Papers by Jose Pelayo-Teran
Schizophrenia Bulletin
levels were conducted. Negative symptoms were measured by High Royds Evaluation of Negativity (HE... more levels were conducted. Negative symptoms were measured by High Royds Evaluation of Negativity (HEN) Scale. Individual class membership of negative symptoms derived from LCGA was based on HEN ratings at baseline, 1, 2 and 3-year follow-up. Results: Three distinct negative symptom trajectories were identified including low-stable (59.6%, n=81), moderate-stable (29.4%, n=40) and high-increasing (11.0%, n=15) trajectories. Multinomial regression analysis revealed that poorer premorbid adjustment, lower baseline cognitive composite scores and more severe baseline depression predicted high-increasing trajectory membership (Nagelkerke pseudo R2=0.339, Model χ2=277.96, p<0.01). At 13 years, 88 patients (64.7%) completed follow-up assessment, with attrition analysis indicating lack of significant differences in demographic, premorbid and baseline characteristics between completers and non-completers. Analysis of covariance (controlling for premorbid adjustment, baseline cognition and depression) followed by post-hoc comparison analyses found that high-increasing trajectory was significantly associated with poorer global functional outcome and higher negative symptom levels at 13-year follow-up. Discussion: Our results indicate that 11% of first-episode non-affective psychosis patients displayed persistently high levels of negative symptoms with gradual symptom worsening over 3-year follow-up. This trajectory membership was predictive of poorer negative symptom and functional outcomes 13 years after presentation. High-increasing negative symptom trajectory identified in the initial 3 years of treatment for first-episode psychosis may represent a subgroup of patients having markedly elevated risk of developing deficit syndrome in the later course of illness.
Schizophrenia Bulletin
Background: Studies have established the high risk of suicide in first episode psychosis (FEP). B... more Background: Studies have established the high risk of suicide in first episode psychosis (FEP). Between 15%-26% of FEP patients attempt suicide at least once before their first contact with psychiatric services and 2-5% die from suicide. Also, many patients with schizophrenia spectrum disorders lack insight into having a mental disorder. However, the relationship between insight changes and suicidal behaviour in FEP remains poorly understood. Methods: Information about suicidal behaviour was available on a cohort of 397 FEP patients. Three dimensions of insight (into mental illness, the need for treatment, and the social consequences) were measured at: baseline, 1 and 3 years after the initiation of treatment. Survival analyses examined time to suicidal behavior in relation to i) insight at baseline, ii) the closest insight measure to the suicide attempt, and iii) changes in insight during the follow-up. Results: No associations were found between baseline insight dimensions and time to suicidal behaviour. However, poor insight at the evaluation closest to the suicide attempt was associated with an increased risk of suicide. Stability of insight did not affect the risk of suicidal behaviour, while changes in either direction were linked with an increased risk of suicidal behaviour, particularly worsening insight. Discussion: Insight in psychosis is a dynamic concept and we demonstrated the relationship between insight and suicide risk to be equally dynamic. Poor insight seems to increase the risk, especially when insight levels change. Repeated insight assessment to detect change from early psychosis may play a role in suicide prevention.
Cuadernos De Psiquiatria Comunitaria, 2012
ADHD is a complex disorder. It affects people in an age rank that may result in social alarm. Som... more ADHD is a complex disorder. It affects people in an age rank that may result in social alarm. Some beliefs such as the inexistence of the disorder, the toxicity of the treatment and adverse outcomes are not completely based in empiric evidence and appear to be false myths. A proper knowledge on ADHD and its treatment may help clinicians and families to achieve a more effective and patient centred treatment.
Neurology and therapy, 2016
Implementing the most suitable treatment strategies and making appropriate clinical decisions abo... more Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes....
Retos Para La Psiquiatria Y La Salud Mental En Espana 2003 Isbn 84 9706 057 1 Pags 51 68, 2003
The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), Jan 8, 2016
The catechol-O-methyltransferase (COMT) enzyme plays a crucial role in dopamine degradation and t... more The catechol-O-methyltransferase (COMT) enzyme plays a crucial role in dopamine degradation and the COMT Val158Met polymorphism (rs4680) is associated with significant differences in enzymatic activity and consequently dopamine concentrations in the prefrontal cortex. Multiple studies have analyzed the COMT Val158Met variant in relation to antipsychotic response. Here, we conducted a meta-analysis examining the relationship between COMT Val158Met and antipsychotic response. Searches using PubMed, Web of Science, and PsycInfo databases (03/01/2015) yielded 23 studies investigating COMT Val158Met variation and antipsychotic response in schizophrenia and schizo-affective disorder. Responders/non-responders were defined using each study's original criteria. If no binary response definition was used, authors were asked to define response according to at least 30% PANSS score reduction (or equivalent in other scales). Analysis was conducted under a fixed-effects model. Ten studies met...
Cuadernos De Psiquiatria Comunitaria, 2012
Canadian journal of psychiatry. Revue canadienne de psychiatrie
To investigate potential changes and associations in clinical dimensions and cognitive functionin... more To investigate potential changes and associations in clinical dimensions and cognitive functioning after the first 6 weeks of pharmacological treatment as the relation between cognitive and clinical change may have an impact in determining the importance of cognition as a treatment target. Patients (n = 42) completed a brief battery of 5 neurocognitive tests within 72 hours of commencing, and 6 weeks after, standard pharmacological treatment. The cognitive testing comprised 5 domains: attention, visuomotor speed, declarative memory, working memory, and executive function. Volunteers (n = 43) were recruited to control for practice effects. Patients and control subjects improved over time in the raw scores in cognitive tests. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; performance, at baseline and end point assessments, was below that of the control subjects in all cognitive variables, except the Stroop interference score. No interaction effect between time and group was found. Further, after controlling for practice effects and adjusting for multiple comparisons, patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; cognitive performance showed no significant improvement. Accordingly, there was no association between clinical improvement and cognitive change. This lack of association was also observed in the subgroup of people who showed decreased scores in negative symptoms. Cognitive response is not clearly enhanced by antipsychotic drugs and it is not a by-product of clinical recovery during the acute phase (first 6 weeks) of a first-episode nonaffective psychosis.
American Journal of Psychiatry, 2015
Schizophrenia Research, 2003
IV criteria for drug abuse or dependence consented to participate in the study. All of the women ... more IV criteria for drug abuse or dependence consented to participate in the study. All of the women were administered the Structured Diagnostic Interview for DSM-IV (SCID), the Clinician Administered PTSD Scale (CAPS), and several other clinical assessments. The results confirm high lifetime rates of trauma, especially physical abuse (81%) and sexual abuse (61%). In fact, close to the entire sample (96%) reported experiencing at least one lifetime traumatic event, and the average number of traumatic life events reported was 8. The prevalence of PTSD in the sample was 47%. This rate is noticeably higher compared to similar studies of PTSD in persons with schizophrenia (30%) and drug using women with SMI (30-37%). The results illustrate the increased risk of trauma and PTSD in substance abusing women with schizophrenia. Childhood sexual abuse and sexual assault in adulthood were strongly related to PTSD, as was revictimization. When contextual variables were examined closer to highlight any differences between physical and sexual abuse, the results were astoundingly distinctive for the perpetrator of the abuse. While the vast majority of women reported being sexually abused by a stranger (94%), physical abuse was more likely to happen by someone close to the study participant (94%). These findings highlight how little is known about the context of abuse. Further results will elaborate on the relationship between PTSD and TLEs, including the association between TLEs mad psychiatric symptoms. The treatment implications of these findings will also be discussed.
This article summarises recent findings from the first-episode psychosis program of Cantabria (PA... more This article summarises recent findings from the first-episode psychosis program of Cantabria (PAFIP). The program was implemented in 2001 and offers an integrated clinical service with a well structure research program. The high participation rates and the characteristics of this study population represent a unique opportunity for research on schizophrenia. Findings regarding efficacy and tolerability of antipsychotic treatment, structural neuroimaging and the influence of genetic variations on specific phenotypes are discussed.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2007
Background: Structural brain anomalies are present at early phases of psychosis. The objective wa... more Background: Structural brain anomalies are present at early phases of psychosis. The objective was to examine the impact of Catechol-O-Methyltransferase (COMT) gene variations on brain morphology in first-episode non-affective psychosis. We hypothesized that the low activity-COMT (COMT L ) allele would be associated with the presence of structural brain changes as assessed by quantitative magnetic resonance imaging (MRI). Methods: Fifty-two males and 23 females underwent COMT genotyping and MRI. Patients were categorized into three genetic subgroups: COMT H/H , COMT L/H and COMT L/L . MRI data were analyzed using BRAINS2. Global and lobar volumes of grey matter (GM) and cerebrospinal fluid (CSF) were compared among the three groups after controlling for total intracranial volume and age of illness onset. Results: COMT L carriers showed a significant enlargement of the lateral ventricles (F = 7.13, p = 0.009), right lateral ventricle (F = 5.99, p = 0.017) and left lateral ventricle (F = 6.22, p = 0.015). No other significant differences in any of the brain structures were found among subgroups. Conclusions: Our findings suggest that genetic variations of COMT can contribute to the enlargement of the lateral ventricles described in early phases of non-affective psychosis.
Psychiatry Research, 2010
Age of onset COMT First episode psychosis Schizophrenia Cannabis Gene by enviroment interaction N... more Age of onset COMT First episode psychosis Schizophrenia Cannabis Gene by enviroment interaction New models of interaction between genetic and environmental factors have been proposed to explain the pathogenesis of schizophrenia. The Val158Met polymorphism of the COMT (Catechol-O-Methyltransferase) gene, involved in dopamine regulation and related to negative symptoms, has been previously thought to interact with cannabis use in the modulation of risk of psychosis. The aim of the study was to explore the existence of an interaction between COMT genotype and cannabis use in early stages of psychosis and its effects on the age of onset in a representative group of first-episode psychosis patients. Age of onset, DUP (Duration of Untreated Psychosis) and cannabis use (regular user versus sporadic or non-user) were assessed in 169 Caucasian patients with a first-episode schizophrenia spectrum disorder. COMT polymorphism was typed using PCR of the relevant region followed by digestion with NlaIII and electrophoresis. A multivariate ANCOVA was performed with DUP and age of onset as dependent variables, cannabis and the COMT genotype as fixed factors, and gender as a covariate. The MANCOVA was significant for age of onset and DUP. Cannabis users had a significant earlier age of onset. Age of onset was later in the Met homozygote group (non-significant). The cannabis-COMT interaction showed a significant effect on both DUP and age of onset. Post hoc analyses showed that differences between genotypes were only present in the non-users' group. Based on these results, the use of cannabis could exert a modulator effect on the genotype, suppressing the delay effect for the age of onset in the case of the Met allele patients.
Schizophrenia Research, 2008
Schizophrenia Research, 2009
Objective: This study examined the main metabolic side effects induced by antipsychotic treatment... more Objective: This study examined the main metabolic side effects induced by antipsychotic treatment in a cohort of first episode drug-naïve subjects after the first year of treatment.
Schizophrenia Research, 2010
Background: There has been increasing interest in the potential for early detection during the pr... more Background: There has been increasing interest in the potential for early detection during the prodromal phase of a psychotic disorder. A major focus is on determining the risk of conversion to psychosis and on developing algorithms of prediction. Although there is much variation in the literature on rates of conversion it is always a minority of the samples, i.e. 85% to 50% of putatively prodomal samples do not go on, at least in the duration of the studies (usually one year) to develop psychosis. Little is known about those individuals that have been termed "false-positive". Methods: A prospective, longitudinal study with up to 2.5 years of follow-up of 291 prospectively identified treatment-seeking patients meeting Structured Interview for Prodromal Syndromes (SIPS) criteria, were recruited and evaluated across 8 clinical research centers as part of the North American Prodrome Longitudinal Study (NAPLS). Of this sample at one year 78% and at 2.5 years 65% had not made the transition. The sample being studied included 136 individuals who had at least 1 year of follow up, had not made the transition to psychosis within the duration of the study and were not on any antipsychotics. Results: In the first year there were significant improvements (p < 0.0001) in symptoms (SIPS) and in social and role functioning. However, functioning was still significantly poorer (p < 0.0001) compared to the normal controls in the sample. Only 23% still met prodromal criteria at one year and in a subsample of 65 only 8% met prodromal criteria at 2 years. At one year attenuated positive symptoms improved in 89%, increased in 7.3% and did not change in 3.6% of the sample. For those who had 2 year followups there were further changes, most of which reflected further improvement. 44% at one year and 38% at two years had at least one attenuated positive symptom. Those who were still symptomatic at their final assessment were older, and had poorer social and role functioning and more symptoms at baseline. Discussion: Help seeking Individuals who meet prodromal criteria appear to fall into 3 groupsthose who develop a psychotic illness, those who improve and those who have poor functioning and continue to have some positive symptoms at an attenuated level. In this study there are limitations in terms of the length of follow-up but there are implications for the kinds of treatments we may offer and how we conceptualize those who have a prodromal risk syndrome.
Psychiatry Research, 2008
An overactivation of the Th1 activity in schizophrenia had been described. Interleukin-12 (IL-12)... more An overactivation of the Th1 activity in schizophrenia had been described. Interleukin-12 (IL-12), a proinflammatory cytokine, plays a key role in the regulation of the Th1 response. The aims of this study were to investigate the effect of first and second generation antipsychotic drugs on IL-12 production during the acute phase of the illness and its association with clinical features. Participants comprised 56 drug-naïve first episode psychotic patients and 28 healthy volunteers. Patients were initially randomly assigned to risperidone (n = 16), olanzapine (n = 20) or haloperidol (n = 20); subject were maintained on the same medication throughout the study. Clinical assessments were conducted at baseline and at 6 weeks. IL-12 plasma levels were assessed at baseline and after 6 weeks of antipsychotic treatment. IL-12 haplotypes were also analysed. Patients showed higher IL-12 plasma levels at baseline compared with controls, and had a significant increase in IL-12 plasma level after 6 weeks of antipsychotic treatment. No significant differences in IL-12 level increase were found among the three antipsychotic treatments. IL-12 plasma levels at week 6 were not significantly associated with the severity of psychopathology at week 6. Thus, patients with a first episode of psychosis have inflammatory-like immunological function during early phases of the illness that it is independent of the antipsychotic treatment used.
Revista de Psiquiatría y Salud Mental, 2013
Introduction: The study of administrative prevalence from cumulative psychiatric case registers a... more Introduction: The study of administrative prevalence from cumulative psychiatric case registers allows the mental health state of the studied region and the functioning of its Health Services to be estimated. Methods: Data were extracted from the Asturias Cumulative Psychiatric Case Register (RACPAS) between January 1st 1998 and December 3rd 2010. Characteristics of the population of the catchment area were studied, and their relationship with the administrative prevalence was analysed. Results: The mean population in the studied period was 1,078,406 inhabitants. The Fritz index and the Youth and replacement indices of the active population decreased throughout the period. There was no significant increase in the prevalence of organic mental disorders, psychosis, mood disorders, and substance use in males, or behavioural disorders associated with somatic factors and physiological dysfunctions in females. There were significant gender differences in the prevalence of all disorders, except for personality disorders and organic mental disorders. Population ageing had a significant influence on the increase in the prevalence of most mental disorders in both males and females. Conclusions: A slight general increase in the administrative prevalence of mental disorders is observed during the studied period, and it was influenced by population ageing.
Schizophrenia Research, 2012
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Papers by Jose Pelayo-Teran