outcome was depression severity measured by MADRS. Resting state functional connectivity was measured between a priori key seeds in the default mode (DMN), cognitive control, and limbic networks.

In primary analyses of blinded data, lower post-treatment MADRS score was associated with higher resting connectivity between: (a) posterior cingulate cortex (PCC) and left medial prefrontal cortex; (b) PCC and subgenual anterior cingulate cortex (ACC); (c) right medial PFC and subgenual ACC; (d) right orbitofrontal cortex and left hippocampus. Lower post-treatment MADRS was further associated with lower connectivity between: (e) the right orbitofrontal cortex and left amygdala; and (f) left dorsolateral PFC and left dorsal ACC. Secondary analyses associated mood improvement on escitalopram with anterior DMN hub connectivity. Exploratory analyses of the bupropion open-label trial associated improvement with subgenual ACC, frontal, and amygdala connectivity.

Response to antidepressants in LLD is related to connectivity in the DMN, cognitive control and limbic networks. Future work should focus on clinical markers of network connectivity informing prognosis.

ClinicalTrials.gov NCT02332291

Schizophrenia is heterogeneous in terms of symptoms and outcome, but neurobiology of this heterogeneity is not well-studied. Local correlation analysis of fMRI data provides a measure of local coherence, i.e., average correlation between BOLD-signal in a voxel and its neighbours. Local correlation is a promising approach, and it seems important to find links between local brain coherence and schizophrenia outcome.

We aimed to compare brain local coherence between schizophrenia patients with varied long-term outcomes and healthy controls (HC).

Patients with chronic schizophrenia spectrum disorders (37 males, mean age 41.5±5.5) and HC (17 males, mean age 38±7.7) underwent resting-state fMRI (3T). Cluster analysis based on PANSS and PSP allowed us to allocate patients into two subgroups (N = 13/24). The second subgroup had significantly more marked negative and general psychopathology symptoms and worse functioning than the first subgroup. Local coherence in the brain was compared between clinical subgroups and HC (ANOVA, p<.001 voxelwise, p[FDR]<.05 clusterwise).

Local coherence in the paracingulate gyri bilaterally ({-2; 58; 14}; 2712 mm3) differentiated the groups. Post hoc analysis revealed decreased local coherence in the subgroup with poorer outcome compared to HC, along with the absence of differences between the subgroup with better outcome and HC. There were no differences between clinical subgroups.

Hypoactivity of the cingulate cortex is related to negative symptoms (Bersani et al., 2014). Their severity, in turn, is strongly associated with outcome. Thus, local coherence in the cingulate cortex may be one of the factors which underlie outcome heterogeneity.

No significant relationships.

Major depressive episodes (MDE) occur in major depressive (MDD) and bipolar disorders (BD), and are frequently complicated by borderline personality disorder (BPD). Mixed affective symptomatology is a hallmark of BD, and affective lability of BPD; both may markedly influence illness course. However, direct comparisons of outcome of depression in MDD, BD and BPD are scarce.

To investigate course of illness and outcome of depression in MDD, bipolar and borderline patients.

In this six-month, prospective cohort study of secondary-level psychiatric MDE patients (n = 95), after initial assessment, the patients (N = 95) completed biweekly online assessments of mood symptoms. We divided the follow up period into qualitatively different mood state periods based on multiple prospective information sources. We examined mixed affective symptoms and borderline symptom severity dimensionally. Outcomes assessed included clinical course, time to first full symptomatic remission, and factors predicting these.

Remission rates according to DSM-5 were similar in MDD, MDE/BD and MDE/BPD patients. Bipolar patients experienced more shorter qualitatively distinct mood state periods during follow-up than the others. Bipolar disorder was associated with shorter (HR = 2.44, 95% CI = 1.27–4.67, see fig. 1) and dimensionally assessed BPD severity with longer time to first remission (HR = 0.95 per point., CI = 0.91–1.00).

Course of illness differs between the three depressive groups in the medium term. Bipolar depressive patients have the most alternating course and the shortest time to first remission. Dimensionally assessed severity of BPD may be prognostic of longer depressive remission latency.

I am employed by a psychiatric treatment provider, treating e.g. patients suffering from depression, bipolar disorder and borderline personality disorder.

A psychotic episode might stem from various psychiatric disorders, such as Major Depressive Disorder, Mania, Autism Spectrum Disorder, it might lead to Schizophrenia, or it might be a single event.

The study aimed to assess the main comorbidities encountered in the onset of psychotic episodes in children and adolescents, who were hospitalized in a pediatric psychiatry department for at least one night. Furthermore, another objective was to establish whether a family history of mental illness or a poor socio-economic status have bigger impact on the evolution of these patients.

To analyze the objectives, it was used an observational study, based on patients with the onset of a psychotic episode and associated diagnosis according to ICD-10, evaluated in Child and Adolescent Psychiatric Department of “Prof. Dr. Al. Obregia” Hospital, between 2015-2019. Patients with psychotic episodes with onset related to Major Depressive Disorder and Mania or a personal history of Schizophrenia were excluded.

The most frequent associated comorbidity was Autism Spectrum Disorder. In terms of long-term evolution, patients with comorbidities have poorer outcomes, more relapses and hospitalizations. Family history of mental illness, low socio-economic status, the age of onset were found to be prognostic factors and have an important impact on the outcome.

This study compared patients with psychotic episodes with and without comorbid conditions associated, considering the length of hospitalization period, the evolution and the number of relapses. The presence and the type of comorbidities are important factors of evolution and prognostic for these patients.

No significant relationships.

during the study period (08/02/2021 – 11/05/2021) the Centre of Psychiatry in the Jahn Ferenc South-pest Hospital (CP-JFSH) was one of the two psychiatric wards in Budapest, specialized for the treatment of COVID-19 infected psychiatric patients.

the aim of the study was to survey the characteristics and evaluate the outcome of the COVID-19 infected psychiatric patients treated in the CP-JFSH.

retrospective analysis of the files of COVID-19 infected psychiatric patients admitted to the CP-JFSH in a 3 month period. In addition to demographic data, diagnostic distribution, co-morbidities, date of infection, method of detection of the virus, presence of pneumonia, severity of infection, outcome, treatment, vaccination data were evaluated.

in the study period 124 COVID-19 infected psychiaric patients were admitted to the CP-JFSH. The gender distribution was aproximately equal, the mean age of the patients was 62.8+/-15.7 years. Majority of the patients suffered from major neurocognitive disorder followed by schizophrenia spectrum disorder. Most common co-morbidities were cardiovascular diseases and diabetes. Pneumonia was present in 41% of the patients. Majority of the patients were already infected at the time of admission, detected with the first PCR examination and haven’t been vaccinated yet. Thirty-one percent of the patients suffered from moderate to severe COVID-19 illness. COVID-19 specific therapy (favipiravir, remdesivir, fluvoxamin) was introduced in 57%. Mortality was 12% while the relaps rate 4%.

comparing with inpatient mortality rate published in the literature, mortality rate was higher among psychiatric patients, underlining the need for special attention of this population.

No significant relationships.

The occurrence of a first episode-psychosis in adolescents or young adults represents a difficult struggle with an uncertain and divergent outcome, since the clinician does not have at his disposal the clinical elements sufficient to predict these different disease trajectories.

Our aims are to describe the socio-demographic, clinical characteristics and the short and long-term outcomes of a first episode-psychosis and to identify the predictive factors of the transition to schizophrenia.

We conducted a retrospective study about 117 patients hospitalized for a first episode-psychosis in the Psychiatric Department of Monastir (Tunisia). Sociodemographic and clinical features were collected using a pre-established form.

First-episode psychosis affected young male subjects with low educational level. Stressors were present in 54.7%. An 8-week prodromal phase preceded the onset of the disorder in 59%. The disorder course included diagnosis of: Brief psychotic disorder (32.5%), schizophrenia (31.6%) and bipolar disorder (18.8%). The short-term outcome was characterized by a complete remission rate of 58.1% at 3 months and 37.6% at 6 months. The long-term outcome was marked by a high rate of lost to follow-up: 70.8% after 5 years. The transition to schizophrenia was linked to the presence of delirium of influence and the absence of favorable course at 3 months.

Our results led to the identification of the profile of patients with a first episode-psychosis and the factors correlated with a diagnosis of schizophrenia. Indeed, the determination of risk factors would make it possible to adapt earlier the care.

No significant relationships.

Stigma against lesbian, gay, bisexual or queer (LGBQ) people may increase their risk of mental illness and reduce their access to and/or benefit from evidence-based psychological treatments. Little is known about the feasibility, acceptability and effectiveness of adapted psychological interventions for sexual minority individuals in the UK.

To describe and evaluate a novel LGBQ Wellbeing group therapy for sexual minority adults experiencing common mental health problems, provided in a UK Improving Access to Psychological Therapies (IAPT) service.

An eight-session LGBQ Wellbeing group intervention was developed drawing on CBT and LGBQ affirmative principles. We compare the socio-demographic and clinical characteristics of patients who completed and dropped out of the groups, and explore changes in self-reported symptoms of depression, anxiety and functional impairment.

Over eight courses provided, 78 service-users attended at least one session, of whom 78.2% completed the intervention (drop-out rate 21.8%). Older participants were more likely to drop out. There was a lower proportion of female and bisexual or ethnic/racial minority individuals than would be expected. There were significant reductions in severity of depression, anxiety and functional impairment following the group, and more than half of those who completed the intervention needed no further treatment.

There was preliminary evidence of the feasibility of, and potential clinical benefit in, a group therapy intervention for sexual minority adults experiencing common mental health problems. Future research should investigate access and outcomes for participants with additional social disadvantage, e.g. those who are female, older, bisexual or ethnic/racial minority.