Browsing by Author "Ramos, Josep"

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    Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood
    (2022) Verdolini, Norma; Borràs, Roger; Sparacino, Giulio; Garriga, Marina; Sagué, Maria; Madero, Santiago; Palacios, Roberto; Serra, Maria; Florencia, Maria; Salagre, Estela; Aedo, Alberto; Salgado, Pilar; Montoro, Irene; Sánchez, Vanessa; Pomarol, Edith; Ramos, Josep; Carvalho, Andre; Garcia, Clemente; Undurraga, Juan; Reinares, María; Martinez, Anabel; Bernardo, Miguel; Vieta, Eduard; Pacchiarotti, Isabella; Amoretti, Silvia
    Objective: This study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies. Methods: Patients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Chi-squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models. Results: The total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal-directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM. Conclusion: Early characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.
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    Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis
    (2022) Sagué, Maria; Amoretti, Silvia; Garriga, Marina; Mezquida, Gisela; Williams, Evelyn; Serra, Maria; Forte, Maria; Varo, Cristina; Montejo, Laura; Palacios, Roberto; Madero, Santiago; Sparacino, Giulio; Anmella, Gerard; Fico, Giovanna; Giménez, Anna; Pons, Maria; Salgado, Pilar; Montoro, Irene; Sánchez, Vanessa; Pomarol, Edith; Ramos, Josep; Undurraga, Juan; Reinares, María; Martínez, Anabel; Pacchiarotti, Isabella; Valli, Isabel; Bernardo, Miguel; García, Clemente; Vieta, Eduard; Verdolini, Norma
    Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.

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