Attachment styles and associated psychosocial factors in patients at ultra-high risk for psychosis: A systematic review.

BACKGROUND: Patients with an ultra-high risk of psychosis (UHR) are more likely to transition to psychosis. Attachment style has also been associated with psychosis and other symptoms. AIMS: To review attachment styles in UHR patients and to analyze related psychosocial factors. Ours is the first systematic review of attachment in this population. METHOD: We performed a systematic review of attachment and related psychosocial factors in UHR patients following the PRISMA methodology. RESULTS: We identified five studies. The results revealed high rates of insecure attachment in this population (more than 80%). The UHR sample presented high levels of depression, anxiety, social anxiety, emotional reactivity, trauma, and poor mentalization. Premorbid social adjustment was a predictor of improvement in disorganization and negative symptoms. The rate of transition to psychosis was 10%. Attachment patterns accounted for 16.8% of the variance. This vulnerability for psychosis was also associated with poor mentalization. CONCLUSION: Early detection of patients with UHR and insecure attachment is crucial, since early intervention to address symptoms, mentalization, and attachment is feasible and may lead to an improvement in the remaining associated psychosocial related factors (secure style: better global functioning and less affective and anxious symptoms). PROSPERO ID440957.

Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study.

BACKGROUND: Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP. METHODS: We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP. FINDINGS: Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries. INTERPRETATION: Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.

A meta-analysis of cognitive interventions for patients with recent onset psychosis: are they effective for improving functioning?

The increasing popularity of cognitive interventions for patients with psychosis calls for further exploration on how these interventions may benefit functional outcomes. We conducted a meta-analysis of randomized controlled trials (RCTs) to examine the effectiveness of cognitive interventions (i.e. Cognitive Remediation, Cognitive Training, Social Cognition, and their combination) on functioning of patients with recent onset psychosis, established as the period within the first five years from the first episode. The following databases were searched: Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus for research published until January 2022. In total, 12 studies were eligible. The total number of participants was 759, of which 32.2% in the intervention and 30.8% in the control group were female. We extracted data to calculate the standardized mean change from pre-test to post-test comparing the intervention with the control conditions. Overall, there was no effect of any of the cognitive intervention types on functioning. None of the examined factors (intervention type, length, and modality; control condition, follow-up time; cognitive functions; medication; symptoms) seemed to moderate these findings. Our results indicate that cognitive interventions as standalone interventions do not appear to improve functioning in patients with recent onset psychosis. Given the small number of eligible studies, further RCTs with larger and more refined samples are needed to test whether these interventions should be applied as single interventions with these patients.

Experiencias psicóticas autoinformadas: diferencias según la edad y la psicopatología asociada / Self-reported psychotic experiences: differences by age and associated psychopathology

Este trabajo pretende explorar las diferencias en sintomatología psicopatológica que puede haber en la población general adulta con o sin experiencias psicóticas (EP) en función del rango de edad. Se evaluó la presencia de EP, la sintomatología psicopatológica general y diferentes características sociodemográficas y psicosociales en 216 personas sin antecedentes psiquiátricos personales. La muestra se dividió en adultos jóvenes (18-35 años) y maduros (36-60 años). Los jóvenes mostraron una mayor expresión de EP (33,6%). Los adultos maduros con EP presentaban más sintomatología psicopatológica en las dimensiones de hostilidad-ira, somatización, depresión y ansiedad que los adultos maduros sin EP. Los adultos jóvenes con EP mostraron significativamente más síntomas en las mismas dimensiones, así como también en las dimensiones de obsesión-compulsión, ideación paranoide y psicoticismo que los participantes de esta edad sin EP. Las EP son más frecuentes en personas de 18-35 años, sin embargo, pueden estar presentes en distintos rangos de edad y podrían alertar de la presencia de niveles elevados de sintomatología afectiva y de ira-hostilidad. (AU)

This study aims to explore the differences in psychopathological symptoms that may This study aims to explore the differences in psychopathological symptoms that may exist in the general adult population with or without psychotic-like experiences (PLEs), depending on the age range. The presence of PLEs, self-reported general psychopathological symptomatology, and different sociodemographic and psychosocial characteristics were assessed in 216 participants without any record of personal psychiatric antecedents. The sample was divided into young adults (18-35 years) and mature adults (36-60 years). The young adults showed a higher expression of PLEs (33.6%). The mature adults with PLEs presented more psychopathological symptoms in the dimensions of hostility-anger, somatization, depression, and anxiety than mature adults without PLEs. Young adults with PLEs showed significantly more symptoms in the same dimensions, and in the obsession-compulsion dimensions, paranoid ideation, and psychoticism, than participants of this age without PLEs. PLEs are more frequent in people between 18-35 years old; however, PLEs can be present in different age ranges and could serve as an alert to high levels of affective and anger-hostility symptoms. (AU)

Vaccination against SARS-CoV-2 and its relationship with public interest in mental health: a study between 2020-2022 in Spain.

The possible relationship between vaccination against SARS-CoV-2 (COVID-19) and mental health has been largely unexplored. We investigated variations in public interest in mental health issues between the different periods of the vaccination campaign against SARS-CoV-2 in Spain and before the initiation of the campaign. Using Google Trends, we explored the relative search volume (RSV) for the terms 'anxiety', 'depression', 'stress', 'insomnia', and 'suicide' between 03/01/2020 and 01/15/2022. The RSV was compared for these terms with respect to four periods: the pre-vaccination pandemic period; the period running from initiation of vaccination until 50% of the population was fully vaccinated (FV); the period running from 50% FV to 70% FV; and the period after 70% FV. Differences in the RSV indices were observed between the studied periods for 'anxiety'(F = 6.07; p = 0.001; ƞ2 = 0.16), 'stress' (F = 7.77; p < 0.001; ƞ2 = 0.19), and 'insomnia' (F = 3.80; p = 0.013; ƞ2 = 0.11). A lower RSV was found for 'anxiety', 'stress', and 'insomnia' after 70% FV compared to the two previous vaccination periods. A lower RSV was also found for 'stress' after achieving the milestone of 70% FV in relation to the period prior to initiation of the campaign. In conclusion, there is less need for information on specific mental health topics in the period after 70% FV. In Spain, reaching this vaccination milestone may have had a positive impact on anxiety, stress, and insomnia levels in the population, as reflected in fewer web searches for information on these psychopathological processes. The promotion of the COVID-19 vaccination campaign could take into account the changes observed in this preliminary study with respect to public interest in stress, anxiety, and insomnia once a large percentage of the population has been vaccinated.

Efficacy of technology-based interventions in psychosis: a systematic review and network meta-analysis.

BACKGROUND: Technology-based interventions (TBIs) are a useful approach when attempting to provide therapy to more patients with psychosis. METHODS: Randomized controlled trials of outcomes of TBIs v. face-to-face interventions in psychosis were identified in a systematic search conducted in PubMed/Ovid MEDLINE. Data were extracted independently by two researchers, and standardized mean changes were pooled using a three-level model and network meta-analysis. RESULTS: Fifty-eight studies were included. TBIs complementing treatment as usual (TAU) were generally superior to face-to-face interventions (g = 0.16, p ≤ 0.0001) and to specific outcomes, namely, neurocognition (g = 0.13, p ≤ 0.0001), functioning (g = 0.25, p = 0.006), and social cognition (g = 0.32, p ≤ 0.05). Based on the network meta-analysis, the effect of two TBIs differed significantly from zero; these were the TBIs cognitive training for the neurocognitive outcome [g = 0.16; 95% confidence interval (CI) 0.09-0.23] and cognitive behavioral therapy for quality of life (g = 1.27; 95% CI 0.46-2.08). The variables educational level, type of medication, frequency of the intervention, and contact during the intervention moderated the effectiveness of TBIs over face-to-face interventions in neurocognition and symptomatology. CONCLUSIONS: TBIs are effective for the management of neurocognition, symptomatology, functioning, social cognition, and quality of life outcomes in patients with psychosis. The results of the network meta-analysis showed the efficacy of some TBIs for neurocognition, symptomatology, and quality of life. Therefore, TBIs should be considered a complement to TAU in patients with psychosis.

COVID-19 pandemic and mental health in Spain: An analysis of their relationship using Google Trends.

INTRODUCTION: This study aims to examine the public interest that exists on Internet regarding various mental health topics and its relationship with evolution of COVID-19 pandemic in Spain. MATERIALS AND METHODS: Google Trends was used to explore relative search volume (RSV) for the following terms related with mental health (TRMH): "anxiety", "depression", "stress", "insomnia" and "suicide"; between January and December 2020. The cross-correlation function was performed to assess association between new COVID-19 cases and RSV levels for TRMH. Finally, Mann-Whitney test was used to examine differences between RSV values for TRMH before and after of state of alarm declarations on March and October 2020. RESULTS: The "anxiety" term showed the highest RSV indices. A significant correlation was found between new COVID-19 cases and RSV for "anxiety" with a time-lag of +1 week (r=0.49; p<.05). Was found an increase of SRV for "anxiety" (U=0.00; p=.01) and a decrease of SRV for "depression" (U=1.00; p=.04) between 4-week period before and after state of alarm of March 2020. Regarding the state of alarm of October 2020, a higher RSV for "anxiety" (U=0.50; p=.02) was found in the four weeks after it compared with a similar previous period. CONCLUSIONS: Anxiety is the mental health topic of greatest public interest on Internet in context of COVID-19 pandemic. Public concern about anxiety rises one week after the increase in COVID-19 cases and is greater after introduction of control measures that entail any type of mobility restriction or activity limitation. There is a greater general need for information on anxiety at specific times in the pandemic evolution.

Psicopatología general en profesionales sanitarios españoles durante la pandemia de Covid-19 y factores sociolaborales y psicológicos asociados / General psychopathology in Spanish health professionals during the Covid-19 pandemic and associated socio-occupational and psychological factors

El objetivo del estudio fue analizar las características sociolaborales, el estrés percibido, las estrategias de afrontamiento y la sintomatología psicopatológica de profesionales sanitarios y la relación entre ellas, durante la pandemia de Covid-19. Participaron 135 sanitarios (médicos, enfermeros y otros), quienes obtuvieron valores superiores a los datos normativos en las puntuaciones medias de las medidas de estrés percibido, ansiedad fóbica y ansiedad. El grupo de médicos mostró un nivel de ansiedad y somatización más bajo que el grupo formado por otros profesionales sanitarios. Ser profesional médico, tener un menor grado de estrés subjetivo percibido, más afrontamiento activo y menos afrontamiento pasivo eran predictores significativos de la presencia de menos síntomas psicopatológicos. La descripción del perfil del profesional sanitario español con un menor riesgo de mostrar sintomatología psicopatológica puede ser de utilidad para identificar a grupos de sanitarios con mayor vulnerabilidad psicológica. Los hallazgos sugieren factores psicológicos específicos de interés a considerar en las intervenciones destinadas al abordaje de las necesidades de salud mental de esta población en el contexto sanitario generado por la Covid-19. (AU)

The objective of this study was to analyze the socio-occupational features, perceived stress, coping strategies and self-reported psychopathological symptoms of different groups of health professionals and the relationship among these variables during the Covid-19 pandemic. One hundred and thirty-five healthcare workers participated (medical staff, nursing staff and other health professionals), who obtained higher values than the normative data in the mean scores of perceived stress, phobic anxiety, and anxiety measures. The medical staff group showed a lower level of anxiety and somatization than the other group of healthcare professionals. Being a medical professional, having a lower level of perceived subjective stress, a greater proportion of active coping and lesser passive coping were significant predictors of fewer psychopathological symptoms. The description of a health professional profile with a lower risk of showing psychopathological symptoms can help identify healthcare groups with greater psychological vulnerability. The findings suggest specific psychological factors of interest to consider in interventions aimed at addressing the mental health needs of this population in the health context generated by Covid-19. (AU)

Neuropsychological functioning and suicidal behaviours in patients with first-episode psychosis: A systematic review.

INTRODUCTION: Suicidal behaviour is particularly frequent in patients with psychosis. Therefore, prevention is a key objective of mental health policies. The aim of the current work is to systematically review the association between neurocognitive functioning and suicidal behaviour in patients with first-episode psychosis (FEP). MATERIAL AND METHODS: Of the 3051 studies reviewed, only 7 met the inclusion criteria. Documents in English from their earliest date of coverage until January 2022 were searched for in the following databases: PubMed, Science Direct, Web of Science, Cochrane Library, PsycINFO (ProQuest), and Springerlink. We used the PICO strategy to collect and categorize the data from each selected manuscript. RESULTS: Overall, the results showed that the risk of suicidal behaviour is higher for FEP patients in the presence of a number of factors: poorer general neuropsychological functioning (except for working memory), poorer social cognition, more depressive symptoms, longer duration of untreated psychosis, higher awareness of the illness, poorer premorbid adjustment, and more frequent cannabis use. DISCUSSION: Comprehensive general neuropsychology and assessment of social cognition, together with routine clinical record keeping, may help to identify FEP patients at a greater risk of attempting suicide.

Mortalidad por COVID-19 y su relación con las búsquedas en internet sobre salud mental durante el primer año de pandemia / COVID-19 mortality and its relationship with internet searches on mental health during the first year of pandemic

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The relationship of symptom dimensions with premorbid adjustment and cognitive characteristics at first episode psychosis: Findings from the EU-GEI study.

Premorbid functioning and cognitive measures may reflect gradients of developmental impairment across diagnostic categories in psychosis. In this study, we sought to examine the associations of current cognition and premorbid adjustment with symptom dimensions in a large first episode psychosis (FEP) sample. We used data from the international EU-GEI study. Bifactor modelling of the Operational Criteria in Studies of Psychotic Illness (OPCRIT) ratings provided general and specific symptom dimension scores. Premorbid Adjustment Scale estimated premorbid social (PSF) and academic adjustment (PAF), and WAIS-brief version measured IQ. A MANCOVA model examined the relationship between symptom dimensions and PSF, PAF, and IQ, having age, sex, country, self-ascribed ethnicity and frequency of cannabis use as confounders. In 785 patients, better PSF was associated with fewer negative (B = -0.12, 95% C.I. -0.18, -0.06, p < 0.001) and depressive (B = -0.09, 95% C.I. -0.15, -0.03, p = 0.032), and more manic (B = 0.07, 95% C.I. 0.01, 0.14, p = 0.023) symptoms. Patients with a lower IQ presented with slightly more negative and positive, and fewer manic, symptoms. Secondary analysis on IQ subdomains revealed associations between better perceptual reasoning and fewer negative (B = -0.09, 95% C.I. -0.17, -0.01, p = 0.023) and more manic (B = 0.10, 95% C.I. 0.02, 0.18, p = 0.014) symptoms. Fewer positive symptoms were associated with better processing speed (B = -0.12, 95% C.I. -0.02, -0.004, p = 0.003) and working memory (B = -0.10, 95% C.I. -0.18, -0.01, p = 0.024). These findings suggest that the negative and manic symptom dimensions may serve as clinical proxies of different neurodevelopmental predisposition in psychosis.

A systematic review of suicide and suicide attempts in adolescents with psychotic disorders.

BACKGROUND: Suicide is the main cause of premature death in patients with psychosis. Therefore, the goal of the present study was to review suicide in adolescents with psychotic disorders by evaluating factors associated with suicidal acts. Ours is the first systematic review of suicide in this population. METHOD: We performed a systematic review of suicide in adolescents (10 to 19 years) with psychotic disorder. RESULTS: We identified 10 studies, only 2 of which were randomized clinical trials. The results revealed high rates of suicidal behaviour in this population: the times of higher risk were the time before admission and the period immediately following discharge. The factors most associated with suicide attempts were depression, distress with psychotic symptoms, fewer negative symptoms at baseline, positive symptoms, and anxiety disorders. Associated factors included previous psychiatric history or psychiatric admissions, female sex, prior suicidal behaviour, family history of completed suicide, and nicotine dependence. LIMITATIONS: Clinical and methodological diversity of the studies. CONCLUSIONS: Adolescents with psychotic disorders had a major risk of suicidal behaviour, and specific factors were associated with the act. Early detection of adolescents with psychosis is vital, since it has been found that early intervention can prevent suicidal acts in young people. However, it is necessary to perform more studies, particularly randomized controlled trials, on suicide and suicide attempts, particularly in adolescents.

[Psychopathological symptoms during Covid-19 quarantine in spanish general population: a preliminary analysis based on sociodemographic and occupational-contextual factors.] / Síntomas psicopatológicos durante la cuarentena por Covid-19 en población general española: un análisis preliminar en función de variables sociodemográficas y ambientales-ocupacionales.

OBJECTIVE: Coronavirus (COVID-19) pandemic disease forced different countries to adopt quarantine measures. These actions could have an impact on mental health in the general population. The objective of this study was to analyze the differences in psychopathological symptoms shown by Spanish general population during the COVID-19 quarantine based on sociodemographic, occupational and environmental-contextual variables. METHODS: A cross-sectional pilot study was performed in a sample of 151 participants aged between 18-76 years old. The Symptom Assessment-45 Questionnaire via online was used to measure the severity of psychopathology symptoms. Socio-demographic, environmental and occupational variables were collected with an ad hoc questionnaire. The data were gathered from the 3rd to the 6th of April, 2020. A descriptive and comparative analysis was carried out using parametric contrasts (t test and ANOVA). RESULTS: The younger participants (18-35 years) showed higher levels of hostility (t=2.24; p=0.02), depression (t=2.56; p=0.01), anxiety (t=2.78; p=0.006) and interpersonal sensitivity (t=2.08; p=0.04) than older participants (36-76 years). The active or employed people presented lower values of depressive symptoms (t=2.10; p=0.04) than unemployed people. The participants who dedicate less than 30 minutes on getting informed about COVID-19 showed higher scores for hostility (t=2.36; p=0.02) and interpersonal sensitivity (t=1.98; p=0.04) than participants who indicated dedicating at least 30 minutes. People who played sport daily reported a lower level of somatization symptoms (t=-2.11; p=0.03) than persons that did not play sport. Those who had relatives, acquaintances, etc. with COVID-19 reported higher levels of anxiety (t=2.09; p=0.04) than those who did not have close people infected. Lastly, participants who lived alone showed a higher level of psychoticism (F=3.93; p=0.02) compared to those who lived with more than two people. CONCLUSIONS: The findings of this study show that during quarantine can be identified groups with higher psychological vulnerability based on sociodemographic and occupational-contextual factors.

OBJETIVO: La enfermedad pandémica por coronavirus (COVID-19) ha hecho necesaria la adopción de medidas de cuarentena en diferentes países. Estas medidas podrían tener un impacto sobre la salud mental de la población general en confinamiento. El objetivo del trabajo fue analizar las diferencias en la sintomatología psicopatológica mostrada por la población general española durante la cuarentena por COVID-19 en función de variables sociodemográficas, ambientales y ocupacionales. METODOS: Se realizó un estudio trasversal en una muestra de 151 participantes, con edades comprendidas entre los 18 y los 76 años, en el que se utilizó de forma online la versión española del Symptom Assessment-45 Questionnaire para medir el nivel de síntomas psicopatológicos. Se recogieron también variables sociodemográficas, ambientales y de ocupación (mediante una encuesta ad hoc). La información fue recogida del 3 al 6 abril de 2020. Se realizó un análisis descriptivo y comparativo utilizando contrastes paramétricos (prueba t y ANOVA). RESULTADOS: Los participantes más jóvenes (18-35 años) mostraron niveles más altos de hostilidad (t=2,24; p=0,02), depresión (t=2,56; p=0,01), ansiedad (t=2,78; p=0,006) y sensibilidad interpersonal (t=2,08; p=0,04) que los participantes mayores (36-76 años). Las personas activas o empleadas presentaron valores más bajos de síntomas depresivos (t=2,10; p=0,04) que las personas desempleadas. Los participantes que dedicaron menos de 30 minutos a informarse sobre el COVID-19 mostraron puntuaciones más altas en hostilidad (t=2,36; p=0,02) y sensibilidad interpersonal (t=1,98; p=0,04) que los participantes que indicaron dedicar al menos 30 minutos. Las personas que practicaban deporte diariamente informaron de un menor nivel de síntomas de somatización (t=-2,11; p=0,03) que las personas que no practicaban deporte. Aquellos que tenían familiares, conocidos, etc. con COVID-19 informaron de niveles más altos de ansiedad (t=2,09; p=0,04) que aquellos que no tenían a personas cercanas infectadas. Por último, los participantes que vivían solos mostraron un mayor nivel de psicoticismo (F=3,93; p=0,02) en comparación con aquellos que vivían con más de dos personas. CONCLUSIONES: Los resultados de este estudio muestran que durante la cuarentena se pueden identificar grupos con mayor vulnerabilidad psicológica en función de factores sociodemográficos y ocupacionales-contextuales.

Cannabis use and nonuse in patients with first-episode psychosis: A systematic review and meta-analysis of studies comparing neurocognitive functioning.

BACKGROUND: The implications of cannabis use in the onset of early psychosis and the severity of psychotic symptoms have resulted in a proliferation of studies on this issue. However, few have examined the effects of cannabis use on the cognitive symptoms of psychosis (i.e., neurocognitive functioning) in patients with first-episode psychosis (FEP). This systematic review and meta-analysis aim to assess the neurocognitive functioning of cannabis users (CU) and nonusers (NU) with FEP. METHODS: Of the 110 studies identified through the systematic review of 6 databases, 7 met the inclusion criteria, resulting in 14 independent samples and 78 effect sizes. The total sample included 304 CU with FEP and 369 NU with FEP. The moderator variables were age at first use, duration of use, percentage of males, and age. RESULTS: Effect sizes were not significantly different from zero in any neurocognitive domain when users and NU were compared. Part of the variability in effect sizes was explained by the inclusion of the following moderator variables: (1) frequency of cannabis use (ß = 0.013, F = 7.56, p = 0.017); (2) first-generation antipsychotics (ß = 0.019, F = 34.46, p ≤ 0.001); and (3) country where the study was carried out (ß = 0.266, t = 2.06, p = 0.043). CONCLUSIONS: This meta-analysis indicates that cannabis use is not generally associated with neurocognitive functioning in patients with FEP. However, it highlights the deleterious effect of low doses of cannabis in some patients. It also stresses the importance of the type of antipsychotic prescription and cannabis dose as moderator variables in the neurocognitive functioning of CU with FEP.