Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice.

AIM: Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. METHODS: Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. RESULTS: An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. CONCLUSIONS: Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis.

Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments.

Influence of Maternal and Paternal History of Mental Health in Clinical, Social Cognition and Metacognitive Variables in People with First-Episode Psychosis.

This study investigates, for the first time, clinical, cognitive, social cognitive and metacognitive differences in people diagnosed with first-episode of psychosis (FEP) with and without a family history of mental disorder split by maternal and paternal antecedents. A total of 186 individuals with FEP between 18 and 45 years old were recruited in community mental-health services. A transversal, descriptive, observational design was chosen for this study. Results suggest that there is a higher prevalence of maternal history of psychosis rather than paternal, and furthermore, these individuals exhibit a specific clinical, social and metacognitive profile. Individuals with a maternal history of mental disorder scored higher in delusional experiences, inhibition of the response to a stimulus and higher emotional irresponsibility while presenting a poorer overall functioning as compared to individuals without maternal history. Individuals with paternal history of mental disorder score higher in externalizing attributional bias, irrational beliefs of need for external validation and high expectations. This study elucidates different profiles of persons with FEP and the influence of the maternal and paternal family history on clinical, cognitive, social and metacognitive variables, which should be taken into account when offering individualized early treatment.

Clinical insight in first-episode psychosis: Clinical, neurocognitive and metacognitive predictors.

OBJECTIVE: Poor insight is a major problem in psychosis, being detrimental for treatment compliance and recovery. Previous studies have identified various correlates of insight impairment, mostly in chronic samples. The current study aimed to determine clinical, neurocognitive, metacognitive, and socio-cognitive predictors of insight in first-episode psychosis. METHODS: Regression analyses of different insight dimensions were conducted in 190 patients with first-episode psychosis. Measures of clinical symptoms, neurocognition, metacognition, social cognition, and 'jumping to conclusions' bias were entered as predictors. RESULTS: Delusions, disorganisation, and certain negative symptoms were associated with unawareness in various domains, while depression was associated with greater awareness of illness. Deficit in theory of mind and self-reflective processes, as well as a 'jumping to conclusions' bias, contributed to poor insight. Several neuropsychological scores also contributed to this but their contribution was no longer observed in regression analyses that included all the previously identified clinical and cognitive predictors. A measure of perseverative errors was still associated with unawareness and misattribution of symptoms. CONCLUSION: In models that account for 28 % to 50 % of the variance, poor insight in first-episode psychosis is mainly associated with delusions and certain negative symptoms. At the cognitive level it does not appear to result from neuropsychological impairment but rather from altered reasoning bias and dysfunction in metacognitive processes. Therapeutic strategies specifically directed at these mechanisms could help improve the evolution of insight in first episode psychosis.

Failure to detect the 22q11.2 duplication syndrome rearrangement among patients with schizophrenia.

Chromosome aberrations have long been studied in an effort to identify susceptibility genes for schizophrenia. Chromosome 22q11.2 microdeletion is associated with DiGeorge and Velocardiofacial syndromes (DG/VCF) and provides the most convincing evidence of an association between molecular cytogenetic abnormality and schizophrenia. In addition, this region is one of the best replicated linkage findings for schizophrenia. Recently, the reciprocal microduplication on 22q11.2 has been reported as a new syndrome. Preliminary data indicates that individuals with these duplications also suffer from neuropsychiatric disorders. In this study we have investigated the appropriateness of testing schizophrenia patients for the 22q11.2 microduplication. We used multiplex ligation-dependent probe amplification (MLPA) to measure copy number changes on the 22q11.2 region in a sample of 190 patients with schizophrenia. Our results corroborate the prevalence of the 22q11.2 microdeletion in patients with schizophrenia and clinical features of DG/VCFS and do not suggest an association between 22q11.2 microduplication and schizophrenia.

Esquizofrenia familiar y esporádica: un estudio clínico comparativo / Family and sporadic schizophrenia: a compared clinical research

Introducción: La esquizofrenia es una enfermedad complejaclínica y etiológicamente que a pesar de la combinaciónde diferentes factores genéticos y ambientales sepresenta con una sintomatología similar. Numerosos estudioshan intentado establecer diferencias clínicas entreenfermos esquizofrénicos con antecedentes familiares ysin antecedentes llegando a resultados poco concluyentes.El objetivo de nuestro estudio es el de establecerdiferencias clínicas entre la esquizofrenia familiar y laesporádica utilizando grupos homogéneos a través decriterios de selección estrictos.Material y Método: Se estudió una serie consecutiva de148 pacientes diagnosticados de Esquizofrenia o TrastornoEsquizoafectivo según criterios DSM-IV, que se clasificaronen Esquizofrenia Familiar o Esporádica segúnla presencia o no de antecedentes familiares. Obteniéndoseuna muestra final de 25 pacientes con Esquizofrenia familiar,30 con Esquizofrenia esporádica y descartándose93 pacientes que no cumplían criterios de uno ni otrogrupo. Se recogieron variables sociodemográficas, clínicas,historia de factores de riesgo pre y perinatales ehistoria familiar de enfermedades psiquiátricas, y se realizóun análisis comparativo de las variables recogidasentre los dos grupos.Resultados: La esquizofrenia familiar se asoció a mayorfrecuencia de complicaciones obstétricas, a la adquisiciónde un nivel educativo más bajo y a una mayor puntuaciónde sintomatología negativa, en periodo de estabilidadclínica, medida por la PANS.Conclusiones: El estudio muestra que existen diferenciasclínicas entre los enfermos afectos de esquizofrenia segúnla presencia o no de antecedentes familiares. Ademáslos resultados van a favor de que la utilización demuestras homogéneas puede ser una metodología fiablepara establecer estas diferencias clínicas

Introduction: Schizophrenia is a clinical and etiologicallycomplex disease that regardless of the combination ofdifferent genetic and environmental factors presents a similarsymptomatology. Many studies have tried to establishclinical differences between schizophrenic inpatients withor without family schizophrenic background reachinginconclusive results. The aim of this study is determiningclinical differences between the familiar schizophreniaand the sporadic one by using homogeneous groupsformed with strict selection criteria.Material and method: A consecutive sequence of 148inpatients with diagnosis of Schizophrenia or SchizoaffectiveDisorder was studied. The diagnosis criteria ofDSM-IV were used. Inpatients were classified in threegroups: 25 with familial schizophrenia, 30 with sporadicschizophrenia and 93 discarded from the sample becausethey followed neither familial nor sporadic criteria. Wegathered socio-demographic and clinical information,obstetric complications record and psychiatric familydiseases background. A comparative analysis betweenthe two groups was made.Results: Familial schizophrenia is associated with higherrates of obstetric complications, with a lower educationallevel and with higher negative symptomatology score inthe PANSS scale during stable clinical periods.Conclusions: The study showed the existence of clinicaldifferences between schizophrenic inpatients dependingon the presence or not of familial background. Additionally,it was proved that using homogeneous samples ofinpatients can be a reliable methodology to identify theseclinical differences