PSYSCAN – July 2017

Clinical utility of magnetic resonance imaging in first-episode psychosis.

Falkenberg I, Benetti S, Raffin M, Wuyts P, Pettersson-Yeo W, Dazzan P, Morgan KD, Murray RM, Reis Marques T, David AS, Jarosz J, Simmons A, Williams S, McGuire P.

The aims of this study were to assess the logistical feasibility of routine MRI and to define the clinical significance of radiological abnormalities in patients with FEP. Radiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR) = 3.1, 95% CI 1.26-7.57, χ2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management. This study suggests that rates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities.

Br J Psychiatry. 2017 May 4. pii: bjp.bp.116.195834     DOI: 10.1192/bjp.bp.116.195834.

Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis.

Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, McGuire P.

91199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder were included in this clinical register-based cohort study. A practical web-based individualized risk calculator tool was developed using a prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex and race/ethnicity. The risk calculator was externally validated, showing good performance and potential clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. This tool may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.

JAMA Psychiatry. 2017 May 1;74(5):493-500.     DOI: 10.1001/jamapsychiatry.2017.0284

Improved individualized prediction of schizophrenia in subjects at familial high risk, based on neuroanatomical data, schizotypal and neurocognitive features.

Zarogianni E, Storkey AJ, Johnstone EC, Owens DG, Lawrie SM.

The authors examined the predictive accuracy of support vector machine (SVM) in later diagnosing schizophrenia (SCZ), at a single-subject level, using a cohort of high risk (RH) individuals. Baseline structural MRI, schizotypal and neurocognitive data from 17 HR subjects, who subsequently developed SCZ and a matched group of 17 HR subjects who did not make the transition, yet had psychotic symptoms, were included in the analysis. Classification accuracy was 94% when a self-completed measure of schizotypy, a declarative memory test and structural MRI data were combined into a single learning algorithm; higher than when either quantitative measure was used alone. The discriminative neuroanatomical pattern involved gray matter volume differences in frontal, orbito-frontal and occipital lobe regions bilaterally as well as parts of the superior, medial temporal lobe and cerebellar regions. The findings suggest that an early SVM-based prediction of SCZ is possible and can be improved by combining schizotypal and neurocognitive features with neuroanatomical variables.

Schizophr Res. 2017 Mar;181:6-12.     DOI: 10.1016/j.schres.2016.08.027.

Diagnostic and prognostic significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in individuals at Ultra High Risk.

Fusar-Poli P, Cappucciati M, De Micheli A, Rutiglano G, Bonoldi I, Tognin S, Ramella-Cravaro V, Castagnini A, McGuire P.

This study was designed to address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors. Eighty individuals who met BLIPS criteria were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74). The findings of this study indicate that BLIPS are most likely to fulfill the ATPD criteria (mainly acute schizophrenic subtypes) and about half of BLIPS cases develop a psychotic disorder during follow-up. Besides, recurrent BLIPS are relatively rare but tend to develop into psychosis and BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.

Schizophr Bull. 2017 Jan;43(1):48-56     DOI: 10-1093/schbul/sbw151.

Sexual dysfunction and central obesity in patients with first episode psychosis.

Theleritis C, Bonaccorso S, Habib N, Stahl D, Gaughran F, Vitoratou S, Atakan Z, Kolliakou A, Gardner SP, Dazzan P, Marques TR, McGuire P, Greenwood K, Breedvelt J, Ferracuti S, Di Forti M, Murray RM, Smith S.

The aim of this study was to investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis. Sexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist-hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients. A total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β=0.36, P=0.01), higher leptin levels (Std. β=0.34, P=0.02), higher waist-hip ratio (Std. β=0.32, P=0.04) and lower testosterone levels (Std. β=-0.44, P=0.002). In contrast, in females, SFQ scores were not associated with any of these factors. While sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist-hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.

Eur Pychiatry. 2017 May;42:1-7.     DOI: 10.1016/j.eurpsy.2016.11.008.