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Systematic epidemiological and clinical comparisons across all 12 DSM-IV psychotic diagnoses in the Cavan–Monaghan First Episode Psychosis Study (CAMFEPS)

  • Nnamdi Nkire (a1) (a2), Paul J. Scully (a1) (a2), David J. Browne (a1) (a2), Patrizia A. Baldwin (a1) (a2), Tara Kingston (a1) (a2), Olabisi Owoeye (a1) (a2), Anthony Kinsella (a2), Eadbhard O'Callaghan (a3), Vincent Russell (a1) (a4) and John L. Waddington (a1) (a2) (a5)...

Abstract

Background

Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses.

Methods

The Cavan–Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life.

Results

Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct.

Conclusions

There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.

Copyright

Corresponding author

Author for correspondence: John L. Waddington, E-mail: jwadding@rcsi.ie

Footnotes

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Deceased.

Footnotes

References

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Ajnakina, O., Morgan, C., Gayer-Anderson, C., Oduola, S., Bourque, F., Bramley, S.David, A. S. (2017). Only a small proportion of patients with first episode psychosis come via prodromal services: A retrospective survey of a large UK mental health service. BMC Psychiatry, 17, 308.
Aleman, A., Kahn, R. S., & Selten, J. P. (2003). Sex differences in the risk of schizophrenia: Evidence from meta-analysis. Archives of General Psychiatry, 60, 565571.
Amador, X. F., Strauss, D. H., Yale, S. A., Flaum, M. M., Endicott, J., & Gorman, J. M. (1993). Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873879.
Anderson, A. E., Marder, S., Reise, S. P., Savitz, A., Salvadore, G., Fu, D. J.Bilder, R. M. (2018). Bifactor modeling of the Positive and Negative Syndrome Scale: Generalized psychosis spans schizoaffective, bipolar and schizophrenia diagnoses. Schizophrenia Bulletin, 44, 12041216.
Baldwin, P., Browne, D., Scully, P. J., Quinn, J. F., Morgan, M. J., Kinsella, A.Waddington, J. L. (2005). Epidemiology of first-episode psychosis: Illustrating the challenges across diagnostic boundaries through the Cavan/Monaghan study at 8 years. Schizophrenia Bulletin, 31, 624638.
Barbuti, M., Barbuti, M., Pacchiarotti, I., Vieta, E., Azorin, J. M., Angst, J.BRIDGE-II-Mix Study Group (2017). Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-Mix study. Journal of Affective Disorders 219, 187192.
Barch, D. M., Bustillo, J., Gaebel, W., Gur, R., Heckers, S., Malaspina, D.Carpenter, W. (2013). Logic and justification for dimensional assessment of symptoms and related phenomena in psychosis: Relevance to DSM-5. Schizophrenia Research, 150, 3135.
Bipolar Disorder and Schizophrenia Working Group of the Psychiatric Genomics Consortium (2018). Genomic dissection of bipolar disorder and schizophrenia, including 28 subphenotypes. Cell, 173, 17051715.
Bora, E., Akgül, Ö, Ceylan, D., & Özerdem, A. (2018). Neurological soft signs in bipolar disorder in comparison to healthy controls and schizophrenia: A meta-analysis. European Neuropsychopharmacology, 28, 11851193.
Bora, E., & Pantelis, C. (2015). Meta-analysis of cognitive impairment in first-episode bipolar disorder: Comparison with first-episode schizophrenia and healthy controls. Schizophrenia Bulletin, 41, 10951104.
Brown, E. S., & Chandler, P. A. (2001). Mood and cognitive changes during systemic corticosteroid therapy. Primary Care Companion to the Journal of Clinical Psychiatry, 3, 1721.
Brainstorm Consortium (2018). Analysis of shared heritability in common disorders of the brain. Science, 360, eaap8757.
Brunette, M. F., Mueser, K. T., Babbin, S., Meyer-Kalos, P., Rosenheck, R., Correll, C. U.Kane, J. M. (2018). Demographic and clinical correlates of substance use disorders in first episode psychosis. Schizophrenia Research, 194, 412.
Buchanan, R. W., & Heinrichs, D. W. (1989). The Neurological Evaluation Scale (NES): A structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research, 27, 335350.
Cannon-Spoor, H. E., Potkin, S. G., & Wyatt, R. J. (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin, 8, 470484.
Castillejos, M. C., Martin-Perez, C., & Moreno-Kustner, B. (2018). A systematic review and meta-analysis of the incidence of psychotic disorders: The distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level. Psychological Medicine, 48, 21012115. doi: 10.1017/S0033291718000235
Craddock, N., & Owen, M. J. (2010). The Kraepelinian dichotomy – going, going… but still not gone. British Journal of Psychiatry, 196, 9295.
Der-Avakian, A., & Markou, A. (2012). The neurobiology of anhedonia and other reward-related deficits. Trends in Neurosciences, 35, 6877.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured clinical interview for the DSM-IV axis I disorders. New York: Biometrics Research.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F.Yung, A. (2013). The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry, 70, 107120.
Fusar-Poli, P., Cappucciati, M., Rutigliano, G., Heslin, M., Stahl, D., Brittenden, Z.Carpenter, W. T. (2016). Diagnostic stability of ICD/DSM first episode psychosis diagnoses: Meta-analysis. Schizophrenia Bulletin, 42, 13951406.
García, S., Martínez-Cengotitabengoa, M., López-Zurbano, S., Zorrilla, I., López, P., Vieta, E., & González-Pinto, A. (2016). Adherence to antipsychotic medication in bipolar disorder and schizophrenic patients: A systematic review. Journal of Clinical Psychopharmacology, 36, 355371.
Goodkind, M., Eickhoff, S. B., Oathes, D. J., Jiang, Y., Chang, A., Jones-Hagata, L. B.Etkin, A. (2015). Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry, 72, 305315.
Guloksuz, S., & van Os, J. (2018). The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychological Medicine, 48, 229244.
Guy, W. (1976). ECDEU assessment manual for psychopharmacology: Publication ADM 76–338 (pp. 534537). Washington, DC: US Department of Health, Education, and Welfare.
Heckers, S., Barch, D. M., Bustillo, J., Gaebel, W., Gur, R., Malaspina, D.Carpenter, W. (2013). Structure of the psychotic disorders classification in DSM-5. Schizophrenia Research, 150, 1114.
Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T. (1984). The Quality of Life Scale: An instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10, 388398.
Iacono, W. G., & Beiser, M. (1992). Where are the women in first-episode studies of schizophrenia? Schizophrenia Bulletin, 18, 471480.
Jääskeläinen, E., Juola, T., Korpela, H., Lehtiniemi, H., Nietola, M., Korkeila, J., & Miettunen, J. (2018). Epidemiology of psychotic depression – systematic review and meta-analysis. Psychological Medicine, 48, 905918.
Jongsma, H. E., Gayer-Anderson, C., Lasalvia, A., Quattrone, D., Mulè, A., Szöke, A.European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2 (EU-GEI WP2) Group (2018). Treated incidence of psychotic disorders in the multinational EU-GEI study. JAMA Psychiatry 75, 3646.
Joyce, E. M. (2018). Organic psychosis: The pathobiology and treatment of delusions. CNS Neuroscience and Therapeutics, 24, 598603.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276.
Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018). The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophrenia Research, 194, 7885.
Kingston, T., Scully, P. J., Browne, D. J., Baldwin, P. A., Kinsella, A., Russell, V.Waddington, J. L. (2013). Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Psychological Medicine, 43, 25232533.
Kirkbride, J. B., Errazuriz, A., Croudace, T. J., Morgan, C., Jackson, D., Boydell, J.Jones, P. B. (2012). Incidence of schizophrenia and other psychoses in England, 1950–2009: A systematic review and meta-analyses. PLoS ONE, 7, e31660.
Kraguljac, N. V., White, D. M., Hadley, N., Hadley, J. A., Ver Hoef, L., Davis, E., & Lahti, A. C. (2016). Abberant hippocampal connectivity in unmedicated patients with schizophrenia and effects of antipsychotic medication: A longitudinal resting state functional MRI study. Schizophrenia Bulletin, 42, 10461055.
Lambert, C., Da Silva, S., Ceniti, A. K., Rizvi, S. J., Foussias, G., & Kennedy, S. H. (2018). Anhedonia in depression and schizophrenia: A transdiagnostic challenge. CNS Neuroscience and Therapeutics, 24, 615623.
Lewine, R., Burbach, D., & Meltzer, H. Y. (1984). Effect of diagnostic criteria on the ratio of male to female schizophrenic patients. American Journal of Psychiatry, 141, 8487.
Longenecker, J., Genderson, J., Dickinson, D., Malley, J., Elvenag, B., Weinberger, D. R., & Gold, J. (2010). Where have all the women gone? Participant gender in epidemiological and non-epidemiological research in schizophrenia. Schizophrenia Research, 119, 240245.
Lyne, J., O'Donoghue, B., Owens, E., Renwick, L., Madigan, K., Kinsella, A.O'Callaghan, E. (2012). Prevalence of item level negative symptoms in first episode psychosis diagnoses. Schizophrenia Research, 135, 128133.
Malla, A., & Payne, J. (2005). First-episode psychosis: Psychopathology, quality of life and functional outcome. Schizophrenia Bulletin, 31, 650671.
Nelson, H. E. (1982). National Reading Test (NART): Test manual. Windsor: NFER-Nelson.
Novick, D., Montgomery, W., Treuer, T., Aguado, J., Kraemer, S., & Haro, J. M. (2015). Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: Results from a 1-year European outpatient observational study. BMC Psychiatry, 15, 189.
Omer, S., Finnegan, M., Pringle, D. G., Kinsella, A., Fearon, P., Russell, V.Waddington, J. L. (2016). Socioeconomic status at birth and risk for first episode psychosis in rural Ireland: Eliminating the features of urbanicity in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Schizophrenia Research, 173, 8489.
Omer, S., Kirkbride, J. B., Pringle, D. G., Russell, V., O'Callaghan, E., & Waddington, J. L. (2014). Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Schizophrenia Research, 152, 152157.
Owen, M. J. (2014). New approaches to psychiatric diagnostic classification. Neuron, 84, 564571.
Owoeye, O., Kingston, T., Scully, P. J., Baldwin, P., Browne, D., Kinsella, A.Waddington, J. L. (2013). Epidemiological and clinical characterization following a first psychotic episode in major depressive disorder: Comparisons with schizophrenia and bipolar I disorder in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Schizophrenia Bulletin, 39, 756765.
Parellada, M., Gomez-Vallejo, S., Burdeus, M., & Arango, C. (2017). Developmental differences between schizophrenia and bipolar disorder. Schizophrenia Bulletin, 43, 11761189.
Peet, M., & Peters, S. (1995). Drug-induced mania. Drug Safety, 12, 146153.
Royall, D. R., Mahurin, R. K., & Gray, K. F. (1992). Bedside assessment of executive cognitive impairment: The executive interview. Journal of the American Geriatric Society, 40, 12211226.
Sami, M., Khan, H., & Nilforooshan, R. (2015). Late onset mania as an organic syndrome: A review of case reports in the literature. Journal of Affective Disorders, 188, 226231.
Sarpal, D. K., Robinson, D. G., Lencz, T., Argyelan, M., Ikuta, T., Karlsgodt, K.Malhotra, A. K. (2015). Antipsychotic activity and functional connectivity of the striatum in first-episode schizophrenia. JAMA Psychiatry, 72, 513.
Schizophrenia Working Group of the Psychiatric Genomics Consortium (2014). Biological insights from 108 schizophrenia-associated genetic loci. Nature, 511, 421427.
Scully, P. J., Coakley, G., Kinsella, A., & Waddington, J. L. (1997). Psychopathology, executive (frontal) and general cognitive impairment in relation to duration of initially untreated versus subsequently treated psychosis in chronic schizophrenia. Psychological Medicine, 27, 13031310.
Sheffield, J. M., Kandala, S., Tamminga, C. A., Pearlson, G. D., Keshavan, M. S., Sweeney, J. A.Barch, D. M. (2017). Transdiagnostic associations between functional brain network integrity and cognition. JAMA Psychiatry, 74, 605613.
Simpson, G. M., & Angus, J. W. (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica Supplementum, 212, 1119.
Stafford, J., Howard, R., & Kirkbride, J. B. (2018). The incidence of very late-onset psychotic disorders: A systematic review and meta-analysis, 1960–2016. Psychological Medicine, 48, 17751786.
Trotta, A., Murray, R. M., & MacCabe, J. H. (2015). Do premorbid and post-onset cognitive functioning differ between schizophrenia and bipolar disorder? A systematic review and meta-analysis. Psychological Medicine, 45, 381394.
Van der Werf, M., Hanssen, M., Kohler, S., Verkaaik, M., Verhey, F. R., RISE Investigators, van Winkel, R.Allardyce, J. (2014). Systematic review and collaborative recalculation of 133693 incident cases of schizophrenia. Psychological Medicine 44, 916.
van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet, 374, 635645.
Waddington, J. L., & Buckley, P. F. (2013). Psychotic depression: An underappreciated window to explore the dimensionality and pathobiology of psychosis. Schizophrenia Bulletin, 39, 754755.
Waddington, J. L., Hennessy, R. J., O'Tuathaigh, C. M. P., Owoeye, O., & Russell, V. (2012). Schizophrenia and the lifetime trajectory of psychotic illness: Developmental neuroscience and pathobiology, redux. In Brown, A. S. & Patterson, P. H. (Eds), The origins of schizophrenia (pp. 321). New York: Columbia University Press.
Waddington, J. L., Kingston, T., Nkire, N., & Russell, V. (2019). Major depressive disorder with psychotic features: Confronting and resolving the dimensional challenge. In van Os, J., Tamminga, C. A., Ivleva, E. I. & Reininghaus, U. (Eds), Dimensions of psychosis: Comprehensive conceptualization and treatments. New York: Oxford University Press (in press).
Watson, P., Zhang, J. P., Rizvi, A., Tamaiev, J., Birnbaum, M. L., & Kane, J. (2018). A meta-analysis of factors associated with quality of life in first episode psychosis. Schizophrenia Research, 202, 2636.
Zhang, B., Lin, P., Shi, H., Öngür, D., Auerbach, R. P., Wang, X.Wang, X. (2012). Mapping anhedonia-specific dysfunction in a transdiagnostic approach: An ALE meta-analysis. Brain Imaging and Behavior, 10, 920939.

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Systematic epidemiological and clinical comparisons across all 12 DSM-IV psychotic diagnoses in the Cavan–Monaghan First Episode Psychosis Study (CAMFEPS)

  • Nnamdi Nkire (a1) (a2), Paul J. Scully (a1) (a2), David J. Browne (a1) (a2), Patrizia A. Baldwin (a1) (a2), Tara Kingston (a1) (a2), Olabisi Owoeye (a1) (a2), Anthony Kinsella (a2), Eadbhard O'Callaghan (a3), Vincent Russell (a1) (a4) and John L. Waddington (a1) (a2) (a5)...

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