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.

Quality of care in psychiatry is related to research activity.

BACKGROUND: The top biomedical research institutions have traditionally been assumed to provide better medical treatment for their patients. However, this may not necessarily be the case. Low-to-moderate negative associations between research activity and the quality-of-care provided by clinical departments have been described. We aimed to examine this relationship in the psychiatric units of the largest hospitals in Spain. METHODS: Scientific publications for 50 hospitals were retrieved from the Web of Science (2006-2015), and quality of mental healthcare data were gathered from Spanish National Health System records (2008-2014). Spearman-rank correlation analyses (adjusting for number of beds and population) were used to examine the associations between research data and quality-of-care outcomes in psychiatry. Stepwise regression models were built in order to determine the predictive value of research productivity for healthcare outcomes. RESULTS: We found a positive association between research activity indicators (i.e., number of publications, number of citations, cumulative impact factor, and institutional H-index) and better quality-of-care outcomes in psychiatry (i.e., number of readmissions, transfers, and discharges from hospital). In particular, a higher research activity predicted a lower level of readmissions for individuals with psychoses (p = 0.025; R = 0.317), explaining 8.2% of the variance when other factors were accounted for. CONCLUSIONS: Higher research activity is associated with better quality of mental healthcare in psychiatry. Our results can inform decision-making in clinical and research management settings in order to determine the most appropriate quality measures of the impact of research on the prognosis of individuals with psychiatric conditions.

Duration of untreated psychosis and neurocognitive functioning in first-episode psychosis: a systematic review and meta-analysis.

BACKGROUND: Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). METHOD: MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. RESULTS: The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. CONCLUSION: There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.

Cognitive effects of adjunctive N-acetyl cysteine in psychosis.

BACKGROUND: Cognitive deficits are predictors of functional outcome in patients with psychosis. While conventional antipsychotics are relatively effective on positive symptoms, their impact on negative and cognitive symptoms is limited. Recent studies have established a link between oxidative stress and neurocognitive deficits in psychosis. N-acetylcysteine (NAC), a glutathione precursor with glutamatergic properties, has shown efficacy on negative symptoms and functioning in patients with schizophrenia and bipolar disorder, respectively. However, there are few evidence-based approaches for managing cognitive impairment in psychosis. The present study aims to examine the cognitive effects of adjunctive NAC treatment in a pooled subgroup of participants with psychosis who completed neuropsychological assessment in two trials of both schizophrenia and bipolar disorder. METHOD: A sample of 58 participants were randomized in a double fashion to receive 2 g/day of NAC (n = 27) or placebo (n = 31) for 24 weeks. Attention, working memory and executive function domains were assessed. Differences between cognitive performance at baseline and end point were examined using Wilcoxon's test. The Mann-Whitney test was used to examine the differences between the NAC and placebo groups at the end point. RESULTS: Participants treated with NAC had significantly higher working memory performance at week 24 compared with placebo (U = 98.5, p = 0.027). CONCLUSIONS: NAC may have an impact on cognitive performance in psychosis, as a significant improvement in working memory was observed in the NAC-treated group compared with placebo; however, these preliminary data require replication. Glutamatergic compounds such as NAC may constitute a step towards the development of useful therapies for cognitive impairment in psychosis.

Neuropsychological evidence for abnormal neurodevelopment associated with early-onset psychoses.

BACKGROUND: The longitudinal neuropsychological study of first-episode early-onset psychosis (EOP) patients, whose brain maturation is still in progress at the time of illness onset, provides a unique opportunity to compare their cognitive development with that of healthy subjects, in search of specific patterns resulting from the interaction between neurodevelopmental processes and the presence of psychotic disorders. Method Seventy-five first-episode EOP patients (schizophrenia n = 35; bipolar disorder n = 17; other forms of psychosis n = 23) with a mean age of 15.53 years were assessed with a neuropsychological battery that included measures of attention, working memory, memory and executive functions within 6 months following the onset of the first psychotic symptom (baseline) and 2 years later. Psychotic symptoms were assessed at both times with the Positive and Negative Symptom Scale (PANSS). Seventy-nine healthy subjects matched for age and education served as controls. RESULTS: EOP patients showed significant cognitive impairment at both baseline and the 2-year follow-up, with no significant differences between diagnostic groups at either time. Both healthy controls and EOP patients improved in all cognitive measures, except for patient working memory. Improvement in patient attention lost significance after controlling for psychotic symptom reduction. No significant time/diagnosis interaction was found among patients (p > 0.405). CONCLUSIONS: Cognitive impairment in EOP is already present at the first episode, and cognitive development seems to be arrested early in EOP patients compared to their healthy peers, at least for some cognitive functions. These and previous similar results support the neurodevelopmental hypothesis of psychosis.

Aplicación de un programa de manejo de conducta para padres de hijos con problemas de comportamiento / Application of a programme of behaviour managing for parents with conduct-problem children

Introducción: El motivo de consulta más frecuente en Psiquiatría Infantil y Adolescente son los problemas de comportamiento. Se han desarrollado intervenciones dirigidas a los padres para manejar los problemas de comportamiento en los niños. Describiremos la aplicación de un programa para padres en nuestra unidad. Métodos: Diez padres de niños con problemas de comportamiento participaron en el grupo. Utilizamos el cuestionario de capacidades y dificultades (SDQ) y la escala del ambiente familiar (FES) al inicio y al final del programa, un cuestionario de utilidad después de cada sesión y de satisfacción general al finalizar el programa (escala Likert de 0 a 6). Resultados: En el SDQ se evidencia una mejoría en todas las subescalas, encontrándose una diferencia significativa en la subescala de problemas de conducta. Los padres valoraron su satisfacción general del programa sobre todo en los ítems: mejoría de los problemas de comportamiento, en las relaciones familiares y en el grado de seguridad para manejar el comportamiento de sus hijos. Conclusiones: Estas intervenciones pueden ayudar en el manejo de los problemas de comportamiento de los niños

Introduction: Behavioural problems are the most frequent referral in the Child and Adolescent Psychiatry Interventions to support parents in the management of these difficulties have been developed. We describe the application of a parenting program in our unit. Methods: Ten parents of children referred to our clinic participated in this program. We used the SDQ and FES, a helpfulness questionnaire of the sessions and general satisfaction questionnaire to evaluate the programme. Results: The SDQ showed an improvement in all subscales (conduct problems was statistically significant). Parents were satisfied with the programme mainly in the items: Improvement in the child´s behaviour, family relationships and greater confidence and security on child´s inappropriate behaviour´s management. All techniques were easy to use, except ignoring and time-out. Conclusions: These interventions may help in the management of behavioural problems in children (AU)

Coordinación de formación de becarios de la red temática de investigación cooperativa (RETIC) en primeros episodios psicóticos en niños y adolescentes. Resultados preliminares / Coordination of scholars' formation of the thematic net of cooperative investigation (RE TIC) in the first psychotic episodes in children and teenagers. Preliminary results

El objetivo de este trabajo es evaluar el impacto en la formación de becarios de la designación de un responsable de formación de becarios en una RETIC. Las misiones del responsable de formación son: coordinación y organización de actividades, propuesta de cursos y búsqueda de financiación, fomento del desarrollo de actividades en la red y los centros, facilitación de medios de comunicación efectivos entre de becarios (página web, listas de distribución) y portavoz de los mismos. En cuanto al método, se recogen las horas de formación en la RETlC durante el 2003 y a partir de la designación del coordinador en enero de 2004. El promedio de horas semanales de formación en 2003 fue 2,4. De éstas 1,1 corresponden a formación global de la red para todos los becarios y 1,3 a la formación específica de cada centro. En 2004, el total fue de 5 horas semanales (2,8 de formación global de la red y 2,2 de formación específica de los centros) aunque hay diferencias entre centros. Se observa un aumento de 2,4 a 5 horas de promedio semanal de formación teniendo en cuenta el cómputo total de la formación de la red como de los centros tras designar un responsable de formación de becarios (AU)

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Terapia electroconvulsiva (TEC) en adolescente: ¿ineficaz ignorada? / Electroconvulsive therapy (ECT) in adolescents: ineffective or ignored?

El TEC es una terapia que ha sido denigrada y que genera diversas opiniones y emociones, sobre todo en relación con su uso en los jóvenes. Este artículo revisa los datos existentes sobre la eficacia del TEC en adolescentes y contribuye información a los clínicos sobre la práctica actual de esta terapia. Los resultados sugieren que el TEC es un tratamiento que se usa raramente pero que es seguro y eficaz en adolescentes con trastornos del humor severos, sobre todo depresión psicótica y trastorno bipolar. Muchos de estos pacientes a menudo reciben diferentes medicaciones y combinaciones de ellas, psicoterapia, desarrollan efectos secundarios serios, tienen riesgo de suicidio y sufren importantes repercusiones en su vida diaria. La mayoría de los psiquiatras infantiles y del adolescente tienen experiencia, conocimientos y habilidades sobre el TEC que son muy limitados. Como resultado, el TEC puede ser ignorado o no considerado como una opción terapéutica valida (AU)

ECT is a much maligned therapy that generates strong opinions and feelings, particularly about its use in adolescents. This article reviews the data available about the effectiveness of ECT in adolescents and provides information to clinicians about the current practice of this treatment. Results suggest that ECT is a treatment rarely used but which is safe and effective in adolescents with severe mood disorders, particularIy psychotic depression and bipolar disorder. Many of these patients often receive several trials of medication or combinations of drugs, psychotherapy, develop severe side effects, risk suicide, and suffer considerable impairment. Because it is seldom used- many child psychiatrists have limited experience, knowledge and skills about ECT. As a result, ECT can be ignored or not considered as a valid treatment option (AU)