R. Segarra

Longitudinal changes of insight in first episode psychosis and its relation to clinical symptoms, treatment adherence and global functioning: one-year follow-up from the Eiffel study.

OBJECTIVES The Eiffel study is a longitudinal, naturalistic study of patients with first episode psychosis (FEP) designed to evaluate the predictive value of defective insight on treatment adherence and global functioning. METHODS Five hundred seventy-seven patients with FEP were assessed at baseline and at a 1-year follow-up. They were compared in terms of sociodemographic factors, psychopathology, insight, treatment adherence and functional outcome. Longitudinal functionality was prospectively assessed with the clinical global impression (CGI) and global assessment of functioning (GAF) rating scales. RESULTS At baseline, up to 50% of our sample presented with a lack of insight. Most clinical symptoms, including insight, improved over the follow-up period. Insight, education and social withdrawal significantly predicted CGI and GAF at follow-up. Insight and level of education were predictive of treatment adherence. CONCLUSIONS Insight significantly predicted the general clinical course, treatment adherence and functional outcome in our FEP sample after 1 year. Only education additionally accounted for the longitudinal course. Since our results suggest that better insight improves treatment adherence and consequently clinical course and functional outcome, insight could be a specific target of treatment in early intervention programs.

Do the same factors predict outcome in schizophrenia and non-schizophrenia syndromes after first-episode psychosis? A two-year follow-up study

OBJECTIVE The aim of this two-year longitudinal study was to identify the best baseline predictors of functional outcome in first-episode psychosis (FEP). We tested whether the same factors predict functional outcomes in two different subsamples of FEP patients: schizophrenia and non-schizophrenia syndrome groups. METHODS Ninety-five patients with FEP underwent a full clinical evaluation (i.e., PANSS, Mania, Depression and Insight). Functional outcome measurements included the WHO Disability Assessment Schedule (DAS-WHO), Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI). Estimation of cognition was obtained by a neuropsychological battery which included attention, processing speed, language, memory and executive functioning. RESULTS Greater severity of visuospatial functioning at baseline predicted poorer functional outcome as measured by the three functional scales (GAF, CGI and DAS-WHO) in the pooled FEP sample (explaining ut to the 12%, 9% and 10% of the variance, respectively). Negative symptoms also effectively contributed to predict GAF scores (8%). However, we obtained different predictive values after differentiating sample diagnoses. Processing speed significantly predicted most functional outcome measures in patients with schizophrenia, whereas visuospatial functioning was the only significant predictor of functional outcomes in the non-schizophrenia subgroup. CONCLUSIONS Our results suggest that processing speed, visuospatial functioning and negative symptoms significantly (but differentially) predict outcomes in patients with FEP, depending on their clinical progression. For patients without a schizophrenia diagnosis, visuospatial functioning was the best predictor of functional outcome. The performance on processing speed seemed to be a key factor in more severe syndromes. However, only a small proportion of the variance could be explained by the model, so there must be many other factors that have to be considered.

Executive functioning correctly classified diagnoses in patients with first-episode psychosis: evidence from a 2-year longitudinal study.

Few studies have analysed factors that predict the ultimate clinical diagnosis in first-episode psychosis (FEP), and none has included cognitive factors. Eighty-six FEP patients and 34 healthy controls were recruited and followed up for two years. Positive and negative symptoms, depression, mania, duration of untreated psychosis (DUP), premorbid functioning, functional outcome and neurocognition were assessed over 2 years. Logistic regression models revealed that Wisconsin Card Sorting Test correctly distinguished the patients ultimately diagnosed with schizophrenia (87%) from those with bipolar disorder (80%) and those with other psychoses (85%), for an overall correct-diagnosis rate of 84.4%. The prediction was stable despite the inclusion of clinical and affective symptoms, DUP, clinical impression, and functional outcome scores. Results highlight the importance of reconsidering neurocognition as a diagnostic criterion for psychosis and schizophrenia.

The course of negative symptoms in first-episode schizophrenia and its predictors: A prospective two-year follow-up study

AIMS This study aimed to investigate the course of negative symptoms and its stability over a two-year period following a first-episode schizophrenia (FES) and the possible predictors of higher severity in this symptomatology after this period. METHODS In this longitudinal two-year prospective follow-up study we included 268 patients with a FES, according to DSM-IV. Analysis of variance was conducted in patients who completed the full follow-up to study changes in negative symptoms over three visits. Regression analyses were conducted to show correlates and potential predictors of negative symptoms at two-year follow-up. RESULTS There was a significant effect for time in negative symptomatology, which was less severe at one-year follow-up after a FES and remained stable up to two years (Time 1>Time 2>Time 3); F(2,151)=20.45, p<0.001. Poorer premorbid adjustment (p=0.01) and higher negative symptoms at baseline (p<0.001) made a significant contribution to the changes in the negative symptoms severity at two-years after a FES (R2=0.21, p<0.001). CONCLUSIONS We found a reduction in the negative symptomatology at one-year after a FES. This change remained stable at two-year. Our results suggested that the presence of this symptomatology early in the course of the illness, together with a poorer premorbid adjustment, predict more severe negative symptoms at mid-term outcome.

RISPERIDONE INJECTABLE LONG-ACTING TREATMENT VS OTHER ORAL ANTIPSYCHOTICS IN FIRST EPISODE PSYCHOSIS: ONE YEAR LONGITUDINAL STUDY

Background: Treatment compliance is a crucial pronostic factor regarding the longitudinal course of patients with First Episode Psychosis (FEP). The rate of oral antipsychotic treatment disconti- nuation at first year is about 70% (1). Risperidone injectable long- acting treatment (RILD) has shown high rates of clinical remission, as well as improvement in treatment compliance. As far as we know, there is no RCT that compared RILD vs oral atipic antipsychotics in FEP. Methods: Eighty-seven FEP patients were randomly located on two groups: patients receiving RILD (N= 18) and patients receiving oral antipsychotic treatment (N= 21). Both underwent a baseline assessment and one year follow-up, including: medical interview, PAS Scale, neuropsychological battery, diagnostic assessment (SCID-I) and stability at one year follow-up, clinical assessment (PANSS; CGI; SUMD; HDRS and YMRS), functional assessment(GAF), quality of life (WHO/DAS), hospitalizations, urgency episodes and treatment com- pliance (subjective for oral antipsychotics). Results: Both groups significantly reduced positive and general psychopathology scales from PANNS at one year follow-up. There were no differences regarding the course of cognitive symptoms. The group receiving RILD significantly improved in functional disability, quality of life and negative symptoms, and showed a trend toward significance in insight and compliance. Two patients receiving oral antipsychotics were rehospitalized, while the rate of rehospitalization for RILD groups was 0. Discussion: RILD an reasonable and treatment alternative for FEP. It treatment compliance, which turns to improvements in insight, negative symptomatology, functional capacity and quality of life.

Smoking does not impact social and non-social cognition in patients with first episode psychosis

BACKGROUND Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group. METHODS A sample of 335 patients with FEP and 253 healthy controls was divided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed. RESULTS Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F=13.45; p≤0.001) and working memory domains (F=4.30; p=0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F=19.60; p≤0.001). No significant differences were revealed in the comparison between the patient groups. CONCLUSIONS This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance.

Antipsicóticos inyectables de liberación prolongada para el tratamiento de la esquizofrenia en España

Antipsychotics are an essential component in the treatment of schizophrenia. Long-acting injectable formulations (LAI) arose to improve adherence with the associated potential of reducing the risk of relapse. The objective of this article is to analyze the use of LAI antipsychotics in Spain, which is similar to other European countries but with a predominance of the use of second generation LAI, to discuss the possible causes of prescribing differences with respect to other countries (including organizational aspects, attitudes of psychiatrists, patients and family members, and clinical practice guidelines), and to discuss their use in acute psychiatric units, first episode, and in children and adolescents. In our view, while it is necessary to increase existing evidence regarding the advantages of LAI antipsychotics and the differentiation between LAI antipsychotics currently available, their use will likely continue to grow driven by clinical experience.

P03-221 - Functional Outcome in First-Episode-Schizophrenia Receiving Assured Antipsychotic Medication: 52-week Prospective Study with Risperidone Long-Acting Injection

Introduction It is well stablished that therapeutic compliance is a fundamental predictive factor in the outcome of first-episode psychosis. Risperidone long-acting injection has demonstrated high remission rates and improvements in treatment adherence. Objective 1- To analyse the efficacy of risperidone long-acting injection vs oral atypical antipsychotics in first-episode psychosis. 2- To describe in both groups the evolution of clinical and cognitive symptoms, functional outcome, quality of life, insight and treatment adherence. Method 18 patients with a first-episode psychosis treated with long-acting risperidone were compared with 21 first-episode psychosis treated with oral atypical antipsychotic medication. They were matched one on one for age, gender and years of education. All subjects were compared regarding psychopathology and functional outcome terms. Patients were examined with Positive and Negative Syndrome Scale (PANSS) for clinical symptoms. Longitudinal functionality was prospectively assessed with the Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) rating scales. Results We found significant differences between both groups in negative symptom severity and global assessment of functioning. There was no statistically significant difference between the two groups in PANSS positive and general components. Negative symptom severity was associated with poorer GAF ratings. Conclusions Our data suggest that risperidone long-acting injection assures treatment compliance and therefore could improve clinical and functional outcome.

P03-122 - Cognitive rehabilitation in executive functioning and processing speed in schizophrenia and first-episode psychosis

Objectives Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties. Material and methods Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference) Results Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning ( F = 9.88, p F = 5.92, p Conclusions Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.

P03-120 - Assessment of a new memory training instrument for patients with schizophrenia

Objective The goal of this study is to test the efficacy of the Memory Module of the REHACOP (Cognitive Training Program for Psychosis, Ojeda, Pena, 2006), in the improvement of cognition in patients with chronic schizophrenia (CS). Chronic patients present a moderate to severe cognitive performance on verbal memory and the severity of the illness and variables associated to the course of the diagnosis prevent them from improving cognition with traditional treatments. Methods 57 patients with CS (illness duration, 10.17±7.22) were allocated randomly into either REHACOP (N=27) or control group (N=30). The REHACOP group received memory training with structured sessions 3 times per week for 8 weeks. Control group attended occupational therapy with the same frequency and timetables. Verbal Learning and Memory (Hopkins Verbal Learning Test; HVLT) and Working Memory (Digits Backwards from WAIS-III) were assessed at baseline and after the intervention. Results Repeated measures of MANOVA showed that the interaction term groupXtime was significant for all the memory measures, suggesting REHACOP group improved significantly when compared to controls. Specifically, the interaction term F value was significant for HVLT learning ( F =6.78, p F =7.02, p F =10.04, p F =11.39, p Conclusions Patients with CS improved significantly in all memory impairments when compared to those receiving other treatment. This study supports the efficacy of the REHACOP in the intervention of memory impairments in patients with schizophrenia, in spite of the severity.