Teresa Sánchez-Gutiérrez

Psychiatric disorders in child and adolescent offspring of patients with schizophrenia and bipolar disorder: A controlled study

BACKGROUND Early clinical manifestations predating schizophrenia (SZ) and bipolar disorder (BP) have not been fully characterized. Child offspring studies are a valuable opportunity to study the natural history of the illness from its earliest stages. However, there is limited evidence assessing young offspring of SZ and BP simultaneously. We set out to assess rates of psychiatric disorders in child and adolescent offspring of SZ and BP, relative to offspring of community controls, so as to characterize the early phenotype of the disorders comparatively. METHODS SZ and BP parents with offspring aged 7-17years were recruited through adult mental health services of two tertiary hospitals. Community control (CC) parents were recruited from the same geographical area. Ninety BP-offspring, 41 SZ-offspring and 107 CC-offspring were assessed using the K-SADS-PL by child psychiatrists blinded to parental status. Differences in prevalence of psychiatric disorders between groups were adjusted for confounders and for sibling correlation using generalised estimating equations. RESULTS We found a gradient of clinical severity and social disadvantage between SZ, BP and CC-offspring. After adjusting for socio-demographic confounders, SZ and BP-offspring presented higher rates of attention deficit hyperactivity disorder (ADHD) than CC-offspring. ADHD was more prevalent in SZ-offspring than BP-offspring, and BP-offspring presented a higher prevalence of depression than CC-offspring. CONCLUSIONS The higher rates of ADHD in SZ-offspring suggest that abnormal neurodevelopmental processes may exert a stronger influence in SZ than BP. Follow-up of these children will help elucidate the role of ADHD and depression phenotypes in predicting future transition to SZ or BP.

Intervention for Adolescents With Early-Onset Psychosis and Their Families: A Randomized Controlled Trial

OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families. The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease, to mitigate crises, and to prevent relapses. METHOD We performed a 9-month, randomized, rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents. A psychoeducational problem-solving group intervention (n = 27) was compared with a nonstructured group intervention (n = 28). The primary outcomes were number of hospitalizations, days of hospitalization, and visits to the emergency department. The secondary outcome measures were clinical variables and family environment. RESULTS Assessments were performed before and after the intervention. At the end of the group intervention, 15% of patients in the psychoeducational group and 39% patients in the nonstructured group had visited the emergency department (χ² = 3.62, df = 1, p = .039). The improvement in negative symptoms was more pronounced in the psychoeducational group (12.84 [7.87]) than in the nonstructured group (15.81 [6.37]) (p = .039). CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family, thus reducing the number of visits to the emergency department. Negative symptoms improved in adolescents in the psychoeducational group. Clinical trial registration information--Intervention Module AGES (AGES-CM); http://clinicaltrials.gov/; NCT02101372. [corrected].

Neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder

BACKGROUND Bipolar disorder (BD) is a severe mental disorder with a strong genetic component. The assessment of child and adolescent offspring of patients diagnosed with BD (BDoff) provides an opportunity to investigate vulnerability factors and the first abnormalities associated with the disorder. Previous literature in child and adolescent BDoff is scarce and controversial. However, some studies concur in identifying significant impairment in executive functions, memory and attention. The present study aims to compare global neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder with a group of offspring of parentswith no history of psychotic disorder, and to assess the influence of psychopathology on neuropsychological performance. METHODS This research was part of The Bipolar and Schizophrenia Young Offspring Study (BASYS). A group of BDoff (N= 90) and a group of offspring of parents with no history of psychotic disorder (CC) (N = 107) were assessed with a complete neuropsychological battery. Intellectual quotient, working memory, processing speed, verbal memory and learning, visual memory, attention and executive functions were included in the cognitive assessment. RESULTS BDoff showed significantly worse performance in processing speed and immediate recall of visual memory relative to CC. When the presence of any lifetime psychopathology was analysed, the results showed that belonging to the BDoff group was the main explicative factor for the scores obtained in both processing speed and visual memory immediate recall, regardless of the presence of psychopathology. CONCLUSIONS These findings suggest that processing speed and visualmemory should be taken into consideration in future research on vulnerability markers of BD.

Neuropsychological characteristics of child and adolescent offspring of patients with schizophrenia or bipolar disorder

BACKGROUND Schizophrenia (SZ) and bipolar disorder (BD) are considered neurobiological disorders which share some clinical, cognitive and neuroimaging characteristics. Studying child and adolescent offspring of patients diagnosed with bipolar disorder (BDoff) or schizophrenia (SZoff) is regarded as a reliable method for investigating early alterations and vulnerability factors for these disorders. This study compares the neuropsychological characteristics of SZoff, BDoff and a community control offspring group (CC) with the aim of examining shared and differential cognitive characteristics among groups. METHODS 41 SZoff, 90 BDoff and 107 CC were recruited. They were all assessed with a complete neuropsychological battery which included intelligence quotient, working memory (WM), processing speed, verbal memory and learning, visual memory, executive functions and sustained attention. RESULTS SZoff and BDoff showed worse performance in some cognitive areas compared with CC. Some of these difficulties (visual memory) were common to both offspring groups, whereas others, such as verbal learning and WM in SZoff or PSI in BDoff, were group-specific. CONCLUSIONS The cognitive difficulties in visual memory shown by both the SZoff and BDoff groups might point to a common endophenotype in the two disorders. Difficulties in other cognitive functions would be specific depending on the family diagnosis.

PIENSA: Development of an Early Intervention Program for Adolescents With Early-Onset Psychosis and Their Families

Interest in the effectiveness of psychological interventions in patients with psychosis has increased in the last 2 decades, and early intervention programs are increasingly common. PIENSA (Programa de Intervencion en Psicosis Adolescente; Intervention Program for Adolescent Psychosis) is a clinical program and pilot study based on previous research into the efficacy of early intervention in preventing relapse and improving outcome in patients with first-episode psychosis. We describe a psychoeducational intervention designed for adolescents with early-onset psychosis and their parents. The intervention is adapted from McFarlanes Multiple Family Therapy model to our setting and population (adolescents treated in the Spanish public health system). It consists of 2 stages: an individual stage comprising 3 sessions and a subsequent group stage comprising 12 sessions. The total program lasts for 1 academic year (9 months). # These authors contributed equally to this article.

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.

F92. COMPARISONS BETWEEN CANNABIS USERS AND NON-USERS PATIENTS WITH FIRST-EPISODE PSYCHOSIS IN NEUROCOGNITIVE FUNCTIONING: A META-ANALYSIS

Abstract Background Patients with first episode psychosis (FEP) frequently report cannabis use although its effects on cognitive functioning are still unclear. Several studies suggest a decrease in the executive function, verbal memory and working memory of FEP cannabis users (González-Pinto et al., 2016; Mata et al. 2008) while other studies show improvements in the neurocognitive function of this group (Setién-Suero et al., 2017, Cuhna et al., 2013, Leeson et al., 2012, Yücel et al., 2012; Rodríguez-Sánchez et al., 2010) or even absence of neurocognitive differences between FEP cannabis users and non-users (Burgra et al., 2013). This meta-analysis aims to explore the magnitude of effect of cannabis use on neurocognition in patients with FEP. Methods Articles for consideration were identified through extensive literature searches using online databases, which included PubMed, Medline and PsychInfo. The search was limited to English language articles. The used keywords were: “first episode psychosis” OR, “neurocognition and cannabis”, in combination with a number of neuropsychology-related terms including “neurocog*” and “neuropsycholog*”. Given that other substances including alcohol, cocaine, and stimulants are associated with altered cognitive performance, studies in which participants met for poly-substance use disorders, even if there was preferential use towards cannabis, were excluded. Eight studies from 2008 to 2017 met inclusion criteria from a total sample of 16 initial studies. Five hundred and eighteen of these participants were cannabis users with FEP, and 639 were patients with no cannabis use. A total of 58 effect sizes of neuropsychological test variables were categorized into 4 cognitive domains (premorbid IQ, executive functioning, working memory and verbal memory and learning). Age of first cannabis use, duration of cannabis use, percentage of males and age were abstracted and assembled as moderator variables. Standardized mean differences were computed for each cognitive domain between cannabis-using patients and patients with no history of cannabis use. Negative effect sizes would display better cognitive functioning of non-cannabis users. We employed a meta-analytic three level model to combine effect sizes across studies. Results Effect sizes were not significantly different from zero in any of the neurocognitive domains when FEP cannabis users and non-users patients were compared [working memory (d= -0.03, SE=0.15, CI = -0.33–0.26, p=0.83), executive function (d= 0,14, SE=0.16, CI = -0.17–0.45, p=0.37), verbal memory and learning (d= 0.04, SE=0.15, CI = -0.25–0.33, p=0.27) and premorbid IQ (d= 0.06, SE=0.09, CI = -0.24–0.12, p=0.50)]. Only one moderator variable resulted significant in the executive function denoting superior performance in FEP cannabis-using patients as they were older. Discussion Cannabis use is not related to an ameliorated or improved neurocognitive functioning in patients with a first episode psychosis. This is consistent with previous studies which showed absence of differences in the neurocognitive functioning between FEP cannabis users and nonusers (Burgra et al., 2013). However, it has been demonstrated that continued cannabis intake worsens cognitive performance although some of the FEP patients had better premorbid capacities (González-Pinto, 2016). Moreover, the doses and the different types of cannabis preparations may interfere the present results. Meta-analysis on longitudinal studies which include these potential moderator variables may be performed in the future.

A Revision of Preventive Web-based Psychotherapies in Subjects at Risk of Mental Disorders

For the last years, the impulse of new technologies has overcome the traditional pathways of face-to-face clinical intervention and web-based psychological methodologies for intervention have started to gain success. This study aims to review the state-of-art about the effectiveness studies on preventive web- based interventions accomplished in samples of subjects at high risk for depressive, anxiety, eating behavior, problematic substance use symptoms and promotion of psychological well-being. Results showed that web-based psychological interventions for the prevention of mental disorders seemed to be effective for at risk individuals. Online health promotion in the general population was also effective to avoid the onset of clinical psychological circumstances. Future research should focus on personalized online intervention and on the evaluation of web-based engagement.

Progress of Health Psychology Regulation: A Comparison between Countries

The independent practice of clinical psychology has experimented recent changes. Spain has achieved to regulate the current professional situation of the different figures of clinical psychologists mainly in three arms: 1) by authorizing those psychologists who met the required legal criteria to continue with their clinical practice, 2) by creating the Master in General Health Psychology (MGHP) and 3) by maintaining the tasks and public scope for Psychologist Specialized in Clinical Psychology (PSCP) This manuscript aims to summarize the process for the regulation of clinical and health psychology in Spain and to compare it to other European and North American countries. Discussion about the quality, benefits and future ambitions of the MGHP programs have been made.

Diagnosis and clinical symptom description in offspring of patients with bipolar disorder

European Child and Adolescent Psychiatry is Europes only peer-reviewed journal entirely devoted to child and adolescent psychiatry. It aims to further a broad understanding of psychopathology in children and adolescents. Empirical research is its foundation, and clinical relevance is its hallmark. European Child and Adolescent Psychiatry welcomes in particular papers covering neuropsychiatry, cognitive neuroscience, genetics, neuroimaging, pharmacology, and related fields of interest. Contributions are encouraged from all around the world.A1-01 Research and Getting Published