PURPOSE:Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population. METHODS:Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics. RESULTS:After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed. CONCLUSIONS:Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis.

Mental capacity assessment plays a crucial role in decision-making, especially in psychiatric contexts, where legal frameworks for determining capacity vary widely. This study explores the relationship between cognitive functioning and decision-making capacity modification (CM) in severe mental disorders (SMD), shedding light on the importance of neuropsychological evaluation in CM processes. Cross-sectional descriptive study, with 77 adult patients with SMD and CM, and 33 without CM from the mental health sector of Parc Sanitari Sant Joan de Déu (Spain). CM, sociodemographic and neuropsychological data were collected. An independent brief assessment of patients' mental capacity was also evaluated. There is an overrepresentation of males in CM processes. All three groups exhibit mild multidomain dysfunction, with impairments in executive functions, memory, and processing speed. Individuals with CM show poorer verbal learning capacity, with an impact on their occupational and family functioning. Mnemonic encoding positively correlates with mental capacity to decide, suggesting it could preliminarily be considered a potential predictive marker in CM processes. This study contributes insights into the cognitive aspects of CM in SMD, underscoring the need for a comprehensive approach integrating clinical, cognitive, and social factors in assessing decision-making capacity in this population.

Aim: To assess whether exposure to childhood traumatic experiences is linked to the inflammatory markers neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in people with a first-episode psychosis. Methods: A cross-sectional study was performed in 83 patients (21 females and 62 males) with a diagnosis of a first psychotic episode. All participants completed the self-reported Spanish version of the Childhood Trauma Questionnaire (CTQ). NLR, MLR, and PLR were calculated in each patient. Results: Highest CTQ scores were noted on the emotional neglect and abuse domains (mean +/- SD = 10.92 +/- 4.41; mean +/- SD = 10.93 +/- 4.78, respectively), being lowest for the sexual abuse domain (mean +/- SD = 6.12 +/- 2.41 ). Backward stepwise linear regressions showed that high emotional neglect significantly predicted increased PLR ((3= 0.452, P = .036), older age and high emotional neglect predicted increased NLR ((3= 0.483, P = .036; (3= 0.442, P = .06, respectively), and high emotional neglect, low physical neglect, high total Positive and Negative Syndrome Scale (PANSS) score, and cannabis and alcohol use predicted increased MLR ((3= 0.698, P = .003; respectively). Conclusions: Our results highlight the relationship between the exposure to emotional neglect and the inflammatory biomarkers NLR, MLR, and PLR in patients with a first-episode psychosis. This study has benefitted from controlling for confounders such as body mass index, smoking status, symptom severity, and alcohol and cannabis use.

Stressful life events (SLE) tend to occur before the onset of psychosis, this highlights the importance of its detection and evaluation in these patients. The need to have instruments that assess SLE easily and quickly underpins the objective of this study, which is to validate a short version of the questionnaire of stressful life events (QSLE). 124 patients with first-episode psychosis and 218 healthy controls aged between 11 and 52 years were recruited. The QSLE scale underwent discrimination analysis, which revealed 18 items had good SLEs discriminability between the two samples. These 18 items were then used to create the shorter QSLE-SV. The QSLE-SV showed good internal consistency (Cronbach's alpha = 0.749). An AUC of 0.830 was observed, suggesting that the predictor was good. Using 2 as the cut-off score to predict an individual as a patient would yield a sensitivity of 91.1% and a specificity of 51.6%, and using a cut-off point of 3, the sensitivity was 77.4% and the specificity was 72.5%. QSLE-SV displayed satisfactory psychometric properties in a Spanish population. The QSLE-SV allows for investigating childhood, adolescent and adult life events by measuring current stress and age on a continuous scale in a quick and easy way.

Mental capacity assessment plays a crucial role in decision-making, especially in psychiatric contexts, where legal frameworks for determining capacity vary widely. This study explores the relationship between cognitive functioning and decision-making capacity modification (CM) in severe mental disorders (SMD), shedding light on the importance of neuropsychological evaluation in CM processes. Cross-sectional descriptive study, with 77 adult patients with SMD and CM, and 33 without CM from the mental health sector of Parc Sanitari Sant Joan de Deu (Spain). CM, sociodemographic and neuropsychological data were collected. An independent brief assessment of patients' mental capacity was also evaluated. There is an overrepresentation of males in CM processes. All three groups exhibit mild multidomain dysfunction, with impairments in executive functions, memory, and processing speed. Individuals with CM show poorer verbal learning capacity, with an impact on their occupational and family functioning. Mnemonic encoding positively correlates with mental capacity to decide, suggesting it could preliminarily be considered a potential predictive marker in CM processes. This study contributes insights into the cognitive aspects of CM in SMD, underscoring the need for a comprehensive approach integrating clinical, cognitive, and social factors in assessing decision-making capacity in this population.

Patients with first-episode psychosis (FEP) report deficits in social support (SS) and diminished and less satisfactory social networks than healthy controls (HC). These SS difficulties are linked with symptomatology. The study objectives were to: (a) compare perceived SS between patients with FEP and HC; (b) study sex differences regarding perceived SS in patients with FEP and HC; and (c) explore which sociodemographic, clinical and psychosocial variables are related to perceived SS in the onset of FEP. A total of 146 participants were included: 76 patients with FEP (24 females, 52 males) and 70 HC (20 females, 50 males). Perceived SS was assessed with the DUKE-UNK instrument, which is divided into two subscales: confidant support (CS) and affective support (AS). Significant differences regarding perceived SS were observed between the samples. No sex differences were found concerning perceived SS in each group. For the group with FEP, more years of education, less anxiety/depressive symptoms and better functioning were the most relevant variables for more overall perceived SS and perceived CS. Also, less suicidal risk was the only important indicator for more perceived AS. Interventions in perceived SS could contribute to a good evolution of FEP.

Stressful life events (SLEs) are important indicators prior to the onset of first-episode psychosis (FEP). Although there are well-validated interviews and self-reports for assessing SLE on proximate events, unfortunately there are no instruments to assess SLE covering an entire lifetime. This study includes detailed specific items of childhood, adolescence, and adulthood focused on the presence of SLE, emotional impact (stressfulness), and the age at which the event occurred. Our research describes 2 studies designed to develop and validate a new scale to assess SLE: the Questionnaire of Stressful Life Events (QSLE). In Study 1, an over-inclusive item pool was generated based on review of group of experts at Parc Sanitari Sant Joan de Déu and content validity was examined by an Expert Survey. The whole scale represents the content domain. In Study 2, item-level analyses revealed good distributional properties, intra-rater reliability, and convergent and discriminant validity. In the sensitivity and specificity analysis, 18 items had high relevance in the discriminability between patients with FEP and healthy controls. We note that there was an AUC of 0.676, indicating a good predictor. Using 7 as a cutoff to predict an individual as a patient would yield a sensitivity of 64.8% and a specificity of 65%. Overall, the QSLE displayed satisfactory psychometric characteristics in a Spanish population. These results suggest that QSLE gives us the opportunity to investigate childhood, adolescent, and adult life events by measuring the stress and age at the moment on a continuous scale.

AIM Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. METHODS Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. RESULTS An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. CONCLUSIONS Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

The onset of first episode psychosis (FEP) is a period of increased risk of suicide, which is 60% higher than in other stages of the disease. This work explored suicidal behaviour and its most relevant factors in a population with FEP and a healthy control (HC) sample. We used the Suicide Risk Scale of Plutchik (SRSP) to assess suicide behaviour, and Calgary Depression Scale for Schizophrenia (CDSS), Young Mania Rating Scale (YMRS), Personal and Social Performance Scale (PSP), Perceived Stress Scale (PSS) and Positive and Negative Syndrome Scale (PANSS) were administered to assess the severity of depression, mania, psychosocial functioning, perceived stress and psychopathology, respectively. Patients with FEP showed a higher prevalence in all measures of suicide behaviour than HC. Younger age and depressive symptoms were the most important predictors of suicide ideation and suicide attempt. More perceived stress and higher hopelessness were the most relevant predictors of suicide risk. Symptoms did not appear to be important factors in suicide behaviour. Younger age, perceived stress and depressive symptoms seem to be the most important factors in suicide behaviours in FEP.

People with a mental disorder have a higher risk of suicidal behavior. Little research has examined the role of childhood trauma in suicide behavior, and even fewer studies have assessed the specific relevance of subtypes of childhood trauma and suicidal behavior in first-episode psychosis (FEP). The aims of the present study were: 1) to compare suicide behavior between FEP and HC; 2) to study the relationship between the five types of ChT and suicide risk in FEP controlling for confounding sociodemographic, clinical, and psychosocial variables. 95 patients diagnosed with FEP and 92 healthy control (HC) were recruited as a part of the PROFEP study. ChT was evaluated using The Childhood Trauma Questionnaire-Short Form (CTQ) and suicide behavior through The Suicide Risk Scale of Plutchik (SRSP). Our results showed that patients with FEP presented more suicide behavior (ideation, attempt, and suicide risk) than HC. Emotional abuse was the most relevant type of ChT in suicide ideation and suicide risk. After controlling for other relevant variables, perceived stress seemed to play an important role in suicide ideations, suicide attempt, and suicide risk. The results highlight the importance of assessing and considering in the clinical practice ChT and the perceived stress.

BACKGROUND:Understanding if there are differential determinants of objective and subjective burdening in caregivers of first episode psychosis (FEP) patients would be essential to optimize current early support programs. Our aim was to elucidate the clinical and sociodemographic characteristics of FEP patients that influence the objective and subjective burdening of their informal caregivers. MATERIALS AND METHODS:75 participants with FEP were assessed in social functioning and psychotic symptoms. Their caregivers were assessed with an instrument of objective and subjective family burden. Objective burdening was assessed in terms of time spent. Subjective burden was assessed in terms of worry experienced. RESULTS:Regression analyses showed that impaired social functioning of the patient was the major determinant of family burdening, in assisting in daily activities and containing disrupted behavior. Excitative symptoms were more determinant than positive symptoms in explaining burdening when containing disrupted behavior. A younger age of the patient specifically determined higher subjective but not objective burdening. Economic incomes had little contribution to family burdening. CONCLUSIONS:Our results suggest that there may not be differential determinants of objective and subjective burdening on domains of family burdening in FEP. Current multicomponent early interventions may consider social functioning and excitative symptoms the factors that may focus on to reduce both objective and subjective family burdening. Caregivers of youngest patients may need additional psychological support as they care of patients with higher dependency level and involving more subjective burdening.

Most of the studies examining the impact of cannabis use in first episode psychosis (FEP) have been carried out in samples with adult-onset FEP. Data in persons with early onset psychosis (EOP) is scarce. The aims of the study were: To describe the prevalence of lifetime cannabis use, current use, and daily use in patients with EOP compared to healthy controls. To study the differences in clinical presentation between cannabis users and non-users. To examine the risk of presenting an EOP associated with cannabis use and the effect of doses and age of onset of use. An observational cross-sectional study was performed in 90 EOP cases and 62 healthy controls, aged between 7 and 17 years. Our results show a higher prevalence of lifetime use (p = 0002), current use (p < 0.001), and daily use (p < 0.001) in EOP cases in comparison with healthy controls. Regarding clinical presentation, we did not find significant differences in any subscale of the Positive and Negative Syndrome Scale (PANSS). Non-user patients presented more severe depressive symptoms (p = 0002) and worse social functioning than cannabis users (p = 0026). Compared with subjects who never used cannabis, the risk of an EOP was significantly higher for those with a lifetime use (OR = 2.88, p = 0.002)current use (O.R = 6.09, p < 0001), and especially in those with daily use (O.R = 42.77, p = <0001). We found a higher risk of EOP in patients that have used cannabis before 15 years of age. In conclusion, it is necessary to develop early- detection and specific treatment programs for adolescents with cannabis use.

This paper reviews and discusses the literature on childhood trauma (CT) in people with first-episode psychosis (FEP). The aim is to update the knowledge on the prevalence and the types of CT suffered by FEP people, to compare them with other samples, to study the impact of gender, and to examine the relationship between CT and symptoms and functional outcomes. We conducted a literature search (1995–2019), to identify reported data on any topic related to CT in FEP samples. The following terms were used in the search: CT or sexual abuse or physical abuse or neglect, and first-episode psychosis. We found 493 studies, of which 68 were included in the review. FEP presented a higher prevalence of CT than controls. Women suffer more sexual abuse. The effect of CT on the severity, the prognosis and the evolution of FEP is unclear. FEP have a high prevalence of CT. Its relationship with symptoms and functional outcomes indicates its importance within treatment. This suggests the importance of creating and implementing specific interventions and personalized therapies addressed to work through their past traumatic experiences to improve their quality of live and their prognosis.

AIMS:to study the differences in cognitive functioning in patients and controls. In addition, study the influence of symptoms, cannabis consumption, chlorpromazine doses, DUP and IQ in cognitive performance in patients, both in the total sample and divided by gender.METHODS:70 first episode psychosis patients and 63 healthy controls (HC) participated in the study and were assessed with the MATRICS battery and the Vocabulary subtest of WAIS-IV. Symptoms in FEP patients were evaluated with the Emsley factors of the PANSS scale.RESULTS:patients showed lower scores than controls in all cognitive domains studied. There were no significant differences between FEP men and FEP women, but we found gender differences in favour of women in processing speed, working memory and composite total scored domains in the HC group. Finally, symptoms and Chlorpromazine doses showed an influence on cognitive performance in the total FEP sample. When splitting the sample by gender, positive symptoms may be more detrimental to women's cognitive functioning, while disorganized symptoms may play the most important role in cognitive performance in men.CONCLUSIONS:patients showed worse cognitive performance in all cognitive domains compared to healthy controls. In our FEP sample, gender does not seem to influence cognitive performance measured with the MATRICS. Severity of symptoms influences positively in cognitive performance. The dose of Chlorpromazine and symptoms are influential variables to be taken into account in cognition rehabilitation programs.

BACKGROUND:Psychosocial stress and the stress hormone prolactin are assumed to play an important role in the pathogenesis of schizophrenia and related psychoses, and have been frequently observed to be increased in antipsychotic-naïve patients with a clinical high risk for psychosis (CHR-P) or first episode of psychosis (FEP). The aim of this study was to further elucidate the relationships between self-perceived stress, psychopathological symptoms and prolactin levels in these patients. METHODS:In this cross-sectional study, 45 healthy controls, 31 CHR-P patients and 87 FEP patients were recruited from two different study centers. Prolactin was measured under standardized conditions between 8 and 10 am. All patients were antipsychotic-naïve and not taking any prolactin influencing medication. Self-perceived stress during the last month was measured with the perceived stress scale (PSS-10) immediately before blood taking. RESULTS:Both CHR-P and FEP patients showed significantly higher levels of self-perceived stress and prolactin than controls. Hyperprolactinemia (i.e. prolactin levels above the reference range) was observed in 26% of CHR-P and 45% of FEP patients. Self-perceived stress was significantly positively associated with affective symptoms, but not with other symptoms. There was no significant association between self-perceived stress and prolactin levels. CONCLUSION:Our results confirm that CHR-P and FEP patients have higher stress levels than healthy controls and frequently have hyperprolactinemia, independent of antipsychotic medication. However, although it is well established that prolactin increases in response to stress, our results do not support the notion that increased prolactin levels in these patients are due to stress.

Despite the evidence related to the role of major life events and childhood trauma in the development of first-episode psychosis (FEP; Varese et al., 2012; Morgan & Fisher, 2007), there are few studies on environmental exposure to stressful life events (SLEs) and how SLEs might influence the onset of a psychotic disorder, and the role of perceived stress in this population. The proposed analyses will investigate the association between the categories of SLEs (education, work, partner, family, home, legal, finances, social and health) and perceived stress between patients with FEP and healthy controls (HC). Participants were patients with FEP (n=15) and HC (n=21). This research was part of a longitudinal observational study called the ‘PROFEP group’ in Catalonia. Stressful life events were assessed with the Questionnaire of stressful life events (QSLE) (Butjosa et al., 2017). We analysed the frequency of the categories of SLEs. Perceived stress was assessed with the Perceived Stress Scale (PSS; Cohen & Williams, 1988). There are more frequency of SLEs in the education (p<0.05) and health (p<0.05) categories, and perceived stress (p<0.05) in FEP sample than HC. Results show the relevance of the presence of SLEs (e.g. education and health) and a potent source of perceived stress in FEP sample. Therefore, more studies are needed to evaluate these stressors to apply future psychological interventions in relation to stress management in FEP population. In addition, it would add protective variables in the analyses such as resilience, coping and social support.

Currently, there is a great interest in stress since many diseases can be affected by stress, including psychotic disorders. Interpretation and capacity of the person to tackle situations of psychosocial stress and their recovery capacities are relevant factors in the prevention of psychotic disorders (López-Soler, 2008; N Pereda, 2009, 2010; Noemí Pereda, Guilera, Forns, & Gómez-Benito, 2009). Some of protector factors that have been studied are the following: Resilience (R), Coping Strategies (CS) and Social Support (SS). Furthermore, few studies have been performed with FEP population. This research was part of a longitudinal observational study called ‘PROFEP Group’ in Catalonia. The patients belong to Mental Health Parc Sanitari Sant Joan de Déu (for adults) and Hospital Sant Joan de Déu (for children and adolescents) health care sector. Participants were FEP patients (N=15); males= 9, females= 6) and HC (N=19; males=6, females=13) between 14 and 42 years. We used the PANSS scale (positive, negative and general) to evaluate psychotic symptoms and DUKE (social support), EMA (coping strategies) and CD-RISC-17 (resilience) scales to evaluate protective factors. FEP patients showed worse resilience (p<0.05), less social support (p<0.05) and more avoidance coping strategies (p<0.05) than HC. On the other hand, in FEP patients, some protective factors correlate with the symptomatology. The DUKE scale and the EMA cautious action subscale correlate with the total PANSS, while the EMA social joining subscale correlates with the positive symptoms (p<0.05). Resilience, Coping Strategies and Social Support seem to have an important role in the appearance and severity of an FEP. It is necessary to carry out more studies with more sample, even so, the results indicate that these factors may be important for the prevention of an FEP and could be worked on in future interventions in FEP patients as well as in HC.

This study presents a quantitative analysis of the incidence of stressful life events (SLEs) and the variables gender, age at onset, family history and psychotic symptoms in patients with first-episode psychosis (FEP). A descriptive, cross-sectional methodology was used to interview 68 patients with FEP between 13 and 47 years of age. The Psychiatric Epidemiology Research Interview Life Events Scale collected one-year period prior to onset of FEP - used to analyse the subcategories academic, work, love and marriage, children, residence, legal affairs, finances and social activities-, Positive and Negative Syndrome Scale, and Clinical Global Impression-Schizophrenia scale were used to assess the relevance of certain SLEs during adolescence. Age at onset showed a significant negative correlation with the categories academic and social activities. By contrast, it showed a positive correlation with work and children. A significant relationship was found between paternal family history and social activities and between maternal family history and academic and love and marriage. Finally, an inverse relationship was observed between negative symptoms and the categories children and finance. Depressive symptoms were significantly correlated with the category academic. Our results show the importance of SLEs during adolescence and suggest that there is a clear need to develop preventive actions that promote effective strategies for dealing with the accumulation of psychosocial stress.