The contribution of cannabis use to the increased psychosis risk among minority ethnic groups in Europe.

BACKGROUND: We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe. METHODS: We used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use. RESULTS: The OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39-2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38-2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25-4.79) to 1.61 (95% CI 0.74-3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07-6.15) to 1.67 (95% CI 0.62-4.53). CONCLUSIONS: The contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam.

Tobacco use in first-episode psychosis, a multinational EU-GEI study.

BACKGROUND: Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. METHODS: The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. RESULTS: After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1-3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day (p = 0.003; AOR 1.7; 95% CI [1.2-2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset (ß = -2.3; p ⩽ 0.001; 95% CI [-3.7 to -0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0-1.8]); however, these results were no longer significant after controlling for cannabis use. CONCLUSIONS: Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.

Low incidence of psychosis in Italy: confirmation from the first epidemiological study in Sicily.

PURPOSE: The incidence of psychotic disorders varies in different geographical areas. As there have been no reports from Southern Italy, this study aimed to determine the incidence rate of first-episode psychosis in Palermo, Sicily. METHODS: All patients, aged 18-65 years, presenting with a first episode of psychosis (FEP) (ICD-10 F20-29, F30-33) to mental health services in Palermo, were recorded over a 3-year period. Incidence rates of psychotic disorders and their 95% confidence intervals (95% CI) were estimated. Poisson regression was applied to estimate the differences in incidence rate ratio (IRR) by age, sex and migrant status. RESULTS: Two hundred and four FEP participants were identified during the 3 years; 183 (89.7%, males n = 112) participants were native Italians and 21 were migrants (10.3%, males n = 14). The crude incidence of all psychoses was 15.9 (95% CI 13.7-18.1). As predicted, the risk of schizophrenia F20 was higher in males compared to females (adjusted IRR = 1.99, 95% CI 1.36-2.88) and in migrants compared to native Italians (adjusted IRR = 4.02, 95% CI 2.39-6.75). CONCLUSIONS: This study, the first from Sicily, confirms previous findings from Northern Italy that the risk of schizophrenia and other psychoses is much lower in Italian cities than those reported from cities in Northern Europe; the reasons for this disparity may provide important clues to the aetiology of psychosis.

Differences in cannabis-related experiences between patients with a first episode of psychosis and controls.

BACKGROUND: Many studies have reported that cannabis use increases the risk of a first episode of psychosis (FEP). However, only a few studies have investigated the nature of cannabis-related experiences in FEP patients, and none has examined whether these experiences are similar in FEP and general populations. The aim of this study was to explore differences in self-reported cannabis experiences between FEP and non-psychotic populations. METHOD: A total of 252 subjects, who met International Classification of Diseases (ICD)-10 criteria for FEP, and 217 controls who reported cannabis use were selected from the Genetics and Psychosis (GAP) study. The Medical Research Council Social Schedule and the Cannabis Experience Questionnaire were used to collect sociodemographic data and cannabis use information, respectively. RESULTS: Both 'bad' and 'enjoyable' experiences were more commonly reported by FEP subjects than controls. Principal components factor analysis identified four components which explained 62.3% of the variance. Linear regression analysis on the whole sample showed that the type of cannabis used and beliefs about the effect of cannabis on health all contributed to determining the intensity and frequency of experiences. Linear regression analysis on FEP subjects showed that the duration of cannabis use and amount of money spent on cannabis were strongly related to the intensity and frequency of enjoyable experiences in this population. CONCLUSIONS: These results suggest a higher sensitivity to cannabis effects among people who have suffered their first psychotic episode; this hypersensitivity results in them reporting both more 'bad' and 'enjoyable' experiences. The greater enjoyment experienced may provide an explanation of why FEP patients are more likely to use cannabis and to continue to use it despite experiencing an exacerbation of their psychotic symptoms.

Self-reported suicidal ideation among individuals with first episode psychosis and healthy controls: Findings from the international multicentre EU-GEI study.

INTRODUCTION: Suicidal ideation is common among individuals with first episode psychosis (FEP), with prevalence estimates up to 56.5 %. Despite its high prevalence, relatively little is known about how sociodemographic, clinical and/or developmental characteristics contribute to the experience of suicidal ideation in individuals with FEP. METHODS: In this cross-sectional study (FEP n = 551 and controls n = 857), univariate logistic regression analyses were performed to study the associations of sociodemographic, clinical, and developmental factors with suicidal ideation in individuals with FEP as well as controls. Suicidal ideation was assessed using the Community Assessment of Psychic Experiences (CAPE). In addition, multivariate logistic regression analyses were conducted based on a stepwise approach. RESULTS: In FEP, only depressive symptoms remained significantly associated with suicidal ideation when all correlates were integrated into one model. In the multivariate model in controls, depressive symptoms, positive symptoms, and traumatic childhood experiences were significantly associated with suicidal ideation. CONCLUSIONS: This study showed that depressive symptoms are an important factor relating to suicidal ideation in individuals with FEP, over and above other clinical, sociodemographic, and developmental factors. This underscores the relevance of screening for suicidal ideation in individuals with FEP, and highlights the need for a better understanding of the diagnostic uncertainty and course of mood symptoms in early psychosis. LIMITATIONS: Cross-sectional study design, self-reported questionnaires.

Genetic and psychosocial stressors have independent effects on the level of subclinical psychosis: findings from the multinational EU-GEI study.

AIMS: Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample. METHODS: Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of 'Genetic' models (solely fitted with PRS-SZ), 'Environmental' models (solely fitted with each environmental stressor), 'Independent' models (with PRS-SZ and each environmental factor), and 'Interaction' models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models. RESULTS: There were no genes-environment associations. PRS-SZ was associated with positive dimensions (ß = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension. CONCLUSIONS: This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.

The influence of risk factors on the onset and outcome of psychosis: What we learned from the GAP study.

The GAP multidisciplinary study carried out in South London, recruited 410 first episode of psychosis patients and 370 controls; the aim was to elucidate the multiple genetic and environmental factors influencing the onset and outcome of psychosis. The study demonstrated the risk increasing effect of adversity in childhood (especially parental loss, abuse, and bullying) on onset of psychosis especially positive symptoms. Adverse life events more proximal to onset, being from an ethnic minority, and cannabis use also played important roles; indeed, one quarter of new cases of psychosis could be attributed to use of high potency cannabis. The "jumping to conclusions" bias appeared to mediate the effect of lower IQ on vulnerability to psychosis. We confirmed that environmental factors operate on the background of polygenic risk, and that genetic and environment act together to push individuals over the threshold for manifesting the clinical disorder. The study demonstrated how biological pathways involved in the stress response (HPA axis and immune system) provide important mechanisms linking social risk factors to the development of psychotic symptoms. Further evidence implicating an immune/inflammatory component to psychosis came from our finding of complement dysregulation in FEP. Patients also showed an upregulation of the antimicrobial alpha-defensins, as well as differences in expression patterns of genes involved in NF-κB signaling and Cytokine Production. Being of African origin not only increased risk of onset but also of a more difficult course of illness. The malign effect of childhood adversity predicted a poorer outcome as did continued use of high potency cannabis.

Predictors of early dropout in treatment for gambling disorder: The role of personality disorders and clinical syndromes.

Several treatment options for gambling disorder (GD) have been tested in recent years; however dropout levels still remain high. This study aims to evaluate whether the presence of psychiatric comorbidities predicts treatment outcome according to Millon's evolutionary theory, following a six-month therapy for GD. The role of severity, duration of the disorder, typology of gambling (mainly online or offline) and pharmacological treatment were also analysed. The recruitment included 194 pathological gamblers (PGs) to be compared with 78 healthy controls (HCs). Psychological assessment included the South Oaks Gambling Screen and the Millon Clinical Multiaxial Inventory-III. The "treatment failure" group (n = 70) comprised PGs who prematurely dropped out of the treatment whereas the "abstinent group" (n = 124) included PGs who completed the treatment regardless of whether the outcome was successful or not. As expected, the presence of psychiatric comorbidities was highlighted as a significant predictor in dropping out of the therapy. Specifically negativistic personality disorder, antisocial personality disorder, drug dependence and PTSD were associated with early dropout. These variables were predictive of treatment outcome independently from the typology of gambling, severity, duration of the disorder and pharmacological treatment. Implications for psychological and psychiatric care are discussed.

[The complement fixation test in leishmaniasis. Comparison between an antigen extracted from leishmania cultures and one extracted from BCG]. / La reazione di fissazione del complemento nella leishmaniosi. Confronto tra un antigene estratto da culture di leishmanie e un antigene estratto da BCG.

A comparison between a BCG antigen and various batches of an antigen extracted at different times from leishmania cultures in the fixation of complement reaction is reported. A better response was obtained with BCG (further confirmation on a larger series is being sought), whereas the leishmania antigens were difficult to prepare and their batch titres were not constant.

[Correlation between values of alpha-1-fetoprotein and clinical manifestations of cirrhosis in the evaluation of a carcinomatous course of the disease. Preliminary data on case material on elderly patients]. / Correlazione fra valori di alfa-1-fetoproteina e manifestazioni cliniche della cirrosi nella valutazione di una evoluzione carcinomatosa della malattia. Dati preliminari su una casistica di pazienti anziani.

Early diagnosis of PHC development in cirrhosis is sometimes difficult through common tests excluding invasive diagnostic procedures; liver biopsy as a routine periodical control during the course of the disease is not advisable and AFP monitoring as a diagnostic test is preferable. The present study shows the results of a screening for AFP levels in a series of 113 cirrhotic patients aged over 50. 11.5% of them presented increased levels of serum AFP, indicating development of PHC. AFP elevated values resulted in 76.5% of cases associated with a previous HBV infection, and the risk of PHC development resulted sixfold greater in anti-HBc positive male cirrhotic patients. In patients with elevated AFP levels the prevalence of complications of cirrhosis resulted up to tenfold greater than in AFP negative patients.

[The complement fixation test with BCG in the diagnosis of leishmaniasis]. / La reazione di fissazione del complemento con BCG nella diagnostica della leishmaniosi

The utility of complement-fixation test with an antigen from commercially lyophilized BCG was investigated in the diagnosis of leishmaniasis. The following results were obtained: Visceral leishmaniasis: 4 positivity on 5 cases; Oriental sore: 3 positivity on 6 cases; Canine leishmaniasis: 6 positivity, at high level, and 2 negativity; Other diseases: 5 positivity, on 17 sera of tbc; No positivity in sera from patients with various diseases, in control and in normal dogs. The results are compared with those quoted in medical literature and discussed. The meaning of the reaction is also briefly discussed, and the hypothesis of the presence of partigens between BCG and leishmania, or presence of autoantibodies is prospected.

[Counterimmunoelectrophoresis in the diagnosis of visceral leishmaniasis]. / La controimmunoelettroforesi (C.I.E.P.) nella diagnostica della leishmaniosi viscerale.

Technique of counter current immunoelectrophoresis (C.I.E.P.) was employed for the diagnosis of V.L. using an antigen grossly extracted (by means of repeated freezing and thawing) from culture of Leishmania. 6 lots of antigen were prepared - in various time - at the same way. Positive results are obtained in V.L. from 83.3 to 94% (according to various lots of antigens). Few false positivity (from 1.4 to 8.8%) are obtained in sera from patients with other diseases (especially) cirrhosis and blood disorders. No positivity in controls (blood donors). The reproducibility of results appear satisfactory. Our results suggested that C.I.E.P., rapid and less sophisticated test, can be applied for the diagnosis of V.L. But false positivity and false negativity limit the value of these test.

[CIEP with cellogel (cellulose acetate membrane) in the diagnosis of visceral leishmaniosis (author's transl)]. / La controimmunoelettroforesi (CIEP) su membrana di acetato di cellulosa (Cellogel) nella diagnostica della leishmaniosi viscerale.

Technique of counter immunoelectrophoresis (CIEP) was employed for the diagnosis of V.L. (human and canine) using strips of cellulose acetate and an antigen grossly extracted (by means of repeated freezing and thawing) from culture of Leishmania. 4 lots of antigen was prepared, in various time, at the same way. Positive results were obtained in V.L. from 81 to 90% (according to various lots of antigen). False positivities (from 1 to 4.5%) occur in patient with other diseases (especially cirrhosis and blood disorders). None positivity in controls (blood donors). Present results and those obtained with same technique in agar, suggested the validity of method and encouraged the production of antigen in a "kit" form for use in the field.

[Further observations on the use of counterimmunoelectrophoresis (CIEP) on cellulose acetate membrane (Cellogel) in the diagnosis of visceral leishmaniasis (author's transl)]. / Ulteriori osservazioni sull'uso della controimmunoelettrosoresi (CIEP) su membrana di acetato di cellulosa (Cellogel) nella diagnostica a della leishmaniosi viscerale.

Technique of counterimmunoelectrophoresis (CIEP) on cellulose acetate membrane (Cellogel) is described for diagnosis of (human and canine) visceral leishmaniasis (VL). Various lots of antigen were grossly obtained from the liquid phase (10, 20 and 30 tubes respectively) of cultures of Leishmania donovani by repeated freezing and thawing. Sera from patients (and, in a few cases, dogs) with confirmed VL, other parasitic and non-parastic diseases (especially blood disorders and hepatosplenomegaly) and from blood donors were tested. Positive results were obtained in 91-93% (according to various lots) of the patients with VL. All sera from infected dogs gave positive results. No precipitin lines were detected in the control sera. Antigens from 30 (or 20 tubes) showed better results with regard to the evidence of the precipitin lines. Clarity of the precipitin bands appears to be in relation to: 1. the protein concentration of the antigens; 2. the antibody levels of the sera. CIEP on cellulose acetate membrane combine the features of good sensitivity, specificity and speed of performance and appear available for use also in epidemiological research.

HBV infection risk in hospital workers.

Prevalence of HBV infection markers and its association with some risk factors has been studied on hospital staff of the University Polyclinic of Palermo. The results show that male sex, job category (technicians, nurses, cleaners) and age are significantly associated with a higher prevalence of HBV infection markers; length of service and working in departments with a presumably higher exposure to blood did not result as a risk factor of higher prevalence of HBV infection when submitted to multiple regression logistic analysis. It is suggested that results of this study may be affected by the elevated spread of HBV infection in this area, and extra risk associated to hospital exposure is too small to be demonstrated.

[Etiopathogenetic considerations on a case record of cirrhotic patients from western Sicily]. / Considerazioni etiopatogenetiche su una casistica di pazienti cirrotici della Sicilia occidentale.

In 38.6% of 88 patients without anamnesis of alcoholism and/or chronic exposure to hepatotoxic drugs, selected among 120 cirrhotic subjects subsequently observed, the illness was HBV related. Markers indicating active viral replication (anti-HBc, HBsAg, HBeAg or anti-HBe) were detected in 48% of patients with active cirrhosis, and in 26% with inactive cirrhosis. It is suggested that high titers of CF antibodies anti-HSV and anti-CMV observed in several patients, indicate either reactivation of latent infections or over-infections. The absence of alcoholism and/or chronic exposure to hepatotoxic drugs, and the absence of viral markers, suggest in 61% of the 88 cirrhotic subjects either a nonA-nonB viruses etiology of the illness, or other etiological factors that escape available diagnostic and prophylactic procedures.

[Hepatitis B virus infection in habitual sexual partners]. / Infezione da virus della epatite B in partners sessuali abituali.

Habitual heterosexual contacts of chronic HBV infection carriers show high prevalence of infection markers that does not result to be sex related, and results significantly associated to increase of age, presumably as a consequence of duration of exposure. Concomitance of habitual sexual contacts does not represent in an infected family setting a risk factor of higher prevalence of HBV infection, in respect of multitude of occurrences of unperceivable expositions to contagion.