The Frequency of Symptom-Based Phenotypes of Mental Disorders is Long-Tailed | The heterogeneity of symptoms among individuals diagnosed with the same mental disorder has been blamed to hinder research in mental health and the development of effective treatments. Although widely acknowledged as problematic, the characteristics of this heterogeneity are largely unknown. We assessed the frequency of symptom phenotypes across a variety of clinical and non-clinical populations and found a consistent, long-tailed distribution. This distribution represents a mixture of a few very commonly expressed phenotypes and the sum of many, each only rarely displayed ones. As a consequence, the non-normality of this distribution induces a systematic bias, affecting all research and treatments relying on a symptom-based definition of mental disorders. | 404/5743 | Secondary Analysis | Shared |
Causal Pathways to Social and Occupational Functioning in the First Episode of Schizophrenia: Uncovering Unmet Treatment Needs | We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. Demographic, clinical, and psychosocial measures were obtained for 279 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and six-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and six-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N=187). In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation (ES = 0.77), and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own six-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. Results from our data-generated model suggest baseline socio-affective capacity and motivation may be the most direct causes of occupational and social functioning six months after entering treatment in early schizophrenia. These findings indicate that social cognitive abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery. | 404/591 | Secondary Analysis | Shared |
Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: Data from the national RAISE-ETP study | The primary aim of this study was to examine the effect of recent tobacco, alcohol and
cannabis use on treatment outcomes among participants experiencing first episode psychosis
(FEP). Secondary data analyses were conducted on 404 participants enrolled in the Recovery
After an Initial Schizophrenia Episode—Early Treatment Program (RAISE-ETP) study. RAISEETP
investigated the effectiveness of a coordinated specialty care (CSC) intervention for FEP
in community mental health agencies in the United States. Generalized estimating equations
were used to examine whether recent tobacco smoking, alcohol, and cannabis use at baseline
were associated with illness severity, number of antipsychotic pills missed, psychiatric symptoms
and quality of life during the 24-month treatment period, after controlling for duration of
untreated psychosis and treatment group. At baseline, roughly 50% (n = 209) of participants reported recent tobacco, 28%
(n = 113) alcohol and 24% (n = 95) cannabis use. Tobacco smokers had higher levels of illness
severity (β = .24; P < .005), a higher number of missed pills (β = 2.89; P < .05), higher psychiatric
symptoms and lower quality of life during treatment relative to non-smokers. Alcohol users
had a higher number of missed pills (β = 3.16; P < .05) during treatment and cannabis users
had higher levels of illness severity (β = .18; P < .05) and positive symptoms (β = 1.56; P < .05)
relative to non-users. Tobacco, alcohol and cannabis use are common in youth seeking treatment for
FEP. Tobacco smoking was associated with more negative clinical outcomes. These findings
have implications for including interventions targeting these areas of substance use within current
CSC models. | 404/404 | Secondary Analysis | Shared |
Racial-Ethnic Disparities in First-Episode Psychosis Treatment Outcomes From the RAISE-ETP Study. | Abstract
OBJECTIVE:
This study examined racial and ethnic differences in treatment outcomes among participants in a randomized controlled trial of an intervention for first-episode psychosis called NAVIGATE.
METHODS:
Secondary data analyses were conducted for participants randomly assigned to usual community care (N=181) and NAVIGATE (N=223). Generalized estimating equations assessed whether race and ethnicity were associated with psychiatric symptoms and service use (medication management, family psychoeducation, and individual therapy) over a 24-month treatment period, accounting for baseline symptoms, duration of untreated psychosis, and insurance status.
RESULTS:
Among persons in usual community care, non-Hispanic blacks scored significantly higher throughout treatment on measures of positive symptoms (β=2.15, p=.010), disorganized thoughts (β=1.15, p=.033), and uncontrolled hostility (β=.74, p=.027), compared with non-Hispanic whites, and non-Hispanic blacks were less likely than non-Hispanic whites to receive individual therapy (OR=.45, p=.001). Families of Hispanic participants in usual community care were less likely than non-Hispanic white families to receive family psychoeducation (OR=.20, p=.01). For NAVIGATE participants, race and ethnicity were not associated with differences in psychiatric symptoms over time; families of non-Hispanic black participants were less likely than those of non-Hispanic white participants to receive family psychoeducation (OR=.53, p=.009). Hispanic participants in NAVIGATE were more likely than non-Hispanic white participants to receive medication management (OR=2.93, p=.001).
CONCLUSIONS:
In usual community care, non-Hispanic blacks scored higher on measures of psychiatric symptoms and were less likely to receive important services, compared with non-Hispanic whites. In NAVIGATE, racial and ethnic differences in psychiatric symptoms were not evident, although non-Hispanic blacks were less likely than non-Hispanic whites to receive family psychoeducation. | 404/404 | Secondary Analysis | Shared |
Smoking is related to reduced motivation, but not global cognition, in the first two years of treatment for first episode psychosis | Smoking is highly prevalent in people with psychotic disorders, even in the earliest phases of the illness. The neural mechanisms of nicotine dependence and psychosis overlap and may also be linked to deficits in neurocognition and motivation in psychosis. Both neurocognition and motivation are recognized as important clinical targets, though previous research examining the effects of smoking on these features has been inconsistent. Here we examine the relationships between smoking status and neurocognition and motivation over the first two years of treatment for psychosis through a secondary analysis of the Recovery After an Initial Schizophrenia Episode – Early Treatment Program (RAISE–ETP) dataset. In a sample of 404 individuals with first-episode psychosis, we examined linear mixed-effects models with the group (smoker vs. non-smoker) by time (baseline, 12-month, 24-month) interaction as a predictor of global cognition and motivation. While all individuals showed enhanced global cognition and motivation over the 24-month course of treatment, non-smokers showed significantly greater gains in motivation. These changes in motivation also corresponded to improvements in functioning over the 24-month period. No significant effects of smoking were observed for global cognition. Our findings suggest that motivation and smoking cessation may be important early treatment targets for first-episode psychosis programs. | 404/404 | Secondary Analysis | Shared |
Suicidal Ideation in First-Episode Psychosis (FEP): Examination of Symptoms of Depression and Psychosis Among Individuals in an Early Phase of Treatment | First-episode psychosis (FEP) is a particularly high-risk period for suicide,
in which risk elevates by 60% within a first year of treatment as compared
to later stages of illness. To date, much of the literature has focused on individuals
with a longer duration of psychosis; thus, there is an urgency for research
to examine suicide risk among individuals in FEP in the beginning stage of
treatment. This study aimed to identify the relationships between demographic
characteristics, symptoms of depression, psychosis (particularly positive symptoms
of psychosis), and suicidal ideation among individuals in FEP. Secondary
data were obtained from National Institute of Mental Health’s Early Treatment
Program of the Recovery After an Initial Schizophrenia Episode project
(N = 404). Consistent with prior research, participants who experienced suicidal
ideation during the study period reported having a longer duration of untreated
psychosis and greater symptoms of depression. Further, positive symptoms of
psychosis, namely hallucinations and delusions, were found to increase the odds
of experiencing suicidal ideation. Findings point toward the implication that
depression and positive symptoms of psychosis relate to the experience of suicidal
ideation among individuals with a FEP and should be evaluated for and
treated in the early stages of treatment. | 404/404 | Secondary Analysis | Shared |
Trajectories of suicidal risk among individuals with first-episode psychosis: Relationship to recovery and symptoms | This study examined trajectories of suicide-risk and their relationship to symptoms, recovery, and quality of life over time. Data was obtained from the Recovery after an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study. 404 individuals with first-episode psychosis (FEP) completed measures of suicide-risk, depression, positive symptoms, recovery, and quality of life at baseline, 6mo, 12mo, 18mo, and 24mo. Latent class analysis was used to identify temporal trajectories of suicide-risk. General linear mixed models for repeated measures were used to examine the relationship between the latent trajectories of suicide-risk and clinical variables. Results identified three latent trajectories of suicide-risk (low-risk, worsening, and improving). The low-risk and improving classes experienced improvements in depression, positive symptoms, quality of life, and recovery over time. The worsening class experienced improvements in positive symptoms and quality of life, but no change in depression or recovery. These results suggest that some individuals with FEP are at risk for persistent depression and worsening suicide-risk during treatment despite experiencing improvements in positive symptoms and quality of life. These findings have important clinical implications, as persistent depression and worsening suicide-risk might be masked by the primary focus on positive symptoms and quality of life in most FEP clinics. | 404/404 | Secondary Analysis | Shared |