Publications by authors named "Pilar Saiz"

155 Publications

Examining facial emotion recognition as an intermediate phenotype for psychosis: Findings from the EUGEI study.

Prog Neuropsychopharmacol Biol Psychiatry 2021 Sep 15:110440. Epub 2021 Sep 15.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain.

Background: Social cognition impairments, such as facial emotion recognition (FER), have been acknowledged since the earliest description of schizophrenia. Here, we tested FER as an intermediate phenotype for psychosis using two approaches that are indicators of genetic risk for schizophrenia: the proxy-genetic risk approach (family design) and the polygenic risk score for schizophrenia (PRS-SCZ).

Methods: The sample comprised 2039 individuals with schizophrenia, 2141 siblings, and 2049 healthy controls (HC). The Degraded Facial Affect Recognition Task (DFAR) was applied to measure the FER accuracy. Schizotypal traits in siblings and HC were assessed using the Structured Interview for Schizotypy-Revised (SIS-R). The PRS-SCZ was trained using the Psychiatric Genomics Consortium results. Regression models were applied to test the association of DFAR with psychosis risk, SIS-R, and PRS-SCZ.

Results: The DFAR-total scores were lower in individuals with schizophrenia than in siblings (RR = 0.97 [95% CI 0.97, 0.97]), who scored lower than HC (RR = 0.99 [95% CI 0.99-1.00]). The DFAR total score was negatively associated with SIS-R total scores in siblings (B = -2.04 [95% CI -3.72, -0.36]) and HC (B = -2.93 [95% CI -5.50, -0.36]). Different patterns of association were observed for individual emotions. No significant associations were found between DFAR scores and PRS-SCZ.

Conclusions: Our findings based on a proxy genetic risk approach suggest that FER deficits may represent an intermediate phenotype for schizophrenia. However, a significant association between FER and PRS-SCZ was not found. In the future, genetic mechanisms underlying FER phenotypes should be investigated trans-diagnostically.
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http://dx.doi.org/10.1016/j.pnpbp.2021.110440DOI Listing
September 2021

Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms.

Front Psychiatry 2021 9;12:700747. Epub 2021 Aug 9.

Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.

Interest in the idea of recovery for certain patients with schizophrenia has been growing over the last decade. Improving symptomatology and functioning is crucial for achieving this. Our study aims to identify those factors that substantially contribute to real-world functioning in these patients. We carried out a cross-sectional study in stable outpatients with schizophrenia on maintenance antipsychotic monotherapy. : We studied 144 outpatients with schizophrenia (DSM-IV-TR criteria) meeting the following criteria: (1) 18-65 years of age; (2) being clinically stable for at least the previous three months; (3) on maintenance antipsychotic monotherapy (prescriptions ≤ 10 mg olanzapine, ≤200 mg quetiapine, or ≤100 mg levomepromazine as hypnotics were also allowed); and (4) written informed consent. : We collected information on demographic and clinical variables by using an questionnaire. For psychopathology, we employed the Spanish versions of the following psychometric instruments: the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS-Sp), and the Calgary Depression Scale (CDS). In addition, cognitive domains were assessed using the Verbal Fluency Test (VFT), the Digit Symbol Substitution Test (DSST), and the Trail Making Test, parts A and B (TMT-A and TMT-B). Finally, we employed the Spanish versions of the University of California San Diego Performance-based Skills Assessment (Sp-UPSA) and the Personal and Social Performance (PSP) for assessing functional capacity and real-world functioning, respectively. : A forward stepwise regression was conducted by entering those variables significantly associated with PSP total score into the univariate analyses (Student's -test, ANOVA with Duncan's test, or bivariate Pearson correlation). A total of 144 patients; mean age 40 years, 64% males, mean length of illness 12.4 years, PSP total score 54.3. The final model was a significant predictor of real-world functioning [ = 36.371, < 0.001] and explained 66.0% of the variance. Variables retained in the model: BNSS-Sp abulia, asociality, and blunted affect, PANSS general psychopathology, Sp-UPSA transportation, TMT-B, and heart rate. Our model will contribute to a more efficient and personalized daily clinical practice by assigning specific interventions to each patient based on specific impaired factors in order to improve functioning.
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http://dx.doi.org/10.3389/fpsyt.2021.700747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381019PMC
August 2021

Real-World Functioning in Patients With Schizophrenia: Beyond Negative and Cognitive Symptoms.

Front Psychiatry 2021 9;12:700747. Epub 2021 Aug 9.

Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain.

Interest in the idea of recovery for certain patients with schizophrenia has been growing over the last decade. Improving symptomatology and functioning is crucial for achieving this. Our study aims to identify those factors that substantially contribute to real-world functioning in these patients. We carried out a cross-sectional study in stable outpatients with schizophrenia on maintenance antipsychotic monotherapy. : We studied 144 outpatients with schizophrenia (DSM-IV-TR criteria) meeting the following criteria: (1) 18-65 years of age; (2) being clinically stable for at least the previous three months; (3) on maintenance antipsychotic monotherapy (prescriptions ≤ 10 mg olanzapine, ≤200 mg quetiapine, or ≤100 mg levomepromazine as hypnotics were also allowed); and (4) written informed consent. : We collected information on demographic and clinical variables by using an questionnaire. For psychopathology, we employed the Spanish versions of the following psychometric instruments: the Positive and Negative Syndrome Scale (PANSS), the Brief Negative Symptom Scale (BNSS-Sp), and the Calgary Depression Scale (CDS). In addition, cognitive domains were assessed using the Verbal Fluency Test (VFT), the Digit Symbol Substitution Test (DSST), and the Trail Making Test, parts A and B (TMT-A and TMT-B). Finally, we employed the Spanish versions of the University of California San Diego Performance-based Skills Assessment (Sp-UPSA) and the Personal and Social Performance (PSP) for assessing functional capacity and real-world functioning, respectively. : A forward stepwise regression was conducted by entering those variables significantly associated with PSP total score into the univariate analyses (Student's -test, ANOVA with Duncan's test, or bivariate Pearson correlation). A total of 144 patients; mean age 40 years, 64% males, mean length of illness 12.4 years, PSP total score 54.3. The final model was a significant predictor of real-world functioning [ = 36.371, < 0.001] and explained 66.0% of the variance. Variables retained in the model: BNSS-Sp abulia, asociality, and blunted affect, PANSS general psychopathology, Sp-UPSA transportation, TMT-B, and heart rate. Our model will contribute to a more efficient and personalized daily clinical practice by assigning specific interventions to each patient based on specific impaired factors in order to improve functioning.
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http://dx.doi.org/10.3389/fpsyt.2021.700747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381019PMC
August 2021

Impact of previous tobacco use with or without cannabis on first psychotic experiences in patients with first-episode psychosis.

Schizophr Res 2021 Oct 5;236:19-28. Epub 2021 Aug 5.

Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, CIBERSAM, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Spain. Electronic address:

Objective: There is high prevalence of cigarette smoking in individuals with first-episode psychosis (FEP) prior to psychosis onset. The purpose of the study was to determine the impact of previous tobacco use with or without cannabis on first psychotic experiences in FEP and the impact of this use on age of onset of symptoms, including prodromes.

Methods: Retrospective analyses from the naturalistic, longitudinal, multicentre, "Phenotype-Genotype and Environmental Interaction. Application of a Predictive Model in First Psychotic Episodes (PEPs)" Study. The authors analysed sociodemographic/clinical data of 284 FEP patients and 231 matched healthy controls, and evaluated first psychotic experiences of patients using the Symptom Onset in Schizophrenia Inventory.

Results: FEP patients had significantly higher prevalence of tobacco, cannabis, and cocaine use than controls. The FEP group with tobacco use only prior to onset (N = 56) had more sleep disturbances (42.9% vs 18.8%, P = 0.003) and lower prevalence of negative symptoms, specifically social withdrawal (33.9% vs 58%, P = 0.007) than FEP with no substance use (N = 70), as well as lower prevalence of ideas of reference (80.4% vs 92.4%, P = 0.015), perceptual abnormalities (46.4% vs 67.4%, P = 0.006), hallucinations (55.4% vs 71.5%, P = 0.029), and disorganised thinking (41.1% vs 61.1%, P = 0.010) than FEP group with previous tobacco and cannabis use (N = 144). FEP patients with cannabis and tobacco use had lower age at first prodromal or psychotic symptom (mean = 23.73 years [SD = 5.09]) versus those with tobacco use only (mean = 26.21 [SD = 4.80]) (P = 0.011).

Conclusions: The use of tobacco alone was not related to earlier age of onset of a first psychotic experience, but the clinical profile of FEP patients is different depending on previous tobacco use with or without cannabis.
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http://dx.doi.org/10.1016/j.schres.2021.07.017DOI Listing
October 2021

Excessive and pathological Internet use - Risk-behavior or psychopathology?

Addict Behav 2021 12 9;123:107045. Epub 2021 Jul 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.

Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
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http://dx.doi.org/10.1016/j.addbeh.2021.107045DOI Listing
December 2021

Excessive and pathological Internet use - Risk-behavior or psychopathology?

Addict Behav 2021 12 9;123:107045. Epub 2021 Jul 9.

National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Stockholm, Sweden.

Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.
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http://dx.doi.org/10.1016/j.addbeh.2021.107045DOI Listing
December 2021

Spanish Validation of the MAP-SR: Two Heads Better Than One for the Assessment of Negative Symptoms of Schizophrenia.

Psicothema 2021 08;33(3):473-480

Universidad de Oviedo, Instituto de Neurociencias del Principado de Asturias (INEUROPA).

Background: There is little research on self-reported negative symptomatology measures in schizophrenia. The aims of this study were to validate the Spanish version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) and determine the concordance between patient-reported outcome measures for reflecting the severity of negative symptoms of schizophrenia and clinician-rated outcome measures.

Method: A sample of 174 subjects who completed the MAP-SR and 104 who completed the Self-Evaluation of Negative Symptoms (SNS) were analyzed. The clinician-reported outcome measures (CROMs) were the Spanish versions of the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Positive and Negative Syndrome Scale (PANSS), while the patient-reported outcome measures (PROMs) were MAP-SR and SNS. Cronbach's a, bivariate analyses and Lin's concordance correlation coefficient (CCC) were calculated.

Results: The Spanish version of the MAP-SR demonstrated excellent reliability (Cronbach's α=.923). Its correlation coefficients were higher with CAINS [CAINS-Total: r=.608, p<.005; CAINS-Motivation and Pleasure subscale(CAINS-MAP): r=.662, p<.005] than with PANSS negative scales [PANSS-Negative scale(PANSS-N): r=.393, p<.005; PANSS-Marder Negative Factor(PANSS-MNF): r=.478, p<.005]. Finally, concordance between clinician and patient ratings was low in all cases, varying from a CCC of 0.661 to .392.

Conclusions: We found poor concordance between patient and clinician ratings, hence we believe that the two evaluations are not mutually exclusive but complementary.
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http://dx.doi.org/10.7334/psicothema2020.457DOI Listing
August 2021

Cognitive functioning after six months of follow-up in a sample of alcohol use disorder outpatients.

Adicciones 2021 Jun 15;0(0):1672. Epub 2021 Jun 15.

Servicio de Salud Mental del Principado de Asturias (SESPA). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).

Until now, no follow-up studies had simultaneously evaluated executive functions, other non-executive functions related cognitive func-tions, and impulsivity in a large enough sample of moderate to severe alcohol use disorder (AUD) patients. The main objective of the present study was to compare neuropsychological performance and its relation to alcohol use in patients with AUD and healthy controls, and to determine the evolution of cognitive impairment and alcohol use over time. For this purpose, a 6-month follow-up study was designed to compare a sample of 100 outpatients with AUD (DSM-5 criteria) with 100 matched healthy controls. The patient group was recruited from three different health centres in Spain located in Orense, Gijón and Barcelona. The assessment consisted of a systematic battery of cognitive tests to evaluate the following functions: attention, anterograde memory, processing speed, verbal fluency, executive function, and implicit attitude toward alcoholic beverages. We also compared clinical variables associated with alcohol use, such as alcohol craving and impulsivity. After 6 months, anterograde memory, working memory, and resistance to interference improved remarkably in AUD patients, although not enough to match the normal population. With regard to clinical variables, there was a small but significant cognitive improve-ment related to a reduction in alcohol use and impulsivity. Executive dysfunction and other non-executive functions related cognitive func-tions impairment can be considered prognostic factors in outpatients with moderate to severe AUD.
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http://dx.doi.org/10.20882/adicciones.1672DOI Listing
June 2021

Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.

Adicciones 2021 Jun 14;0(0):1569. Epub 2021 Jun 14.

Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona.

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.
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http://dx.doi.org/10.20882/adicciones.1569DOI Listing
June 2021

Clinical practice guideline on pharmacological and psychological management of adult patients with an Anxiety Disorder and comorbid substance use.

Adicciones 2021 Jun 14;0(0):1548. Epub 2021 Jun 14.

Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA) (Oviedo).

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid anxiety disorders and SUDs while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus anxiety symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Clinical trials are only available for posttraumatic stress disorder (PTSD) and for social anxiety. Concerning the comorbid substance use, all the studies have included patients with alcohol use, none of them have dealt with cocaine, cannabis or nicotine use. Although some treatments have shown benefit for anxiety symptoms without benefits for alcohol or other substance use, only limited pharmacological approaches have been assayed (sertraline, desipramine, paroxetine, buspirone, naltrexone and disulfiram). Our results suggest that 1) we can (weakly) recommend the use of desipramine over paroxetine to alleviate symptoms of anxiety in patients with a PTSD and alcohol use; 2) In these patients, the use of naltrexone to reduce symptoms of anxiety is also recommended (weak strength); and 3) SSRI antidepressants vs placebo can be recommended to reduce alcohol use (weak recommendation). Our review highlights the need for more research in this area and for larger, multisite studies with generalizable samples to provide more definite guidance for clinical practice.
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http://dx.doi.org/10.20882/adicciones.1548DOI Listing
June 2021

Clinical practice guideline on pharmacological and psychological management of adult patients with bipolar disorder and comorbid substance use.

Adicciones 2021 Jun 14;0(0):1528. Epub 2021 Jun 14.

Instituto de Investigación Sanitaria BIOARABA. OSI Araba. Hospital Universitario. CIBERSAM, UPV/EHU. Vitoria.

This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.
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http://dx.doi.org/10.20882/adicciones.1528DOI Listing
June 2021

Factors associated with alcohol and tobacco consumption as a coping strategy to deal with the coronavirus disease (COVID-19) pandemic and lockdown in Spain.

Addict Behav 2021 10 3;121:107003. Epub 2021 Jun 3.

Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Servicio de Salud del Principado de Asturias (SESPA) Oviedo, Spain.

Aim: To provide a population-based characterization of sociodemographic and clinical risk and protective factors associated with consumption of alcohol, tobacco, or both as a coping strategy in a sample of the Spanish general population during the early phase of the COVID-19 pandemic.

Methods: Cross-sectional study based on an online snowball recruiting questionnaire. The survey consisted of an ad hoc questionnaire comprising clinical and sociodemographic information and the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES).

Results: The final sample included 21,207 individuals [mean age (SD) = 39.7 (14.0); females: 14,768 (69.6%)]. Up to 2867 (13.5%) of participants reported using alcohol, 2545 (12%) tobacco and 1384 (6.5%) both substances as a strategy to cope with the pandemic. Sex-related factors were associated with alcohol consumption as a coping strategy [female, OR = 0.600, p < 0.001]. However, education level, work status, and income played different roles depending on the substance used to cope. Having a current mental disorder was associated only with tobacco consumption as a coping strategy [OR = 1.391, p < 0.001]. Finally, sex differences were also identified.

Conclusions: Sociodemographic, clinical, and psychological factors were associated with consumption of alcohol, tobacco, or both as a coping method for the COVID-19 pandemic and lockdown. Our findings may help develop specific intervention programs reflecting sex differences, which could minimize negative long-term outcomes of substance use after this pandemic.
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http://dx.doi.org/10.1016/j.addbeh.2021.107003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172276PMC
October 2021

Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder.

Adicciones 2021 Mar 12;0(0):1559. Epub 2021 Mar 12.

IMIM-Institut Hospital del Mar d'Investigacions Mèdiques.

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.
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http://dx.doi.org/10.20882/adicciones.1559DOI Listing
March 2021

Clinical Practice Guideline on Pharmacological and Psychological management of adult patients with Schizophrenia Spectrum Disorders and a comorbid substance use.

Adicciones 2021 Mar 11;0(0):1504. Epub 2021 Mar 11.

CIBERSAM. Universitat de Barcelona.

Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).
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http://dx.doi.org/10.20882/adicciones.1504DOI Listing
March 2021

Psychopathy, addictions and female gender: comparative study using the Psychopathy Checklist Revised and the Comprehensive Assessment of Psychopathic Personality.

Adicciones 2021 Mar 11;0(0):1500. Epub 2021 Mar 11.

CIBERSAM. Servicios Médicos del Centro Penitenciario de Pereiro de Aguiar.

Traditionally, psychopathy research has focused on assessing men with the Psychopathy Checklist Revised (PCL-R). Research on women with other assessment tools is scarce. The objective of this study is to evaluate psychopathy, using various tools, in a sample with both women and men. The study involved 204 inmates (mean age (DS) = 40.93 (11.8)), 28 women (13.7%), in the Pereiro de Aguiar penitentiary (Ourense). Sociodemographic, substance use, and criminal variables were collected, and all were evaluated with the following tools: PCL-R,  Comprehensive Assessment of Psychopathic Personality (CAPP), and the International Personality Disorder Examination. In this sample, when assessed with the PCL-R, males obtained significantly higher scores on facet 4, which measures antisocial behaviour. Women obtained significantly higher scores on the Self domain in the CAPP, measuring narcissism. No symptom or item was able to clearly discriminate psychopathic women from psychopathic men in a Support Vector Machine model. The construct of psychopathy is similar for women and men in this representative penitentiary sample. Women showed higher scores for narcissism and men for antisociality. It is better to combine the PCL-R with another tool such as the CAPP to assess these psychopathological differences. No symptom or item has a score that can be recommended as a method for discriminating psychopathic women from psychopathic men.
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http://dx.doi.org/10.20882/adicciones.1500DOI Listing
March 2021

Examining the association between exposome score for schizophrenia and functioning in schizophrenia, siblings, and healthy controls: Results from the EUGEI study.

Eur Psychiatry 2021 Mar 19;64(1):e25. Epub 2021 Mar 19.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.

Background: A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls.

Methods: This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate.

Results: ES-SCZ was associated with the GAF dimensions in patients (symptom: B = -1.53, p-value = 0.001; disability: B = -1.44, p-value = 0.001), siblings (symptom: B = -3.07, p-value < 0.001; disability: B = -2.52, p-value < 0.001), and healthy controls (symptom: B = -1.50, p-value < 0.001; disability: B = -1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group.

Conclusions: Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
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http://dx.doi.org/10.1192/j.eurpsy.2021.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080213PMC
March 2021

Impact of the coronavirus outbreak on mental health in the different Spanish regions.

Actas Esp Psiquiatr 2021 Mar 1;49(2):64-70. Epub 2021 Mar 1.

Departamento de Psiquiatría, Universidad de Oviedo, Oviedo, España. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España. Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, España. Servicio de Salud del Principado de Asturias (SESPA), Oviedo, España.

COVID-19 is an infectious disease that has affected millions of people worldwide, Spain being one of the countries most affected by the pandemic. It is key to study its impact on the mental health of the Spanish population during the lockdown situation.
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March 2021

Early Impact of the COVID-19 Outbreak on Sleep in a Large Spanish Sample.

Behav Sleep Med 2021 Mar 2:1-16. Epub 2021 Mar 2.

Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain.

Coronavirus disease 2019 (COVID-19) forced Spain to implement unprecedented lockdown restriction. In this context, different factors could worsen sleep quality, but the impact of the pandemic and lockdown on sleep is still mostly unknown. In this cross-sectional study, we describe self-reported sleep disturbances in people without mental health disorders from a large Spanish sample (n = 15,070). During the early phase of the lockdown (19-26 March), an online survey was launched using a snowball sampling method and included sociodemographic and clinical data along with the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). Two items of the IES were employed to assess sleep characteristics. Descriptive and bivariate analysis and logistic regression models were performed. Difficulty initiating or maintaining sleep were reported by 23.9% of the sample and was associated in the regression model with age (OR = 1.008, = .003), female sex (OR = 1.344, < .001), an income reduction >50% (OR = 1.248, = .037), having one (OR = 1.208, = .029) and two or more (OR = 1.299, = .035) elderly dependents, drinking alcohol (OR = 1.129, = .024), and a higher score on DASS-21 depression (OR = 1.148, < .001), anxiety (OR = 1.218, < .001), or stress (OR = 1.302, < .001) subscales, whereas being able to enjoy free time (OR = 0.604, < .001) and painting or listening to music (OR = 0.853, = .012) were protective factors. Dreams related to COVID-19 were reported by 12.9% of the sample and were associated in the regression model with female sex (OR = 1.617, < .001), being married (OR = 1.190, = .015), self-employed (OR = 1.373, = .032), or a civil servant (OR = 1.412, = .010), having been tested for COVID-19 (OR = 1.583, = .012), having infected family or friends (OR = 1.233, = .001), reading news about coronavirus (OR = 1.139, = .023), drinking alcohol (OR = 1.251, < .001), and higher scores on DASS-21 depression (OR = 1.102, < .001), anxiety (OR = 1.222, < .001), or stress (OR = 1.213, < .001) subscales, while protective factors were older age (OR = 0.983, < .001) and being retired (OR = 0.625, = .045). These findings could help clinicians and public health systems design and deliver tailored interventions, such as internet-delivered campaigns, to promote sleep quality in the general population.
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http://dx.doi.org/10.1080/15402002.2021.1890597DOI Listing
March 2021

Genetic predisposition to alcohol dependence: The combined role of polygenic risk to general psychopathology and to high alcohol consumption.

Drug Alcohol Depend 2021 04 29;221:108556. Epub 2021 Jan 29.

Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain. Electronic address:

Background: High alcohol consumption and alcohol dependence are only partly genetically correlated and they differ considerably in their correlations with other traits. The existence of genetic correlation among alcohol dependence and psychiatric disorders may be attributed to the presence of a general psychopathology factor, the p factor. This study investigates the relationship of polygenic risk to general psychopathology and to high alcohol consumption on alcohol dependence.

Methods: Participants were 524 alcohol-dependent patients and 729 controls. Polygenic risk scores (PRS) were computed for alcohol consumption (drinks per week) and nine psychiatric disorders. Principal component analysis (PCA) applied to the psychiatric PRS was used to calculate the first principal component as a proxy of the polygenic p factor.

Results: Both the polygenic p factor and the drinks per week PRS were associated with alcohol dependence in our sample. Both variables are only weakly correlated, contributing additively to the risk for alcohol dependence. Sensitivity analyses showed that the polygenic p factor was also associated with alcohol dependence in the subset of patients without any psychiatric or substance use comorbidity.

Conclusions: Polygenic risk for alcohol dependence can be split at least into two components, involved in general psychopathology and high alcohol consumption. The first component of PCA based on PRS for different psychiatric disorders allows estimation of the contribution of the polygenic p factor to alcohol dependence. The pleiotropic effects of genetic variants across psychiatric disorders are mainly manifested as alcohol dependence in some patients.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108556DOI Listing
April 2021

Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings.

Mol Psychiatry 2021 Jan 7. Epub 2021 Jan 7.

Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey.

Important questions remain about the profile of cognitive impairment in psychotic disorders across adulthood and illness stages. The age-associated profile of familial impairments also remains unclear, as well as the effect of factors, such as symptoms, functioning, and medication. Using cross-sectional data from the EU-GEI and GROUP studies, comprising 8455 participants aged 18 to 65, we examined cognitive functioning across adulthood in patients with psychotic disorders (n = 2883), and their unaffected siblings (n = 2271), compared to controls (n = 3301). An abbreviated WAIS-III measured verbal knowledge, working memory, visuospatial processing, processing speed, and IQ. Patients showed medium to large deficits across all functions (ES range = -0.45 to -0.73, p < 0.001), while siblings showed small deficits on IQ, verbal knowledge, and working memory (ES = -0.14 to -0.33, p < 0.001). Magnitude of impairment was not associated with participant age, such that the size of impairment in older and younger patients did not significantly differ. However, first-episode patients performed worse than prodromal patients (ES range = -0.88 to -0.60, p < 0.001). Adjusting for cannabis use, symptom severity, and global functioning attenuated impairments in siblings, while deficits in patients remained statistically significant, albeit reduced by half (ES range = -0.13 to -0.38, p < 0.01). Antipsychotic medication also accounted for around half of the impairment in patients (ES range = -0.21 to -0.43, p < 0.01). Deficits in verbal knowledge, and working memory may specifically index familial, i.e., shared genetic and/or shared environmental, liability for psychotic disorders. Nevertheless, potentially modifiable illness-related factors account for a significant portion of the cognitive impairment in psychotic disorders.
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http://dx.doi.org/10.1038/s41380-020-00969-zDOI Listing
January 2021

Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings.

Mol Psychiatry 2021 Jan 7. Epub 2021 Jan 7.

Department of Psychiatry, Dokuz Eylül University, School of Medicine, Izmir, Turkey.

Important questions remain about the profile of cognitive impairment in psychotic disorders across adulthood and illness stages. The age-associated profile of familial impairments also remains unclear, as well as the effect of factors, such as symptoms, functioning, and medication. Using cross-sectional data from the EU-GEI and GROUP studies, comprising 8455 participants aged 18 to 65, we examined cognitive functioning across adulthood in patients with psychotic disorders (n = 2883), and their unaffected siblings (n = 2271), compared to controls (n = 3301). An abbreviated WAIS-III measured verbal knowledge, working memory, visuospatial processing, processing speed, and IQ. Patients showed medium to large deficits across all functions (ES range = -0.45 to -0.73, p < 0.001), while siblings showed small deficits on IQ, verbal knowledge, and working memory (ES = -0.14 to -0.33, p < 0.001). Magnitude of impairment was not associated with participant age, such that the size of impairment in older and younger patients did not significantly differ. However, first-episode patients performed worse than prodromal patients (ES range = -0.88 to -0.60, p < 0.001). Adjusting for cannabis use, symptom severity, and global functioning attenuated impairments in siblings, while deficits in patients remained statistically significant, albeit reduced by half (ES range = -0.13 to -0.38, p < 0.01). Antipsychotic medication also accounted for around half of the impairment in patients (ES range = -0.21 to -0.43, p < 0.01). Deficits in verbal knowledge, and working memory may specifically index familial, i.e., shared genetic and/or shared environmental, liability for psychotic disorders. Nevertheless, potentially modifiable illness-related factors account for a significant portion of the cognitive impairment in psychotic disorders.
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http://dx.doi.org/10.1038/s41380-020-00969-zDOI Listing
January 2021

Early psychological impact of the 2019 coronavirus disease (COVID-19) pandemic and lockdown in a large Spanish sample.

J Glob Health 2020 Dec;10(2):020505

Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.

Background: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD).

Methods: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors.

Results: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%,  = 1011.459,  < 0.001). Risk factors were female sex and classification as a case in any psychological domain. Protective factors were younger age and ability to enjoy free time. Variables related to COVID-19 had almost no impact except for having COVID-19 symptoms, which was a risk factor for anxiety in all three groups.

Conclusions: Our results can help develop coping strategies addressing modifiable risk and protective factors for each mental status for early implementation in future outbreaks.
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http://dx.doi.org/10.7189/jogh.10.020505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567432PMC
December 2020

Evidence, and replication thereof, that molecular-genetic and environmental risks for psychosis impact through an affective pathway.

Psychol Med 2020 Oct 19:1-13. Epub 2020 Oct 19.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.

Background: There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.

Methods: We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.

Results: The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: -0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465).

Conclusions: The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
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http://dx.doi.org/10.1017/S0033291720003748DOI Listing
October 2020

A replication study of JTC bias, genetic liability for psychosis and delusional ideation.

Psychol Med 2020 Oct 13:1-7. Epub 2020 Oct 13.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.

Background: This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.

Methods: Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.

Results: JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.

Conclusions: These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
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http://dx.doi.org/10.1017/S0033291720003578DOI Listing
October 2020

A replication study of JTC bias, genetic liability for psychosis and delusional ideation.

Psychol Med 2020 Oct 13:1-7. Epub 2020 Oct 13.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.

Background: This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.

Methods: Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.

Results: JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.

Conclusions: These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
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http://dx.doi.org/10.1017/S0033291720003578DOI Listing
October 2020

A replication study of JTC bias, genetic liability for psychosis and delusional ideation.

Psychol Med 2020 Oct 13:1-7. Epub 2020 Oct 13.

Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.

Background: This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.

Methods: Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.

Results: JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.

Conclusions: These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
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http://dx.doi.org/10.1017/S0033291720003578DOI Listing
October 2020

Cognitive impairment and C-reactive protein in clinically stable schizophrenia outpatients: a focus on sex differences.

Sci Rep 2020 09 29;10(1):15963. Epub 2020 Sep 29.

Área de Psiquiatría, Universidad de Oviedo, Oviedo, Spain.

Although previous findings identified an association between C-reactive protein (CRP) levels, and impaired cognitive functions in patients with schizophrenia (SZ), little is currently known about the relationship between inflammation, cognition, and sex in SZ. The current study aimed to explore the association between peripheral inflammation and cognitive impairment in SZ as a function of sex. The sample included 132 clinically stable patients with SZ, of whom 82 were males (62.1%) and 50 females (37.9%). Sociodemographic data were collected, an accurate assessment was performed using the Positive and Negative Syndrome (PANSS), Clinical Assessment Interview for Negative Symptoms (CAINS), and Calgary Depression (CDS) scales, and the MATRICS Consensus Cognitive Battery (MCCB), and CRP levels were tested. A Pearson correlation and multiple regression analyses, including potential confounding factors, were performed. We found an inverse association between CRP levels and performance on visual learning (r = - 0.386, p = 0.006) domain in female patients only, whereas no correlations were found in males. The regression model for women retained age (β = - 0.319, p = 0.017), the CAINS-MAP score (β = - 0.247, p = 0.070), and the CRP (β = - 0.321, p = 0.013) as predictors of visual learning. Our results suggest the possible existence of sex-specific modulation of the association between systemic inflammation and the cognitive features of the illness.
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http://dx.doi.org/10.1038/s41598-020-73043-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524709PMC
September 2020

Early Psychological Correlates Associated With COVID-19 in A Spanish Older Adult Sample.

Am J Geriatr Psychiatry 2020 12 7;28(12):1287-1298. Epub 2020 Sep 7.

Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) (TBB, PAS, AV, CMC, LFT, LGA, MPGP, JB), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) (TBB, PAS, AV, CMC, LFT, LGA, MPGP, JB), Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA) (TBB, PAS, AV, CMC, LFT, LGA, MPGP, JB), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA) (TBB, PAS, CP, AP, MPGP, JB), Oviedo, Spain; Department of Psychiatry (PAS, AV, CMC, LFT, LGA, MPGP, JB), Universidad de Oviedo, Oviedo, Spain.

Objective: Main aims of the study are to examine the early psychological correlates associated with the COVID-19 pandemic and lockdown on the mental health of a Spanish older adult sample and to analyze the influence of past mental disorder (PMD) and current mental disorder (CMD) on those correlates.

Methods: Cross-sectional study based on an online snowball recruiting questionnaire. Psychological correlates assessed with the Depression, Anxiety, and Stress Scale (DASS-21) and Impact of Event Scale (IES). Binary and multinomial logistic regression models were used to identify risk and protective factors.

Results: Final sample included 2,194 individuals aged 60 years or more (mean age [SD]: 65.62 [5.05]; females: 1,198 [54.6%]). There were 342 (15.6%) individuals who reported a PMD and 162 (7.4%) who reported a CMD. Avoidant (32.1%) and depressive (25.6%) styles were the most prevalent, regardless of mental health status. Main risk factors for negative affectivity were female gender and history CMD or PMD. However, job stability and the ability to enjoy free time were generally associated with better outcomes. No differences were found in psychological correlates between those with no lifetime history of mental disorder versus PMD on the DASS-21 or IES. However, CMD was associated with higher anxiety scores on the DASS-21 (odds ratio: 1.838, p < .001).

Conclusion: Regardless of mental status, avoidant and depressive styles were the most prevalent in this older adult sample. Main protective factor in all subgroups was the ability to enjoy free time, whereas the main risk factors were being female and current or past history of mental disorder.
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http://dx.doi.org/10.1016/j.jagp.2020.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476442PMC
December 2020

A Smart Band for Automatic Supervision of Restrained Patients in a Hospital Environment.

Sensors (Basel) 2020 Sep 12;20(18). Epub 2020 Sep 12.

Department of Psychiatry, University of Oviedo, 33006 Oviedo, Spain.

Mechanical contention (MC) is a restrictive, vital but controversial measure, prescribed in the majority of EU countries to handle patients with psycho-motor agitation that do not respond to other types of intervention, with an imminent risk of physical violence and aggression involved. This last resort approach implies risks for the somatic health of the contained individual that go from trauma injuries to, in some extreme cases, sudden death. Despite these risks, somatic supervision and the monitoring of patients under MC is limited, being periodically and manually carried out by nursing personnel with portable equipment. In this context, ensuring continuous monitoring using fully automated equipment is an uncovered yet urgent need. There are several devices already in the market capable of monitoring vital signs, but they are not specifically designed for these type of patients and they can be expensive and/or difficult to integrate with other systems from a software perspective. The work described in this paper gives answers to these necessities with the introduction of a low-cost system, targeted at psychiatric patients, for the acquisition and wireless transmission in real-time of physiological parameters, making use of micro-controllers for collecting and processing sensor data, and WiFi technology to upload the information to the server where a patient's profile with all the relevant vital parameters resides. In addition to data collection and processing, an application aimed at use by nursing staff has also been developed to raise alerts in case any critical condition is detected.
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http://dx.doi.org/10.3390/s20185211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571058PMC
September 2020

Hostility and aggressive behaviour in first episode psychosis: Results from the OPTiMiSE trial.

Schizophr Res 2020 09 11;223:271-278. Epub 2020 Sep 11.

Department of Neuroscience, University Medical Center Groningen, Deusinglaan 2, Groningen, the Netherlands; Department of Medical and Biological Psychology, University of Bergen, Norway.

Aim: The aim of this paper is to determine clinical factors related to hostility and disturbing and aggressive behaviour and to examine the effect of medication on these behaviours in FEP.

Methods: Data from phase I and II of the OPTiMiSE trial are used. Outcome measures are the hostility item of the Positive and Negative Syndrome Scale (PANSS P7) and the disturbing and aggressive behaviour domain of the Personal and Social Performance scale (PSP-D).

Results: Moderate, severe or extreme hostility (PANSS P7 > 3) was present in 42 patients (9.4%). The PANSS P7 and PSP-D were low to moderate but significantly associated with the selected PANSS items: delusions, hallucinatory behaviour, excitement, tension, uncooperativeness, unusual thought content, impulsivity, and lack of judgement and insight. In a subsample of 185 patients (41.5%) with baseline PANSS P7 > 1, the PANSS P7 and PSP-D scores improved in the first 4 weeks of amisulpride treatment. This effect remained significant after controlling for baseline positive symptoms (PANSS P1-P6). No significant differences were found between olanzapine and amisulpride in the second phase of the trial.

Conclusion: Clinical risk factors such as poor impulse control, uncooperativeness and excitement could help clinicians in detecting and treating hostile and aggressive behaviour in FEP. Amisulpride could be an effective antipsychotic choice in the treatment of FEP patients who express hostile or aggressive behaviour. Future research is needed to compare the effects of amisulpride and olanzapine on hostility in FEP during the first weeks of treatment.
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http://dx.doi.org/10.1016/j.schres.2020.08.021DOI Listing
September 2020
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