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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.

Background In recent years, the effect of cannabis use on cognitive functions in patients with psychosis has been widely studied, but results are somewhat contradictory. On the other hand, it has also been studied the relevance of the age of onset of consume, suggesting that the early age of onset of consumption may be related to a greater cognitive impairment. Methods 349 patients with a first episode of non-affective psychosis were studied. Patients were classified in cannabis users and non-users. Users were divided according to their age at the beginning of use of cannabis in: early-onset (age

Background Suicide represents the main cause of premature dead in first episode psychosis (FEP) patients. However, our understanding of suicidal behaviour in this population is limited. During the last decade, several works have related suicidal behaviour in FEP patients with structural abnormalities in frontal and temporal areas as well as specific structures such as hippocampus, insula and amygdala. The main aim of this work was to analyse the possible structural brain abnormalities associated with suicide-related-behaviour in a large sample of FEP patients. Methods We use a voxel-based morphometry (VBM) analysis in 146 FEP individuals: 24 FEP with and 122 without suicidal behaviour. All images were taken in the same 3T Phillips scanner. The CAT 12 toolbox, which is implemented in SPM12 was used for VBM analysis of the data. A two-sample t-test was set with sex, age, handedness, total intracraneal volume and global disability score as nuisance covariables. We applied threshold-free cluster enhancement (TFCE) with 5000 permutations and corrected for multiple comparisons (FWE) at p

Background Deficits in auditory-verbal memory have been reported by the vast majority of published research in schizophrenia and also detected in first episode psychosis (FEP), confirming they are already present at the early stages of the illness. However, the specific neurocognitive constructs underlying defective verbal memory and their neuroanatomical correlates remains poorly understood in schizophrenia spectrum disorders patients. Methods Data on the Rey Auditory Verbal Learning Test (RAVLT), a widely used verbal memory measure that provides a range of performance indexes to evaluate distinct memory processes including: a) acquisition/learning b) sensitivity to interference c) retrieval; d) retention or rate of forgetting; e) and retrieval efficiency was available for 388 FEP patients and 184 healthy controls (HC). In 218 FEP patients and 146 HC, structural magnetic resonance imaging data were analysised using Voxel based morphometry (VBM) toolbox. Results The FEP group showed significantly lower results on acquisition/learning, delayed recall as well as higher rates of forgetting. They also exhibited a significant sensitivity to retroactive but not proactive interference. We also found significant correlations between bilateral frontal lobe morphometry and proactive interference as well as between right frontal lobe morphometry and retroactive interference. Rate of forgetting was significantly correlated with right occipital cortex morphometry. Those with higher rates of forgetting and proactive and retroactive interference demonstrated further gray matter reductions in frontal and occipital cortical areas. Discussion The application of a process oriented approach to the neuropsychological evaluation of verbal memory allows a finer-grained analysis of the neurocognitive constructs underlying defective verbal memory in FEP. The results suggest specific relationships between different neuroanatomical structures and discrete memory processes with these structures playing an important role in verbal memory deficits found in FEP.

Background Structural abnormalities in First Episode of Non- Affective Psychosis (FEP) are shown to be present at the time of onset of the illness. Although there are multiple cross-sectional studies in chronic patients there is no clear evidence how these alterations progress years after the appearance of the first episode. Methods Data for the present investigation were obtained from an ongoing epidemiological and longitudinal intervention programme of first-episode psychosis (PAFIP) conducted at the Marqués de Valdecilla University Hospital (HUMV), Spain. Images for 62 FEP patients and 47 healthy controls were acquired at baseline and 10 year follow-up on the same 1.5-T whole-body scanner (SIGNA, GE, Milwaukee, WS, USA). Three-dimensional T1-weighted images, using a spoiled gradient-recalled acquisition in the steady state (GRASS) (SPGR) sequence, were acquired in the coronal plane with the following parameters: TE=5 msec, TR =24 msec, NEX=2, rotation angle =45°, FOV= 26 x 19.5 cm, slice thickness =1.5 mm and a matrix of 256 x 192. Structural imaging data for each subject was analyzed using serial longitudinal Statistical Parametric Mapping software (SPM12). After segmenting the mid-point average and multiply the result by the jacobian maps, DARTEL was applied to spatially normalise de diferences. T-test between both groups was performed, allowing voxel-wise comparison of progressive structural change. All results were p