José Salavert

Predictors of schizophrenia in patients with a first episode of psychosis

Early identification of schizophrenia in patients with a first episode of psychosis (FEP) may help to avoid inappropriate treatment and may enhance long-term outcome by addressing issues such as family network, treatment adherence and functional and symptomatic outcome. It was the aim of the study to determine baseline variables that significantly predicted a diagnosis of schizophrenia in patients with FEP. The sample consisted of 133 FEP patients hospitalized for at least 6 weeks, in whom a DSM-IV diagnosis was confirmed after 1 year follow-up. Patients were divided into two groups, those with a diagnosis of schizophrenia (Schizophrenia group, n=63; 47.8%), and those with other psychosis, who were grouped under Non-Schizophrenic Psychosis (NSP, n=70; 52.2%). Sociodemographic (marital status, educational level) and clinical variables were recorded for each patient. Substance use (alcohol, cannabis and cocaine) did not statistically differ between the two groups. Absence of characteristics defined as criteria for good prognosis, lack of > or = 20% improvement in the total Positive and Negative Syndrome Scale score at 6 weeks, and a poor premorbid adjustment as determined by the Premorbid Adjustment Scale score significantly predicted the presence of schizophrenia. The regression model including these three variables achieved a predictive value of 76.3%, with a sensitivity of 74.6% and a specificity of 77.9%.

Functional Imaging Changes in the Medial Prefrontal Cortex in Adult ADHD.

Objective: Functional imaging studies have found reduced frontal activity, mainly in dorso/ventro-lateral regions and reduced task-related de-activation of the default mode network in childhood ADHD. Adult studies are fewer and inconclusive. We aimed to investigate the potential neural bases of executive function in ADHD adults, examining brain activity during N-back task performance, and to explore the potential corrective effects of long-term methylphenidate treatment. Method: We recruited a large adult ADHD-combined sample and a matched control group and obtained functional magnetic resonance imaging (fMRI) images during task. ADHD participants were subdivided in a group under long-term treatment with methylphenidate (washed out for the scan) and a treatment-naive group. Results: ADHD participants showed deficient de-activation of the medial prefrontal cortex during 2-back task, implying default mode network dysfunction. We found no relationship between blunted de-activation and treatment history. Conclusion: As de-activation failure in the medial frontal cortex is linked to lapses of attention, findings suggest a potential link to ADHD symptomatology.

Brain abnormalities in adults with Attention Deficit Hyperactivity Disorder revealed by voxel-based morphometry.

UNLABELLED Attention Deficit Hyperactivity Disorder (ADHD) commonly affects children, although the symptoms persist into adulthood in approximately 50% of cases. Structural imaging studies in children have documented both cortical and subcortical changes in the brain. However, there have been only a few studies in adults and the results are inconclusive. METHOD Voxel-based morphometry (VBM) was applied to 44 adults with ADHD, Combined subtype, aged 18-54 years and 44 healthy controls matched for age, sex and IQ. RESULTS ADHD patients showed reduced gray matter (GM) volume in the right supplementary motor area (SMA). Using more lenient thresholds we also observed reductions in the subgenual anterior cingulate (ACC) and right dorsolateral prefrontal (DLPFC) cortices and increases in the basal ganglia, specifically in the left caudate nucleus and putamen. There was a positive correlation between the cumulative stimulant dose and volume in the right SMA and DLPFC clusters. CONCLUSIONS The findings suggest that adults with ADHD show brain structural changes in regions belonging to the so-called cool executive function network. Long-term stimulant medication may act to normalize these GM alterations.

Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis

Objective:  The study aimed to establish clinical predictors of non‐affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile.

Association Between Vitamin D Status and Schizophrenia: A First Psychotic Episode Study

Abstract Vitamin D deficiency has been linked with schizophrenia. We aimed to determine whether patients with a first episode of psychosis (FEP) had lower vitamin D levels compared with controls considering their final diagnosis. We conducted a cross-sectional study determining 25-hydroxyvitamin D blood levels. 25-Hydroxyvitamin D levels were considered optimum at 20 ng/mL or greater. A group of 45 adult patients with FEP and a group of 22 healthy controls matched for age were recruited. The patient group was subdivided in two final diagnosis groups (schizophrenia versus other psychoses) after a 6-month follow-up. Average vitamin D values were deficient for FEP patients, especially those 22 with a final diagnosis of schizophrenia. These results relating vitamin D and schizophrenia generate interest to further examine this association.

AB0890 Is There a Relationship Between Vitamin D and Schizophrenia

Background Studies suggest a neuroprotective role for vitamin D. Its deficit has been linked with various psychiatric disorders such as schizophrenia (1). Increase in the prevalence of schizophrenia has been associated with high latitudes, winter/spring births, migration, urbanicity and cold climates (2,3). Vitamin D deficiency could be an important environmental risk factor, linking all of the previously exposed. Objectives We aimed to determine whether patients with a first psychotic episode had low levels of vitamin D compared to controls, considering their final diagnoses (schizophrenia vs other psychoses). Methods Cross-sectional study in an acute inpatient psychiatric unit. Vitamin D (25-hydroxyvitamin D) was determined by direct competitive chemiluminescence immunoassay. Vitamin D levels (ng/ml) were considered optimum >30, insufficient 20–30 and deficient <20 (4). Final diagnosis was obtained from the outpatient mental health service after a 6 month follow-up. Results We analyzed 27 patients with first-episode psychosis (13 with final diagnosis of schizophrenia and 14 of other psychoses) and 17 healthy controls, with no differences in mean age between the three groups (χ2 (2)=5.20, p>0.05). Schizophrenic patients showed deficient average values (ng/ml) of vitamin D (mean 12.87, range 6-24.9). Vitamin D levels in the other psychoses patient group were higher but also deficient (mean 15.74, range 6-34.6). Controls presented higher levels of vitamin D, but still insufficient (mean 21.45, range 11.20-33.5). Vitamin D levels in the schizophrenia group were significantly lower compared to controls (CI 1.8 – 15.4; p<0.009). No other significant differences were found between groups. Conclusions We observed deficient vitamin D levels in all the patients studied, being significantly lower for schizophrenic patients. Future studies are required to further examine this association in schizophrenia because vitamin D deficiency may be an easily modifiable risk factor by means of a cheap and save public health intervention. References Belvederi Murri, M., Respino, M., et al. 2013 Vitamin D and psychosis: mini meta-analysis. Schizophr Res 150, 235-239. McGrath, J. J., Eyles, D.W., et al. 2010 Neonatal vitamin D status and risk of schizophrenia: a populationbased case-control study. Arch Gen Psychiatry 67, 889-94. McGrath, J. J., Burne, T.H., et al. 2010 Developmental vitamin D deficiency and risk of schizophrenia: a 10-year update. Schizophr Bull 36, 1073-8. Holick, M.F. 2007 Vitamin D deficiency. N Engl J Med 357, 266-81. Disclosure of Interest None declared