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Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations – incorporating a task-shifting approach and modifying the mode of community-based service delivery – are examined from users' perspectives.
A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS.
Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil.
CTI-TS’ major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.
Percutaneous closure of atrial septal defect is recognised as a safe and effective procedure, however, in some patients complications may occur. Although chest pain has been sporadically reported, its exact aetiology has been poorly studied. Herein, a 14-year-old female with an atypical and long-lasting chest pain after percutaneous atrial septal defect closure is described.
This study analyzes the effects of the Pedernales earthquake (April 2016) on Ecuador’s health care system.
A research was carried out in Chone Canton, which combined documentary, quantitative, and qualitative techniques. Epidemiological and service production information taken from official documents was analyzed systematically. In-depth interviews and surveys were conducted with health care program directors and technicians from the Health Centres of the Ministry of Public Health and the users.
Deficiencies in the health care system were already observed in Chone Canton prior to the earthquake mainly due to the lack of doctors, nurses, and hospital beds. According to the interviewees, the health district was not prepared for an emergency like the earthquake. Some buildings fell after the earthquake, and Chone Hospital was disabled. These problems coupled with preventive action failures at the community level led to an increase in diseases after the earthquake.
The shortage of personnel and physical infrastructure, weaknesses in primary health care in the Ecuadorian health system, the lack of preparation, and limited availability of information on health indicators were the causes of the sharp increase in pre-existing diseases in the area, and of new epidemic outbreaks after the earthquake.
A 4-year-old child of 10 kg weight, with four previous sternotomies, presented a severe right heart failure, due to a severe regurgitation of his bioprosthetic tricuspid valve. A percutaneous tricuspid valve in valve procedure with an Edwards S3 valve was offered for compassionate use, and performed, with no complications, and significant clinical condition improvement.
Evaluate the relevance of the coronavirus disease 2019 (COVID-19) positive case detection policy or model implemented by the Ministry of Public Health (MPH) of Ecuador and to compare it with the experiences of other countries.
Data contained the daily reports publicized by the MPH. The formulations were carried out under the Conditioned Probability modality applying Bayes’ Theorem. All the COVID-19 tests applied in relation to the confirmed cases per million inhabitants were considered to obtain their level of positivity, and compared with the experience of Iceland and South Korea.
The probability of detecting positive cases of COVID-19 in Ecuador was higher than Iceland and South Korea, because the diagnostic tests were aimed at symptomatic patients, without identifying asymptomatic or mild symptomatic, who play an important role in the transmission of the disease. In addition, many symptomatic patients were examined but will remain undiagnosed due to the unavailability of tests and the low quality of many of them.
The daily reports on the behavior of the COVID-19 issued by the Ecuadorian government do not adequately represent the growth in the number of those infected each day, nor the actual behavior of the epidemic, affecting possible control measures.
This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD).
A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk.
TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01–1.65) were associated with TRD risk.
Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.
An experiment of divergent selection for intramuscular fat was carried out at Universitat Politècnica de València. The high response of selection in intramuscular fat content, after nine generations of selection, and a multidimensional scaling analysis showed a high degree of genomic differentiation between the two divergent populations. Therefore, local genomic differences could link genomic regions, encompassing selective sweeps, to the trait used as selection criterion. In this sense, the aim of this study was to identify genomic regions related to intramuscular fat through three methods for detection of selection signatures and to generate a list of candidate genes. The methods implemented in this study were Wright’s fixation index, cross population composite likelihood ratio and cross population – extended haplotype homozygosity. Genomic data came from the 9th generation of the two populations divergently selected, 237 from Low line and 240 from High line. A high single nucleotide polymorphism (SNP) density array, Affymetrix Axiom OrcunSNP Array (around 200k SNPs), was used for genotyping samples. Several genomic regions distributed along rabbit chromosomes (OCU) were identified as signatures of selection (SNPs having a value above cut-off of 1%) within each method. In contrast, 8 genomic regions, harbouring 80 SNPs (OCU1, OCU3, OCU6, OCU7, OCU16 and OCU17), were identified by at least 2 methods and none by the 3 methods. In general, our results suggest that intramuscular fat selection influenced multiple genomic regions which can be a consequence of either only selection effect or the combined effect of selection and genetic drift. In addition, 73 genes were retrieved from the 8 selection signatures. After functional and enrichment analyses, the main genes into the selection signatures linked to energy, fatty acids, carbohydrates and lipid metabolic processes were ACER2, PLIN2, DENND4C, RPS6, RRAGA (OCU1), ST8SIA6, VIM (OCU16), RORA, GANC and PLA2G4B (OCU17). This genomic scan is the first study using rabbits from a divergent selection experiment. Our results pointed out a large polygenic component of the intramuscular fat content. Besides, promising positional candidate genes would be analysed in further studies in order to bear out their contributions to this trait and their feasible implications for rabbit breeding programmes.
Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients.
In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping.
Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%).
The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.
Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence.
The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity.
Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively.
Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing.
The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.
The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values.
We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting.
Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items.
The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to ‘Sleep disturbances’ was found.
The Wide AmbispectiVE study of clinical management and burden of bipolar disorder (BD) (WAVE-bd; NCT01062607) is ongoing to address limitations of longitudinal BD studies to-date focused on single disease phases or treatment.
To understand current treatment approaches for patients with BD in daily clinical practice.
Multinational, multicentre, non-interventional, longitudinal study of patients diagnosed with BD-I or BD-II with ≥1 mood event in the preceding 12 months, followed-up for 12-27 months (including retrospective and prospective phases). Site and patient selection provided a sample representative of bipolar populations. The study includes descriptive analyses of demographics, diagnosis, medical history and clinical management. Medication use during the retrospective phase will be presented.
Preliminary results (based on data availability at time of submission) are presented from 2829 patients recruited March-September 2010. During the retrospective period, 94.3% (94.2% BD-I, 94.6% BD-II) of patients received BD therapy. Among BD-I and BD-II patients, respectively, the most common number of prescribed drugs was two (29.5%, 31.5%); 17.6% and 18.1% were prescribed one drug, and 11.5% and 9.8% were prescribed five or more. Drug classes most commonly used (BD-I, BD-II, respectively) were atypical antipsychotics (64.5%, 48.9%) anticonvulsants (58.0%, 54.3%), antidepressants (39.6%, 66.7%) and lithium (31.2%, 17.3%). Electroconvulsive therapy was used in 12 (0.4%) patients (9 BD-I, 3 BD-II). Average treatment duration with atypical antipsychotics, anticonvulsants and antidepressants was 165.0, 199.7 and 169.7 days, respectively.
This ongoing study provides a multinational perspective on BD patient management practices in a large sample population. Financial support: AstraZeneca
The Wide AmbispectiVE study of the clinical management and burden of bipolar disorder (BD) (WAVE-bd; NCT01062607) is ongoing to address limitations of longitudinal BD studies to-date focused on single disease phases or treatment.
To describe baseline bipolar mood state and severity in a cohort of patients with BD.
Multinational, multicentre, non-interventional, longitudinal study of patients diagnosed with BD-I or BD-II with ≥1 mood event in the preceding 12 months (retrospective data collection from index mood event to enrolment, followed by 9-14 months’ prospective follow-up). Site and patient selection provided a sample representative of bipolar populations. The study includes descriptive analyses of demographics, diagnosis and medical history.
2880 patients (mean age 46.5 years [SD: 13.3]; 62.0% female) were recruited March to September 2010: 1989 (69.1%) BD-I and 891 (30.9%) BD-II. Time (years) from first symptoms to diagnosis was 2.9 [SD: 6.6] (BD-I) and 4.4 [SD: 8.0] (BD-II). Of the total population, 20.8% lived alone (13.9% BD-I, 6.9% BD-II), 36.7% were employed (24.0% BD-I, 12.7% BD-II) and 13.3% unemployed (9.5% BD-I, 3.8% BD-II). Disease status at inclusion (BD-I, BD-II, respectively [mild, moderate, severe]) included hypomania (7.9% [67.7%, 31.0%, 1.3%], 6.5% [70.7%, 29.3%, 0%]), mania (7.1% [26.1%, 47.2%, 26.8%], 0%), euthymia (58.6%, 60.3%), depression (19.7% [38.8%, 47.7%, 13.5%], 31.1% [41.2%, 46.9%, 11.9%]) and mixed (5.7% [30.1%, 46.9%, 23.0%], 0%).
This ongoing study provides detailed insight into a large BD population, showing the majority with euthymia and an important proportion with depression both in BD-I and BD-II patients.
Pre- and perinatal insults, childhood maltreatment, and personality traits have been separately related to suicidal behavior.
To explore if all these factors act in an additive fashion.
To examine characteristics of suicide attempts in a life course perspective.
Sample and procedure: Cross-sectional study of 1042 suicide attempters. Indexes of pre- and perinatal adversity were hospitalization in neonatology, very premature birth (< 31 weeks of pregnancy), tobacco during mother's pregnancy, and mother's and father's age at patient's birth. All suicide attempters were evaluated using the French version of the Childhood Trauma Questionnaire, and the Tridimensional Personality Questionnaire. Characteristics studied in suicide attempters included violence of suicide attempt, age at first suicide attempt, and number of suicide attempts. Statistical Analyses: Comparisons between groups was made using c2 with crude and adjusted odds ratios, and 95% confidence intervals. All analyses were adjusted for gender, age, study level, Alcohol dependence or abuse, Substance dependence or abuse, Tobacco, Episode of major depression, Bipolar, Anxiety, Eating disorders, and Schizophrenia.
We found an additive effect between prematurity and sexual abuse (OR[95%] = 3.57[1.03–12.50];p < 0.001), emotional abuse (OR[95%] = 4.54[1.76–12.50];p < 0.05), novelty seeking (OR[95%] = 9.09[1.76-12.50];p < 0.001), and harm avoidance (OR[95%] = 5.88[2.38-14.28];p < 0.001) for a younger age at first suicide attempt. Tobacco during mother's pregnancy, and harm avoidance also had an additive effect on the age at first suicide attempt (OR[95%] = 4.76[1.96–11.11];p < 0.05) and number of suicide attempts (OR[95%] = 3.31[1.37–7.99];p < 0.05).
Pre- and perinatal insults, childhood maltreatment, and personality traits influence in an additive fashion characteristics of suicide attempts.
WAVE-bd addresses limitations of previous longitudinal bipolar disorder (BD) studies (mainly single disease phase- or treatment-focused).
To provide real-world data on BD treatment practices across countries.
To report descriptive analyses of patients’ profiles and use of quetiapine extended and immediate release (XR and IR).
Multicentre, non-interventional, longitudinal study of BD-I/II patients, with ≥1 mood episode in the preceding year (minimum 9 months’ follow-up). Sample was representative of BD populations from Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela.
During the index episode, 662/2896 (22.9%) patients took quetiapine (326 XR, 336 IR); baseline analysis of this population revealed higher incidence rates of previous hospitalisations (hospitalisations/person-year; diagnosis to study-start) in patients taking XR at index event (0.29) vs those taking IR (0.22) (p < 0.0001). Analysis of all episodes occurring during WAVE-bd in quetiapine patients revealed more frequent prescription of XR vs IR in manic (56.2% vs 43.8%) and depressive (60.5% vs 39.5%) episodes. XR prescriptions also exceeded IR prescriptions during euthymia (62.0% vs 38.0%). XR was more frequently started before, and continued after, episodes (mania: 46.5% [XR] vs 23.4% [IR], p < 0.0001; and depression: 48.1% [XR] vs 34.0% [IR], p = 0.0002). Average dose (mg/day) was higher for XR vs IR (mania: 493.7 vs 423.4 [p = 0.0194]; depression: 371.0 vs 269.0 [p < 0.0001]).
Quetiapine XR and IR use differs in BD. the XR formulation appears to be prescribed more than IR, both for patients previously hospitalised more frequently, and irrespective of disease phase. AstraZeneca-funded study; Clinical Trials Registry: NCT01062607.
CYP2D6 and CYP2C19 are involved in the metabolism of widely used antidepressants and other drugs with psychotropic activity. They also participate in the metabolism of endogenous substrates, and are expressed in the brain.
Objectives and Aims
This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort.
Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS).
Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002).
Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.
This work was supported in part by Union Europea Fondo Social Europea (FEDER/FSE), Instituto de Salud Carlos III-FIS (PI10/02758) and Gobierno de Extremadura Consejería de Economía, Competitividad e Innovación (IB13186 and PD10199). CHU Montpellier (PHRC UF 7653), Agence Nationale de la Recherche (ANR NEURO 2007 'GENESIS').
There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.
To validate the self-administered PLE Scale.
Material and methods:
In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).
The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).
Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.
In the absence of biological measures, diagnostic long-term stability provides the best evidence of diagnostic validity.Therefore,the study of diagnostic stability in naturalistic conditions may reflect clinical validity and utility of current schizophrenia diagnostic criteria.
Describe the diagnostic evolution of schizophrenia in clinical settings.
We examined the stability of schizophrenia first diagnoses (n=26,163) in public mental health centers of Madrid (Spain).Probability of maintaining the diagnosis of schizophrenia was calculated considering the cumulative percentage of each diagnosis per month during 48 months after the initial diagnosis of schizophrenia.
65% of the subjects kept the diagnosis of schizophrenia in subsequent assessments (Figure 1). Patients who changed (35%) did so in the first 4-8 months. After that time gap the rates of each diagnostic category remained stable. Diagnostic shift from schizophrenia was more commonly toward the following diagnoses: personality disorders (F60), delusional disorders (F22), bipolar disorder (F31), persistent mood disorders (F34), acute and transient psychotic disorders (F23) or schizoaffective disorder (F25).
Once it is confirmed, clinical assessment repeatedly maintains the diagnosis of schizophrenia.The time lapse for its confirmation agrees with the current diagnostic criteria in DSM-IV. We will discuss the implications of these findings for the categorical versus dimensional debate in the diagnosis of schizophrenia.
Goodman expanded the conceptualization of addictions to embrace not only drug addiction but other behavioral addictions. In some cases, suicidal behaviour can be viewed as a behavioral addiction.
The main objective of the present study is to analyze the relationships between major suicide repeaters (> or =5 lifetime suicide attempts) and measures of suicidal behaviour addiction.
To characterize major suicide repeaters.
Sample and procedure: This is a transversal study of 954 suicide attempters (Montpellier, France). All suicide attempters were assessed using a protocol including: MINI (Axis I disorders), TPQ (personality traits) and BIS-10 (impulsivity), among others. Statistical Analyses: Comparisons between groups was made using logistic regression models with crude odds ratios and 95% confidence intervals.
Major repeaters were more likely to be female and having low educational level than non-major repeaters (OR[95%]=6.95[3.19–15.10]; p < 0.0001; and OR[95%]=2.17[1.38–3.33]; p < 0.001, respectively). As compared with non-major repeaters, major repeaters more often met criteria for bipolar disorder (OR[95%]=1.82[1.22–2.74]; p < 0.05), anxiety disorders (OR[95%]=1.77[1.03–3.07]; p < 0.05) and eating disorders (OR[95%]=2.81[1.79–4.41]; p < 0.0001). Furthermore, compared with non-major repeaters, major repeaters were more frequently diagnosed with cigarette smoking (63.5% vs. 53.5%), alcohol use (29.3% vs. 25.4%) and substance use (15.4% vs. 13.2%), but none of them reached statistical significance. Finally, major repeaters, as compared with non-major repeaters, were more likely to score high in harm avoidance (OR[95%]=2.52[1.52–4.18];p < 0.001), BIS-10 global score (OR[95%]=2.09[1.25–3.47]; p < 0.05) and BIS-10 non-planning impulsiveness (OR[95%]=3.31[1.37–7.99]; p < 0.05).
Our preliminary results give partial support to the addictive hypothesis of suicidal behaviour.
The objective of the present study was to examine the short-term effectiveness of a 11-week chess training course for children with ADHD. This is a naturalistic, descriptive clinical intervention study.
Sample and procedure: Parents of 44 children between 6 and 17 of age with a primary diagnosis of ADHD consented to take part into the present study. Parents completed the Spanish version of the Swanson, Nolan and Pelham Scale for parents (SNAP-IV) and the the Abbreviated Conners Rating Scales for parents (CPRS-HI) prior to 11-week chess training course. Statistical Analyses: We used a paired t test statistic to compare pre- to post- intervention outcomes, and Cohen-d calculations to measure the magnitude of the effect. Statistical significance was set at p< 0.05.
After 11 weeks of these pilot programme, more than 80% of children showed improvement in the severity of ADHD. T-test revealed that children with ADHD improved in both the SNAP-IV (t=6.23; d.f.=41; p< 0.001) and the CPRS-HI (5.39; d.f.=33; p< 0.001). Our results suggest a large effect in decreasing the severity of ADHD as measured by the SNAP-IV (d=0.96) and the CPRS-HI (d=0.92)
Recently, several authors have argued in favor of extending the less common clinical phenotype of schizophrenia to a vulnerability phenotype of schizophrenia in the general population. It has been proposed that high levels in any of four different symptom dimensions (affective, psychosis, negative and cognitive) would lead to clinical assessment, identification of correlated symptoms in other dimensions and finally, the diagnosis of schizophrenia. Being so, we would expect to find such a dimensional pattern in the previous diagnoses of schizophrenic patients.
We examined previous contacts of a large cohort of patients diagnosed, according to the International Classification of Diseases (ICD-10), with schizophrenia (n = 26,163) in public mental health centers of Madrid (Spain) from 1980 to 2008. Of those patients, 56.7% received another diagnosis prior to schizophrenia. Non-schizophrenia diagnoses within the category of ‘schizophrenia, schizotypal and delusional disorders’ were common (F2; 40.0%). The other most frequent prior diagnoses were ‘neurotic, stress-related and somatoform disorders’ (F4; 47.3%), ‘mood disorders’ (F3; 41.4%), and ‘disorders of adult personality and behavior’ (F6; 20.8%). We then examined the probability of progression to schizophrenia, considering also time proximity. The strongest associations were between several F2 spectrum diagnoses with schizophrenia. However, some affective disorders (F3x) were also linked with schizophrenia but anxiety (F4) or personality disorders (F6) were not.
Our findings support two of the previously described dimensions (psychotic, affective) in the development of schizophrenia. Several limitations of the dimensional model will be discussed in view of these findings.