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The ‘jumping to conclusions’ (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.
A total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.
The estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI −0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25–0.76, p < 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B = −1.7, 95% CI −2.8 to −0.5, p = 0.006), but did not relate to delusions in patients.
Our findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis.
Characterizing the profile of schizophrenic patients with high hospitalization rates seems relevant. The aim of this study is to describe characteristics of patients with schizophrenia hospitalized at Acute Care Units, and identify clinical profiles associated to relapse.
Observational retrospective study (case-control). Hospitalized patients diagnosed for schizophrenia or schizoaffective disorder for more than 2 years. Data related to the previous 3 years and current hospitalization were recorded: sociodemographics, diagnosis, CGI, reason for current/previous hospitalizations, life events, drug abuse, therapy prior and during hospitalization and compliance.
Preliminary results from 1607 patients are presented: cases are patients with no hospitalization (No-HOSP) in the previous 3 years (N=508); controls are those who had some hospitalization (HOSP) during that period (N=1099). HOSP patients were significantly younger than No-HOSP (p<0.0001). 41% of HOSP and 28.4% of No-HOSP patients showed No-Low family support (p<0.0001). 55.9% of HOSP and 50.2% of No-HOSP patients showed some drug abuse close to current hospitalization (p<0.05). The most frequent factor for current hospitalization was relapse due to non-compliance in both HOSP (66.2%) and No-HOSP (59.4%; p=0.0092). Through artificial intelligence methods, fourteen variables are identified as related to relapse (Number of previous antipsychotics, Time of evolution, CGI, Age, Gender, Educational Level, Family support, Compliance, Heroine, Cocaine or Cannabis abuse, Stressing events, Diagnosis, Number of previous hospitalizations), which have permitted to develop a predictive model for relapse (PRECOG Project).
The main factor for hospitalization was non-compliance. Age, family support, drug abuse seem to be also related to hospitalization.
Neurocognitive impairment is a core feature of schizophrenia and is closely associated with functional outcome. The importance of cognitive assessment is broadly accepted today, and an easy-to-use, internationality validated cognitive assessment tool is needed by researchers and in daily clinical practice. The Brief Assessment of Cognition in Schizophrenia (BACS) has been validated in English, French, Japanese and Italian. It is as sensitive to cognitive dysfunction as a standard test battery, with the advantage of requiring less than 35 minutes to complete. In our study, we tested the psychometric characteristics of a Spanish version of the BACS in 117 patients with schizophrenia-spectrum disorders and 36 healthy controls. All BACS cognitive subtests discriminated between patients and controls (P < .001), and the concurrent validity between the BACS and a traditional neuropsychological test battery was similar to that reported in other languages. We conclude that the BACS can facilitate the comparison of the cognitive performance of patients with schizophrenia in many different countries.
Prevalence of cardiovascular disease is high in schizophrenia. Our aim is to estimate the prevalence of cardiovascular risk factors (CVRF) among schizophrenia patients.
National cross-sectional study in patients diagnosed with schizophrenia under treatment with second generation antipsychotics and admitted to short-stay hospitalisation units.
A sample of 733 consecutively admitted patients was enrolled; the most prevalent CVRFs were smoking 71% (95% CI: 67–74%) and hypercholesterolemia 66% (61–70%) followed by hypertriglyceridemia 26% (26–32%), hypertension 18% (15–21%) and diabetes 5% (4–7%). Metabolic syndrome showed 19% (95% CI: 16–23%) prevalence or, according to updated definitions (Clin Cornerstone 7  36–45), 24% (95% CI: 20–28%). The rate of patients within the high-risk range of a 10-year fatal cardiovascular event was 6.5%. CVRFs under routine management were diabetes (60%), hypertension (28%) and, to a lesser extent, dyslipemia (14%). Treatment for CVRFs was associated to gender, men for hypertension OR = 25.34, p < 0.03 and women for diabetes OR = 0.02, p < 0.03.
We found that CVRFs in schizophrenia were prevalent and under-diagnosed, and thus with insufficient therapeutic management.
To describe the consumption of ultra-processed foods according to demographic and socioeconomic characteristics in three birth cohorts.
Data from the 2004, 1993 and 1982 Pelotas Birth Cohorts were used at 11, 22 and 30 years, respectively, collected between 2012 and 2015. Outcome was the relative contribution of ultra-processed foods from the total daily energy intake. Maternal-independent variables were self-reported skin colour, schooling, age and family income (obtained in the perinatal study), and variables of the cohort member, sex, skin colour, schooling and current family income (the last two obtained at the 11-, 22- and 30-year follow-ups of the respective cohorts). We calculated crude and adjusted means of the outcome for the whole cohorts and according to the independent variables.
11-, 22- and 30-year-old individuals.
Daily energetic contribution from ultra-processed foods was higher in the younger cohort (33·7, 29·8 and 25·1 % at 11, 22 and 30 years, respectively). Maternal schooling and family income at birth showed an inverse dose–response relationship at 11 and 22 years, but a positive dose–response at 30 years. Female sex, lower schooling and family income at 22 years and higher schooling at 30 years were associated to a higher contribution from ultra-processed foods in the daily energy intake.
Information from food and nutrition policies needs a higher dissemination, mostly among women and population groups of lower income and schooling, including its promotion in media and health services, aiming for a decreased consumption of ultra-processed foods.
Intramuscular paliperidone palmitate (PP) is a long-acting, atypical antipsychotic for ntramuscular (IM) administration in the treatment of patients with schizophrenia.
To study efficacy and quality of life in patients with schizophrenia and schizoaffective disorders treated with long-acting paliperidone palmitate.
A non-randomized, prospective naturalistic study was performed in out-patients with schizophrenia and schizoaffective disorder unsuccessfully treated with oral antipsychotics. Efficacy of PP over time was evaluated by using BPRS 24-items (Brief Psychiatric Rating Scale) Quality of life was evaluated by the QL-Index (Quality of life Index) at T0 and at most recent visit (T1).
Data were available for 16 outpatients consecutively prescribed PP and naturalistically treated attending at the Psychiatric Clinic, University of Sassari. Patients were predominantly male (n = 9; 56.2%), with schizophenia (n = 10; 62.5%). Three patients dropped out (18.8%). Mean time on PP treatment was 870.0 days (sd 217.02) at a mean PP maintenance dose of 97.82 ± 37.17 mg eq. BPRS mean total score at T0 was 55 (sd 14.5) and at T1 was 44.8 (sd 11.8). Ql-Index mean total score was 5 (sd 1.6) at T0 and 7.2 (sd 2.4) at T1. Paired sample test showed a statistically significant difference in deacreasing symptoms at BPRS over time (P = 0.009) and in improving Quality of life at QL-Index (P = 0.017). The analyses showed a significant improving at the following BPRS sub-items: Depression (P = 0.021), Hostility (P = 0.022), Suspiciousness (P = 0.005), Hallucinations (P = 0.050), Unusual thought content (P = 0.029), Self-neglet (P = 0.028), Conceptual disorganization (P = 0.044), Emotional withdrawal (P = 0.028) and Distractibility (P = 0.014).
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The association between the neurocognitive impact of cannabis use and deficits in working and declarative memory is well documented. Studies with cannabis users suggest that recognition memory is particularly susceptible to cannabinoid acute intoxication. Studies carried out in the 1970s using free memory tests, showed that cannabis users not only named fewer words having also a tendency to evoke intrusive memories. Interestingly, a recent study has exposed an association between cannabis consumption and increased likelihood of creating fake memories.
The main objective of this work is to do literature revision, framing old data with recent works, exposing the relationship between cannabis consumption and memory confabulation/intrusion.
Literature review, comparison and description of empirical data .
Recent studies show that both cannabis users and abstinents are more susceptible to create false memories, not being able to identify trap stimuli as events that never occurred.
Changes in perception and memory deficits are two common consequences of acute marijuana intoxication. The fact that these deficits remain during drug abstinence demonstrates the relevance of better understanding the mechanisms by which cannabinoids alter such cognitive functions. Reductions in the activation of brain areas comprised in the lateral and temporal lobe and in frontal cortex zones involved in the processes of attention and performance monitoring may be a possible explanation.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Daily use of high-potency cannabis has been reported to carry a high risk for developing a psychotic disorder. However, the evidence is mixed on whether any pattern of cannabis use is associated with a particular symptomatology in first-episode psychosis (FEP) patients.
We analysed data from 901 FEP patients and 1235 controls recruited across six countries, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) study. We used item response modelling to estimate two bifactor models, which included general and specific dimensions of psychotic symptoms in patients and psychotic experiences in controls. The associations between these dimensions and cannabis use were evaluated using linear mixed-effects models analyses.
In patients, there was a linear relationship between the positive symptom dimension and the extent of lifetime exposure to cannabis, with daily users of high-potency cannabis having the highest score (B = 0.35; 95% CI 0.14–0.56). Moreover, negative symptoms were more common among patients who never used cannabis compared with those with any pattern of use (B = −0.22; 95% CI −0.37 to −0.07). In controls, psychotic experiences were associated with current use of cannabis but not with the extent of lifetime use. Neither patients nor controls presented differences in depressive dimension related to cannabis use.
Our findings provide the first large-scale evidence that FEP patients with a history of daily use of high-potency cannabis present with more positive and less negative symptoms, compared with those who never used cannabis or used low-potency types.
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
Psychiatric disorders are often considered the leading cause of violence. This may be due to a stereotype created by media and general opinion.
The Modified Overt Aggression Scale (MOAS) was used to evaluate the severity of aggressive and violent behaviors in 400 patients who attended a post-acute psychiatric service in Milan from 2014 to 2016 and suffered from different psychiatric disorders. The psychopathological clinical picture was evaluated by Clinical Global Impression (CGI). The study also assessed the possible correlation between epidemiologic and sociodemographic factors, clinical variables, and aggression and violence.
Of the total number of subjects, 21.50% showed a MOAS score >0, 11.50% presented mild aggression (0–10 MOAS weighted score), 9% moderate aggression (11–20), and 1% severe aggression (MOAS >20). With respect to violent behaviors, 16% of patients showed a score >0 in one MOAS subscale other than verbal aggression according to violence definition. The severity of clinical picture seemed to be related to higher weighted MOAS score. Multivariate testing of different sociodemographic and clinical variables showed that violence was related to unemployment status, and significantly correlated to compulsory admission (TSO), suicide attempts (TS), and personality disorders, while the severity of clinical psychiatric picture seemed to play a secondary role.
Results have shown that personality disorders and sociodemographic factors, including economic factors, seem to be major determinants of violence among patients diagnosed with mental disorders.
The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment.
This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions.
A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions.
Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
Patients with schizophrenia exhibit a reduced life expectancy. Although unhealthy lifestyle or suicide risk plays a role, the main causes are diverse medical conditions such as cardiovascular diseases, type 2 diabetes mellitus and metabolic syndrome. Albeit pharmacological secondary side effects might also trigger previous conditions, studies in naïve patients reflect diverse anomalies at the onset. Patients with a first episode of psychosis, display a wide scope of metabolic abnormalities, ranging from normality till pathological values depending on the parameters studied. We attempted to evaluate the metabolic syndrome and glycemic homeostasis in a subset of antipsychotic-naïve patients with a first episode of non-affective psychosis. Patients (n = 84) showed a similar prevalence of metabolic syndrome compared with a matched control sample (n = 98) (6% vs 4%, P = 0.562), while glucose homeostasis values differed significantly (14% vs. 5%, P = 0.034). Our results suggest that metabolic syndrome is not a useful clinical condition to be evaluated in patients before pharmacological treatment. Abnormal glycemic homeostasis at the onset of the disease requires specific diagnostic tools and preventive measures in order to avoid future cardiovascular events. New strategies must be implemented in order to evaluate the cardiovascular risk and subsequent morbidity in patients at the onset of the disease.
Achromobacter spp. are opportunistic pathogens increasingly recovered from adult patients with cystic fibrosis (CF). We report the characterization of 122 Achromobacter spp. isolates recovered from 39 CF patients by multilocus sequence typing, virulence traits, and susceptibility to antimicrobials. Two species, A. xylosoxidans (77%) and A. ruhlandii (23%) were identified. All isolates showed a similar biofilm formation ability, and a positive swimming phenotype. By contrast, 4·3% and 44·4% of A. xylosoxidans and A. ruhlandii, respectively, exhibited a negative swarming phenotype, making the swimming and swarming abilities of A. xylosoxidans significantly higher than those of A. ruhlandii. A. xylosoxidans isolates from an outbreak clone also exhibited significantly higher motility. Both species were generally susceptible to ceftazidime, ciprofloxacin, imipenem and trimethoprim/sulphamethoxazole and there was no significant difference in susceptibility between isolates from chronic or sporadic infection. However, A. xylosoxidans isolates from chronic and sporadic cases were significantly more resistant to imipenem and ceftazidime than isolates of the outbreak clone.
Early Archaic human skeletal remains found in a burial context in Lapa do
Santo in east-central Brazil provide a rare glimpse into the lives of
hunter-gatherer communities in South America, including their rituals for
dealing with the dead. These included the reduction of the body by means of
mutilation, defleshing, tooth removal, exposure to fire and possibly
cannibalism, followed by the secondary burial of the remains according to
strict rules. In a later period, pits were filled with disarticulated bones
of a single individual without signs of body manipulation, demonstrating
that the region was inhabited by dynamic groups in constant transformation
over a period of centuries.
Cognitive deficits are present from the onset of psychosis and are considered a core feature of the disorder. Increasing evidence suggests that cognitive function is associated with inflammatory processes. This study evaluated the association between cognition and inflammatory biomarkers in first-episode psychosis (FEP), in order to identify cognitive phenotypes from inflammatory expression profiles.
A case-control study of 92 FEP patients and 80 matched controls was used. Neurocognitive assessment, including verbal ability, sustained attention, verbal memory, working memory and executive function, was performed. The expression of pro- and anti-inflammatory mediators of the main intracellular inflammatory pathway was measured in peripheral blood mononuclear cells and plasma.
FEP patients performed worse in all cognitive domains compared to controls and had higher expression of pro-inflammatory mediators and lower expression of anti-inflammatory mediators. In the FEP group, cognition and psychopathology were associated with inflammation. Hierarchical regression analysis showed that association between the anti-inflammatory prostaglandin 15d-PGJ2 and sustained attention on one hand, and COX-2 expression and executive function on the other, were statistically significant.
Our study provides evidence for an association between anti-inflammatory biomarkers and cognition in FEP. The identification of a subgroup of patients based on these measures could be useful to guide treatment programmes by providing tools to select a personalized treatment approach, but longitudinal studies are needed before. In the future, establishment of biomarkers linked to cognition would be useful to monitor the course of cognitive impairment, but substantially more data will be required. Determination of IκBα, the inhibitory protein of the pro-inflammatory transcription factor NFκB, could be useful in early phases to assess clinical severity.
Hippocampal abnormalities have been demonstrated in schizophrenia. It is
unclear whether these abnormalities worsen with age, and whether they
affect cognition and function.
To determine whether hippocampal abnormalities in chronic schizophrenia
are associated with age, cognition and socio-occupational function.
Using 3 T magnetic resonance imaging we scanned 100 persons aged 19–82
years: 51 were out-patients with stable schizophrenia at least 2 years
after diagnosis and 49 were healthy volunteers matched for age and
gender. Automated analysis was used to determine hippocampal volume and
There were differential effects of age in the schizophrenia and control
samples on total hippocampal volume (group×age interaction:
F(1,95) = 6.57, P = 0.012), with steeper
age-related reduction in the schizophrenia group. Three-dimensional shape
analysis located the age-related deformations predominantly in the
mid-body of the hippocampus. In the schizophrenia group similar patterns
of morphometric abnormalities were correlated with impaired cognition and
poorer socio-occupational function.
Hippocampal abnormalities are associated with age in people with chronic
schizophrenia, with a steeper decline than in healthy individuals. These
abnormalities are associated with cognitive and functional deficits,
suggesting that hippocampal morphometry may be a biomarker for cognitive
decline in older patients with schizophrenia.
Following a pretest-posttest design with no control group, this paper evaluates
the efficacy of an intervention program. Consisting of twelve sessions, the
program endeavored to increase knowledge and use of self-regulated learning
strategies, as well as study time, in 277 first-year students in the Spanish
secondary education system. The intervention’s efficacy was assessed
in terms of three variables: knowledge of self-regulated learning strategies,
use of self-regulated learning strategies, and study time. The results of
post-intervention data analysis indicate that statistically significant changes
occurred in students’ knowledge of self-regulated learning strategies
and weekly study time, but not in their use of self-regulated learning
strategies. When the sample was stratified into three groups (high, moderate,
and low) according to baseline scores on the dependent variables, our findings
show that students in the lower group profited most from the intervention on all
three variables. This suggests that participation in the program is especially
useful for at-risk students (i.e. those with little knowledge and use of
effective learning strategies).
Exposed sandy beaches are widespread coastal habitats with temporal and spatial variability. O Rostro beach (Galicia, north-west Spain) was the most severely affected beach in the ‘Prestige’ oil spill (November 2002). Monitoring sampling was conducted to study macroinfaunal composition and structure after the oil spill episode. The purpose of this survey was to characterize macroinfaunal variations on the beach over a yearly scale (2003–2007) and determine the recovery period. These data are compared with the only available data collected before the spill (1995). Two zones where identified with different recovery trends: (1) supralittoral, occupied either by talitrid amphipods, oniscoidean isopods and insects; and (2) intertidal, where marine crustaceans prevailed. Beach morphodynamics partially buried the oil, which gradually reappeared and was dragged to the coast. Negative ecological effects were observed in the short term (six months after the 2002 spill) but macroinfauna apparently recovered in the following years (2004–2007), showing that macroinfaunal assemblages of this beach are resilient enough to recover after severe stress.