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Persistent negative symptoms are associated with worse outcome in both first-episode and chronic subjects with schizophrenia. The identification of these symptoms in recent-onset subjects is still controversial as retrospective data are often unavailable. The prospective assessment of persistence of negative symptoms might represent a valid alternative but the length of the persistence is still to be established. The present study investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline in a large cohort of patients in the early stage of a schizophrenia-spectrum disorder, recruited to the OPTiMiSE trial. Persistent unconfounded negative symptoms were assessed at 4, 10 and 22 weeks of treatment. Symptomatic remission, attrition rate and psychosocial functioning was evaluated in subjects with short-term (4 weeks) persistent negative symptoms (PNS) and in those with negative symptoms that did not persist at follow-up and/or were confounded at baseline (N-PNS). Negative symptoms of moderate severity were observed in 59% of subjects at baseline and were associated to worse global functioning. PNS were observed in 7.9% of the cohort, unconfounded at both baseline and end of 4-week treatment. PNS subjects showed lower remission and higher attrition rates at the end of all treatment phases. Fifty-six percent of subjects completing phase 3 (clozapine treatment) had PNS, and 60% of them were non-remitters at the end of this phase. The presence of short-term PNS during the first phases of psychosis was associated with poor clinical outcome and resistance to antipsychotic treatment, including clozapine.
Prof Mucci has been a consultant and/or advisor to or has received honoraria from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer and Pierre Fabre.
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.
The aim of the 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.
This work was supported by the Carlos III Institute of Health and European Fund for Regional Development (PI08/1213, PI11/ 01977, PI14/01900, PI08/01026, PI11/02831, PI14/01621, PI08/1161, PI16/ 00359, PI16/01164, PI18/00805), the Basque Foundation for He
Impulsivity is associated with different types of disorders, included substance used disorders. The purposed of this study is get to know if alcohol and cocaine affect in the same way to the impulsivity paradigms or if they strength each other or if there are specific bias associated to each one of the substances.
Material and methods
This is a 380 heavy drinker patient's sample recruited from twelve primary care centers. The patients were screened using The Alcohol Use Disorders Identification Test (AUDIT > 8). Neuropsicological tests done at the base line and after the 4 years of the study were the Continous Performance Test (CPT) and the Barrat Impulsivity scale. The alcohol and cocaine consume accumulated along the four years was also study.
The two variables of the CPT (ommission and commission errors) had a significant correlation with the alcohol and cocaine use accumulated in these four years. The variable that was associated with a greater risk of making more commission and ommission errors was the cocaine risk consumption. The years of study were protective variable.
The most important conclusion of this study is that alcohol and cocaine use produces a modification in the conductual paradigm of impulsivity characterized by the inhibition difficulties measured by the CPT. Also, the cocaine use effects are added respect to the alcohol ones and finally that cocaine plus alcohol effects over the number of ommission and commission errors are more potent that the ones made only with alcohol.
The TaqIA polymorphism linked to the DRD2 gene has been associated with alcoholism. The aim of this work is to study attention and inhibitory control as per the continuous performance test and the stop task in a sample of 50 Spanish male alcoholic patients split into two groups according to the presence of the TaqIA1 allele in their genotype. Our results show that alcoholics carrying the TaqIA1 allele present lower sustained attention and less inhibitory control than those patients without such allele.
Different neuropsychological studies have consistently found an attention, memory and executive function deficit in schizophrenic patients. The Positive and Negative Syndrome Scale (PANSS) evaluates different clinical aspects of schizophrenia. Factor analyses of this scale suggest the existence of a “cognitive factor”, constituted by several items pertaining to the different subscales. In order to have an acceptable concurrent validity, this “cognitive factor” should correlate with the execution of neuropsychological tasks. Our objective was to study the correlation between the PANSS “cognitive factor” and the execution of neuropsychological tasks evaluating attention, memory and executive functions.
Thirty-five schizophrenic patients were evaluated using the Continuous Performance Test (CPT), the Rey-Osterrieth Complex Figure Test (Rey CFT) and the Wisconsin Card Sorting Test (WCST). Bivariate partial correlation between the neuropsychological variables and the PANSS “cognitive factor” was examined. In order to obtain this cognitive component, and based on previous studies, items P2, N5, PG10 and PG11 were used.
The PANSS “cognitive factor” was significantly correlated to CPT omission errors (r=0.45; p=0.006), Rey CFT recall after 5 minutes (r=-0.34; p=0.049), Rey CFT recall after 30 minutes (r=-0.40; p=0.020), WCST perseverative responses (r=0.36; p=0.035), and WCST perseverative errors (r=0.35; p=0.041).
The existence of significant correlations between the PANSS “cognitive factor” and performance on neuropsychological tasks evaluating attention (CPT), memory (Rey CFT) and executive functions (WCST) supports the concurrent validity of this factor.
A high prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) history has been found in alcoholic patients. Patients with this history have an earlier onset and greater intensity of alcohol use, more polysubstance use and a poorer prognosis. Our objective was to study differences in neuropsychological functioning in a group of alcoholic patients according to the presence or absence of a history of childhood ADHD.
A sample of 136 male alcoholic patients and 56 male control subjects were evaluated using the Continuous Performance Test (CPT); execution in both groups was compared. The sample of alcoholic patients was then divided into two subgroups according to the presence or absence of a history of childhood ADHD, namely the ADHD+ OH subgroup (61 patients with childhood ADHD history) and the ADHD- OH subgroup (75 patients without this history); CPT execution in these two subgroups was also compared.
The group of alcoholic patients made more omission (p=0.008) and commission (p=0.009) errors in the CPT than the control group. When comparing subgroups, ADHD+ OH patients made more omission and commission errors than ADHD- OH patients, although the differences did not reach statistical significance.
Alcoholic patients perform more poorly on the CPT than control subjects. In the sample of alcoholic patients, a history of childhood ADHD was not associated to significant differences in the execution of this test.
Different types of behavioural impulsivity have been associated with the development of substance use disorders but little is know about what type of impulsivity is provoked by the effect of chronic use of substances.
Determine what type of behavioural impulsivity was associated with the use of alcohol and cocaine.
Design and measurements:
A prospective cohort study was conducted to identify changes on behavioural impulsivity. Non-dependent heavy drinkers (N=471) were recruited from primary care centres. The following assessments were used at baseline and at the end of the 4-year follow-up period: The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension. Diagnoses were rendered using the Structured Interview for DSM-IV.
Amounts on alcohol and cocaine consumption during follow-up correlated positively with changes on all impulsivity measures. Logistic regression analysis indicated that cocaine used was associated specifically with poor performance on CPT and SST and amount of alcohol used during follow-up was related to changes on DRLR.
Substances provoke different pattern of behavioural impulsivity: chronic cocaine use provokes changes mainly on behavioural inhibition dimension and alcohol use induces changes on delay discounting paradigm.
Smoking is an important health problem associated with different medical and psychiatric disorders. A high prevalence of smoking has been described in psychiatric patients. Our objective was to determine the prevalence of smoking in inpatients admitted to a psychiatric hospitalisation unit in a general hospital, and to study the possible differences in this prevalence according to the different psychiatric diagnoses.
A retrospective analysis of the medical records and discharge reports of the 659 patients admitted to our psychiatric hospitalisation unit during three consecutive years (2003-2005) was carried out.
At the time of their admission, 70.2% of our patients were smokers. This percentage reached 97.2% among patients with substance-use disorders (SUDs), and 95.5% among patients with dual diagnosis. However, only 48.6% of patients without concurrent SUDs were smokers; this difference reached statistical significance (p<0.001). According to psychiatric diagnosis, significant differences were also found regarding the percentage of smokers: 83.0% in schizophrenia, 80.0% in schizophreniform disorder, 70.7% in bipolar disorder, 29.3% in major depressive disorder and 56.8% in other disorders (p<0.001).
Although smoking prevalence among psychiatric patients is higher than in the general population, differences were found between the various psychiatric diagnoses. Thus, the prevalence of smoking was highest among psychotic patients and among those with concurrent use of other substances, whilst depressive patients had rates of smoking similar to those of the general population.
The Positive and Negative Syndrome Scale (PANSS) evaluates different psychopathological aspects of schizophrenic patients. Scores on the negative subscale of the PANSS have been associated with clinical and neuropsychological differences in these patients. Our aim was to study the relationship between PANSS negative scores and different clinical and neuropsychological variables in a sample of schizophrenic patients.
Our sample of 174 schizophrenic patients was split into two groups according to scores on the negative subscale of the PANSS: a group of 85 patients (55 male and 30 female; mean age 38.0 years, SD 9.3) with scores below the median (“low negative PANSS” group), and a group of 89 patients (58 male and 31 female; mean age 37.3, SD 8.4) with scores above the median (“high negative PANSS” group). The neuropsychological task used was the Wisconsin Card Sorting Test.
Significant clinical differences were found between both groups. In the “high negative PANSS” group a lower age of illness onset was found (p=0.030), as well as a lower age at first psychiatric admission (p=0.002) compared to the “low negative PANSS” group, without there being significant differences in current age (p=0.570). Regarding cognitive functions, “high negative PANSS” patients achieved fewer categories (p=0.005) and made more perseverative errors (p=0.031) than “low negative PANSS” patients.
Schizophrenic patients with higher scores on the negative subscale of the PANSS had an earlier age of onset of their illness and exhibited poorer cognitive functioning than patients with lower scores.
The link between impulsivity and alcohol use disorders has been established in longitudinal and cross-sectional studies, but little is know about the role of behavioural impulsivity in the development of substance use disorders.
Determine the role of behavioural measures of impulsivity in the development of alcohol use disorders.
Design and measurements:
A prospective cohort study was conducted to identify the risk factors associated with alcohol dependence. Non-dependent heavy drinkers (N=471) and healthy controls (N=149) were recruited from primary care centres. They were assessed at the end of the 4-year follow-up period. Diagnoses were rendered using the Structured Interview for DSM-IV. The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension.
HD participants have significant impairments on all laboratory measures of impulsivity. In the logistic regression model, impairment on DRLR (delay discounting dimension) was the only measure that classified accurately HD. Baseline behavioural measures of impulsivity correlated positively with amount of alcohol consumption during the follow-up period. Logistic regression analysis indicated that performance on inhibitory control (SST) (behavioural inhibition dimension) was a significant predictor (odds=1.52[1.08-2.31]) for developing alcohol dependence.
Our data support the link between behavioural measures of impulsivity and alcohol use disorders. Delay discounting dimension may be a risk factor for begin alcohol use heavily and behavioural inhibition impairment is more involved in the development of dependence.
The Wender-Utah Rating Scale (WURS) was developed for the retrospective diagnosis of childhood attention-deficit/hyperactivity disorder (ADHD). It consists of a list of childhood behaviours and symptoms suggestive of ADHD. Our objective was to study correlations of WURS scores with different impulsivity, personality, anxiety and depression psychometric scales.
A group of 110 healthy university students were evaluated using the WURS. Four subjects scored higher than the cut-off value of 37 (compatible with childhood ADHD) and were excluded. The Barratt Impulsivity Scale (BIS-11), the Big Five Questionarie (BFQ), the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI) were administered. Partial bivariate correlation analyses were performed.
WURS scores were correlated with total scores on the BIS-11 (r=0.430; p<0.001), as well as with the motor (r=0.410; p<0.001), attentional (r=0.328; p=0.001), and improvisation subscales (r=0.289; p=0.003). Regarding the BFQ, a correlation was found between WURS scores and the “emotional stability” factor (r=-0.379; p<0.001) as well as with the subfactors “emotion control” (r=-0.310; p=0.001) and “impulse control” (r=-0.354; p<0.001). Finally, significant correlations were also found between WURS scores and scores on the STAI-trait (r=0.366; p<0.001), STAI-state (r=0.200; p=0.039), and the BDI (r=0.350; p<0.001).
Correlations between the WURS and other impulsivity-related psychometric scales such as the BIS-11, or the “emotional stability” factor and the “emotion control” and “impulse control” subfactors of the BFQ, provides evidence for the concurrent validity of the WURS. The correlation of this instrument with anxiety and depression scales points to possible clinical implications.
Impulsivity has been associated with alcohol dependence, but impulsivity in alcohol-dependent subjects has not been well characterized.
Using a variety of laboratory measures of impulsivity, we assessed whether alcohol-dependent patients (ADP) were more impulsive than control subjects, and the role of Cluster-B personality disorders in impulsivity measurements.
Design and measurements:
A cross-sectional patient survey with a community comparison group. Diagnoses were made using the Structured Interview for DSM-IV. Sustained attention and rapid-response impulsivity were assessed using the continuous performance test (CPT). Inhibitory control was measured by the stop-signal task (SST). Ability to delay reward task was assessed using differential reinforcement for low-rate responding (DRLR).
Participants and setting:
A final sample of 253 males with alcohol-dependence recruited from two alcoholism treatment centres was compared with a matched non-substance-abusing comparison group (n=96).
Patients with alcohol dependence were more impulsive across all behavioural tasks. Alcohol-dependent subjects without personality disorders showed lower efficiency in DRLR than control subjects. Patients with Cluster-B personality disorder performed worse in inhibitory control, but subjects with borderline personality disorder in particular demonstrated increased rates of omission and commission errors in CPT. Inability to delay gratification was associated with antisocial personality disorder.
Our findings support the suggestion of two paradigms in alcohol dependence. The first, based on inability to delay gratification, might be a vulnerability marker for alcohol dependence. The second was related to inhibitory control, and might be specific for antisocial and borderline personality disorders.
Different personality factors have been investigated in connection with addictive disorders such as pathological gambling. “Impulse control”, proposed as a dimension of personality in modern “Big Five” models, has been associated with pathological gambling. Pathological gamblers have a high prevalence of childhood attention-deficit/hyperactivity disorder (ADHD), which is also associated with high impulsivity. Based on a five-factor personality model, our objective was to compare different personality dimensions in a group of pathological gamblers with childhood ADHD history, a group of pathological gamblers without such history and a control group. Special emphasis was placed on the factor “emotional stability”, which includes the subdimensions “emotion control” and “impulse control”.
A sample of 30 pathological gamblers with childhood ADHD history (ADHD+PG group), 33 pathological gamblers without ADHD history (ADHD-PG group) and 42 control subjects were assessed using the Big Five Questionnaire (BFQ). The different BFQ dimensions and subdimensions were compared.
For the “emotional stability” factor, the T-scores obtained indicated statistically significant differences between groups (ADHD+PG group: 44.1; ADHD-PG group: 51.9; control group: 57.9; ANOVA, p<0.001). Scheffe´s post hoc analysis showed the ADHD+PG group to be less emotionally stable than both the ADHD-PG (p=0.002) and the control groups (p<0.001); the ADHD-PG group also scored lower on this “emotional stability” factor than the control group (p=0.015).
Pathological gamblers with a history of childhood ADHD exhibit differential personality traits. ADHD history is associated with a lower score on the “emotional stability” factor, which includes the subdimensions “emotion control” and “impulse control”.
CYP2D6 metabolizes risperidone into 9-hydroxi-risperidone, as well as other drugs. CYP2D6 shows genetic polymorphism, and 6-8% of Caucasians are “slow metabolizers”. “Fast metabolizers” show lower plasma levels of risperidone and higher levels of 9-hydroxi-risperidone than “slow metabolizers”. The aim of this study is to collect information about the hypothetical relationship between metabolism phenotype and parameters related to sanitary resources utilization in patients treated with risperidone.
Plasma levels of risperidone and 9-hydroxi-risperidone were determined in 52 patients treated at the Acute Unit setting, to establish their metabolism phenotype. Patients were grouped as fast (n=11), slow (n=13) or intermediate metabolizers (n=28), according to risperidone/9-hydroxi-risperidone ratio logarithm and using eighty and twenty percentiles as cut-points. Hospitalizations, emergency services utilization and visits to community mental health center during two years were recorded in the three groups.
Fast metabolizers showed a higher mean number of visits to community mental health centers (35.7 vs 24.8, fast and slow metabolizers respectively, p=0.667), a higher mean number of hospitalizations (2.45 vs 1.3, fast and slow metabolizers respectively; p=0.091), a longer mean length of hospitalizations (57.3 vs 47.6 days, fast and slow metabolizers respectively; p=0.581) and a higher number of visits to emergency services (2.45 vs 1, fast and slow metabolizers respectively; p=0.01), although differences only reached statistical significance in this last parameter.
In spite of methodological limitations (mainly the small sample size), the present study shows some preliminary evidence about the influence of pharmacogenetic factors on the evolution of psychotic patients treated with risperidone.
Fibromyalgia and ADHD share some clinical features, and a reduced dopamine function has been proposed for both disorders. Here we found, in a large sample of fibromyalgia female patients, a higher frequency of childhood ADHD antecedent when compared with healthy women. Our data suggest that Fibromyalgia and ADHD have some common etiopathological mechanism.
The enzyme catechol-O-methyl transferase (COMT) is significantly involved in dopamine's catabolism, especially in the prefrontal cortex. The association between several schizophrenic phenotype traits and the presence of prefrontal hypodopaminergia is well known. The purpose of this study was to determine if variations in the gene that encodes this enzyme constitute a risk factor for the development of schizophrenia in our Spanish patient sample.
the study included a total of 199 Spanish male DSM-IV-TR schizophrenic patients and a sample of 186 male healthy controls. Genotyping was performed using Single Strand Conformation Polymorphism (SSCP) of amplified fragments by DNA polymerase chain reaction (PCR). Statistical analysis was done using SPSS (V. 11.0), PHASE (V. 2.0) software and Genetic Data Analysis (GDA).
our results indicate that the homozygous genotypes for Val108/158Met polymorphism are more prevalent in schizophrenic patients than in control population (62% vs. 50%; p: 0.04); regarding the C610G polymorphism, no differences were observed in this sample.
our findings warrant the study of COMT gene in independent samples in order to establish the possible correlation of variants of this gene and the development of schizophrenia in Spanish male population.
Alcohol and cocaine are frequently used together. Little is known about which factors are related with the development of either cocaine or alcohol dependence in dually users.
To determine variables associated with the risk fro the development of either cocaine or alcohol dependence in non-dependent drinkers with recreational cocaine use during a 4 year-follow-up period.
A prospective cohort study was performed to establish the risk factors associated with alcohol and cocaine dependence. Subjects recruited (N=336), from primary care centres. At baseline were classified as heavy drinkers and cocaine users (HD+Co, N=227) and alcohol abusers with cocaine use (AA+Co, N= 109).
At 4-year follow-up assessment, AA+Co subjects had higher rates of prevalence for cocaine (55% vs. 32%, p<0.001)) and alcohol dependence (97.5% vs. 58.2%, p<0.001) than HD+Co participants. Being alcohol abuser and single were eight and three times, respectively, more likely to develop cocaine dependence. When impulse control disorders or alcohol abuse occurred the odds ratio of developing alcohol dependence was 9 and 5.7 respectively. Also, alcohol abuse at baseline was associated with shortened time between onset of abuse and dependence for cocaine use disorders and for alcohol use disorders.
Alcohol abuse in heavy drinkers with recreational cocaine use predicted alcohol and cocaine dependence at follow-up. Our findings agree with previous findings supporting the relationship between impulsivity and risk for substance use disorders.
It is hypothesized that in the etiology of schizophrenia genetic and environmental factors are involved. Between the environmental events linked to the causation of this condition an inmune dysfunction has been described. First degree biological relatives of people with schizophrenia also have an incrased incidence of autoimmune diseases.
The aim of this work was to examine the serum levels of proinflammatory cytokines (IL-1β, sIL-2R IL-6, IL-12p70, TNF-α and IFN-γ) as well as of anti-inflammatory cytokines (IL-4 and IL-10) in male patients with schizophrenia and in their first degree-biological relatives.
Blood samples were obtained from patients with a diagnosis of schizophrenia in a stable psychophatological condition (n = 36), first degree biological relatives of those patients and a healthy control group (n = 26). Serum interleukins were analyzed using a commercial ELISA preparation (Bender MedSystems). We used non-parametric test for statistical analysis.
Patients with schizophrenia showed significantly higher serum levels of proinflammatory cytokines (sIL-2R, IL-6, TNF-α, IFN-γ and IL12-p70) and lower serum levels of the anti-inflammatory cytokine IL-4 than in the healthy control group. The unaffected first-degree relatives showed changes in proinflammatory cytokines (sIL-2R, IL-6 and TNF-α,) in the same way as the corresponding schizophrenia patients, but at a lower level than the healthy control group.
Ours findings suggest that sIL-2R, IL-6 and TNF-a may be biologic vulnerability markers for psychiatric disorders and also these alterations might have an hereditably pattern.
Several studies have stated the possitive effects of physical exercise over mental health, mainly in clinical samples. However, the results of these experimental estudies might not be generalized to general population. Some authors propose that physical activity could be not really promoting a psychological benefit but, instead, be a consequence of some personal or circumstantial features that would be acting as confusion factors. Personality, as it involves a steady pattern of behaviors, is theorized to arise as one of these factors.
Our objective was to assess the relationship between personality features and voluntary physical activity in a medical resident sample from Hospital 12 de Octubre (Madrid).
High levels of voluntary physical activity will be associated to high scores on extraversion and conscientiousness dimensions after assessing personality.
The project has been conducted as a transversal descriptive study. Sample: 80 first-year medical residents, ages 23 to 40, and no story of mental disorder, nor chronic disabilities. Main variables: voluntary physical activity measured through International Physical Activity Questionary (IPAQ) and personality features assessed through Revised NEO Personality Inventory (NEO PI-R) as proposed from the 5 factors model (neuroticism, extraversion, openess, agreeableness and conscientiouness).
Frequency measures have been used to describe qualitative variables. Arithmetic mean and standard deviation were used to describe quantitative variables. Pearson's correlation was used in order to study the relationship between scores on physical activity and personality factors.
We present preliminary results from first stage of the study, as well implications are discused.