Neighborhood Vulnerability and Disability in First Episode of Psychosis: A Multilevel Study.

Objective: Neighborhood socioeconomic status seems to be related to functioning in patients with first episode of psychosis (FEP). The present study aimed to assess if neighborhood vulnerability and risk of social exclusion could predict functional outcomes in people with FEP after controlling for other key variables identified in previous literature.Methods: A total of 137 patients with FEP (DSM-IV-TR criteria) and 90 controls comprised the study sample from February 2013 to May 2019. Functioning was assessed with the WHO Disability Assessment Schedule. Neighborhood vulnerability was measured using a multidimensional socioeconomic deprivation index; data for the index were collected by the Madrid City Council and based on the participant's home address. Multilevel mixed-effects regression analyses were conducted to estimate the effects of neighborhood vulnerability on functioning.Results: Our results show that FEP patients could be more vulnerable to the effects of neighborhood-level characteristics than healthy controls (B = 1,570.173; z = 3.91; P < .001). In addition, our findings suggest that higher neighborhood vulnerability is related to greater functional disability in people with FEP, after controlling for other relevant confounders (B = 1,230.332; z = 2.59; P = .010).Conclusions: These results highlight the importance of incorporating contextual factors into assessment of patients with FEP, since psychosocial difficulties observed in these patients could be partially related to the quality of neighborhood social-related resources.

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition.

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the "Understanding Emotions" and "Managing Emotions" MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the "Managing Emotions" branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the "Managing Emotions" branch of the MSCEIT as part of the MCCB.

Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia.

Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS' score and FAST score. CAINS-MAP was more predictive of FAST scores (ß = 0.44, p = 0.001) than CAINS-EXP (ß = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (ß = -0.63, p < 0.001) than for CAINS-EXP (ß = -0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life.

Cannabis-induced psychosis: clinical characteristics and its differentiation from schizophrenia with and without cannabis use. / Psicosis inducida por cannabis: características clínicas y su diferenciación con la esquizofrenia con y sin consumo de cannabis asociado.

Cannabis use is considered an established risk factor for psychosis development. Differentiating between cannabis-induced disorders and schizophrenia is useful for prognostic and therapeutic purposes. Three inpatients groups were differentiated: cannabis-induced psychosis (CIP) (n = 69; mean age = 27.4, SD = 6.5; 82.6% males), schizophrenia with cannabis abuse or dependence (SZ + CB) (n = 57; mean age = 31.9, SD = 10.1; 94.7% males) and schizophrenia without cannabis abuse or dependence (SZ) (n = 181; mean age = 41.8, SD = 13.3; 54.1% males). The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) scale was used to differentiate induced psychosis. The CIP group presented lower mean scores on the negative PANSS subscale (M = 12.9, SD = 5.9; F = 32.24, p < 0.001), fewer auditory hallucinations (60.3%; X² = 6.60, p = 0.037) and greater presence of mania (26.1% vs. 12.3%; X² = 32.58, p < 0.001) than the SZ + CB group. There were few clinical differences between patients with schizophrenia, regardless of previous cannabis use. The age of first admission due to psychosis was lower in both psychotic inpatients groups with cannabis use (M = 26.1, SD = 6.4 in CIP and M = 25.3, SD = 6.2 in SZ + CB; X² = 20.02, p < 0,001). A clinical pattern characteristic of cannabis-induced psychosis was not observed, but the precipitating role of cannabis in the appearance of psychotic symptoms was demonstrated, given the lower age of first admission due to psychosis in cannabis user groups.

El consumo de cannabis se considera un factor de riesgo establecido para el desarrollo de psicosis. Diferenciar los trastornos inducidos por cannabis de la esquizofrenia resulta útil desde el punto de vista pronóstico y terapéutico. Se diferenciaron tres grupos de pacientes hospitalizados: psicosis inducida por cannabis (PIC) (n = 69; Media de edad = 27,4, DE = 6,5; 82,6 % varones), esquizofrenia con abuso o dependencia de cannabis (EZ + CB) (n = 57; Media de edad = 31,9, DE = 10,1; 94,7% varones) y esquizofrenia sin abuso o dependencia de cannabis (EZ) (n = 181; Media de edad = 41,8, DE = 13,3; 54,1% varones). Se utilizó la escala Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV) para la diferenciación de cuadros inducidos. El grupo PIC presentó puntaciones inferiores en la subescala PANSS negativa (M = 12,9, DE = 5,9; F = 32,24; p < 0,001), menos alucinaciones auditivas (60,3%; X²  = 6,60; p = 0,037) y mayor presencia de manía (26,1% vs. 12,3%; X² = 32,58; p < 0,001) en comparación con el grupo EZ + CB. Hubo pocas diferencias clínicas entre los pacientes con esquizofrenia, independientemente del consumo de cannabis. La edad del primer ingreso por psicosis fue menor en ambos grupos de psicóticos consumidores (M = 26,1, DE = 6,4 en PIC y M = 25,3, DE = 6,2 en EZ + CB; X² = 20,02; p < 0,001). No se observó un patrón clínico característico de las psicosis inducidas por cannabis, aunque sí se demostró el papel precipitante del cannabis en la aparición de psicosis, dada la menor edad de ingreso en los consumidores.

Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology. / Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual.

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. La muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorno bipolar tenía mayor prevalencia de adicción al alcohol y a la cocaína que el resto de los pacientes. Además, la edad de inicio en el consumo de alcohol era más precoz entre los adictos bipolares que entre los adictos no bipolares. Los bipolares duales era un subgrupo con mayor comorbilidad con trastornos de personalidad, otros trastornos mentales como trastornos de ansiedad y mayor riesgo de suicidio. Estos datos apoyan que el alcohol principalmente y la cocaína son las drogas más relacionadas con la presencia de un trastorno bipolar, pero al ser un estudio transversal no se pueden extraer conclusiones etiológicas.

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual / Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology

La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. La muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorno bipolar tenía mayor prevalencia de adicción al alcohol y a la cocaína que el resto de los pacientes. Además, la edad de inicio en el consumo de alcohol era más precoz entre los adictos bipolares que entre los adictos no bipolares. Los bipolares duales era un subgrupo con mayor comorbilidad con trastornos de personalidad, otros trastornos mentales como trastornos de ansiedad y mayor riesgo de suicidio. Estos datos apoyan que el alcohol principalmente y la cocaína son las drogas más relacionadas con la presencia de un trastorno bipolar, pero al ser un estudio transversal no se pueden extraer conclusiones etiológicas

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar dually-diagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined