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Research Paper
Open Access

Multidimensional predictors of negative symptoms in antipsychotic-naive first-episode psychosis

Alba Toll, Laura Blanco-Hinojo, Daniel Bergé, Xavier Duran, Irene Canosa, Teresa Legido, Federico Marmol, Víctor Pérez-Solà, Emilio Fernández-Egea and Anna Mané
J Psychiatry Neurosci January 19, 2022 47 (1) E21-E31; DOI: https://doi.org/10.1503/jpn.210138
Alba Toll
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Laura Blanco-Hinojo
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Daniel Bergé
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Xavier Duran
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Irene Canosa
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Teresa Legido
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Federico Marmol
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Víctor Pérez-Solà
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Emilio Fernández-Egea
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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Anna Mané
From the Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain (Toll, Bergé, Canosa, Legido, Pérez-Solà, Mané); the Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Toll, Bergé, Duran, Canosa, Legido, Pérez-Solà, Mané); the Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain (Toll, Blanco-Hinojo, Bergé, Canosa, Pérez-Solà, Mané); the Department of Psychiatry and Forensic Medicine, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Toll); the MRI Research Unit, Department of Radiology, Parc de Salut Mar, Barcelona, Spain (Blanco-Hinojo); the Pharmacology Unit, Department of Clinical Fundamentals, Faculty of Medicine, Barcelona University, Barcelona, Spain (Marmol); and the Department of Psychiatry and Behavioral and Clinical Neuroscience Institute, University of Cambridge, United Kingdom (Fernández-Egea)
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    Figure 1

    Illustrations of the amygdala (top row) and the hippocampus (bottom row) as segmented by FreeSurfer in a control participant. Segmentations are overlaid on the participant’s anatomic MRI.

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    Figure 2

    Correlations between PANSS-N scores at 1-year follow-up and BDNF levels, left amygdala relative volume and PANSS-N scores at baseline. BDNF = brain-derived neurotrophic factor; PANSS-N = Positive and Negative Syndrome Scale, negative subscale.

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    Table 1

    Sociodemographic, volumetric and clinical characteristics at baseline

    CharacteristicPatients
    n = 50*
    Healthy volunteers
    n = 50*
    Statistical testp valueEffect size†
    Age, yr26 (24–30.25)26 (23–30)t = 9920.07d = −0.36
    Female22 (44%)22 (44%)χ2 = 0.160.42V = 0.08
    Relative volume, mL
     Left hippocampus2.64 ± 0.272.77 ± 0.35t = −3.630.047d = −0.42
     Right hippocampus2.78 ± 0.312.84 ± 0.36t = −2.130.048d = −0.18
     Left amygdala1.01 ± 0.141.11 ± 0.14t = −4.260.001d = −0.71
     Right amygdala1.14 ± 0.151.24 ± 0.14t = −4.320.001d = −0.69
    Duration of untreated psychosis, d31 (8–115)————
    Cannabis user29 (58%)————
    Tobacco use, cigarettes/d4.5 (0–14)————
    Diagnosis
     Schizophreniform disorder18 (36%)————
     Psychosis not otherwise specified28 (56%)————
     Brief psychotic disorder4 (8%)————
    Benzodiazepine treatment43 (86%)————
    BDNF, pg/mL45.27 ± 27.14————
    PANSS positive subscale score24.88 ± 6.74————
    PANSS negative subscale score16.86 ± 6.65————
    PANSS general pathology score43.68 ± 8.27————
    PANSS total score85.24 ± 15.76————
    CDSS score1.22 ± 2.02————
    GAF score29.7 ± 8.89————
    • BDNF = brain-derived neurotrophic factor, CDSS = Calgary Depression Scale for Schizophrenia; GAF = Global Assessment of Functioning; PANSS = Positive and Negative Syndrome Scale.

    • ↵* Values are given as mean ± standard deviation, n (%) or median (interquartile range).

    • ↵† Cohen d or Cramer V.

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    Table 2

    Association of sociodemographic, volumetric and clinical characterics with PANSS negative score and persistent negative symptoms at 1-year follow-up: univariate analysis

    CharacteristicPANSS negative score at 1 yearp valueEffect size*Persistent negative symptoms at 1 yearp valueEffect size*
    Ager = −0.070.69—t = 0.760.45d = 0.08
    Sext = 1.950.06d = 0.64χ2 = 0.240.81V = 0.24
     Male18.58 ± 5.68——68.8%——
     Female14.93 ± 5.71——31.2%——
    Relative volume
     Left hippocampusr = −0.250.12—t = 1.010.32d = 0.37
     Right hippocampusr = −0.210.19—t = 1.210.23d = 0.44
     Left amygdalar = −0.510.001—t = 2.470.018d = 0.91
     Right amygdalar = −0.310.05—t = 1.830.08d = 0.57
    Duration of untreated psychosisr = 0.290.07—t = −1.530.14d = −0.48
    Cannabis uset = −1.20.32d = −0.32χ2 = −0.510.62V = 0.21
     Non-user16.21 ± 5.5——43.8%——
     User18.1 ± 6.25——56.2%——
    Tobacco user = −0.270.10—t = 1.490.14d = 0.46
    Chlorpromazine equivalent at 1 yearr = 0.090.59—t = 0.340.74d = 0.11
    Benzodiazepine treatmentt = −1.610.12d = −0.64χ2 = 1.930.17V = 0.41
    BDNF, baseliner = −0.40.012—t = 2.930.006d = 1.01
    PANSS negative subscale score, baseliner = 0.410.009——
    PANSS positive subscale score, baseliner = −0.270.09—t = 1.230.23d = 0.39
    CDSS score, baseliner = −0.160.34—t = 0.450.66d = 0.14
    GAF score, baseliner = −0.260.12—t = 2.120.07d = 0.72
    • BDNF = brain-derived neurotrophic factor; CDSS = Calgary Depression Scale for Schizophrenia; GAF = Global Assessment of Functioning; PANSS = Positive and Negative Syndrome Scale.

    • ↵* Cohen d or Cramer V.

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    Table 3

    PANSS negative score at 1-year follow-up: linear regression model

    PredictorR2B (95% CI)p value
    Model 10.253< 0.001
     Relative left amygdala volume, mL−24.14 (−37.98 to −10.31)0.001
    Model 20.391< 0.001
     Relative left amygdala volume, mL−23.2 (−35.89 to −10.51)0.001
     BDNF at baseline−0.08 (−0.13 to −0.02)0.007
    Model 30.478< 0.001
     Relative left amygdala volume, mL−21.09 (−33.14 to −9.03)0.001
     BDNF at baseline−0.07 (−0.12 to −0.02)0.011
     PANSS negative subscale score at baseline0.26 (0.04 to 0.48)0.021
    • BDNF = brain-derived neurotrophic factor; CI = confidence interval; PANSS = Positive and Negative Syndrome Scale.

    • View popup
    Table 4

    Persistent negative symptoms at 1-year follow-up: logistic regression model

    Predictor−2 log-likelihoodNagelkerke R2χ2OR (95% CI)p value
    Step 144.090.27χ21 = 8.710.06
     BDNF at baseline0.96 (0.93 to 0.99)0.018
    Step 233.160.53χ22 = 19.62
     Left amygdala relative volume0.99 (0.98 to 0.99)0.010
     BDNF at baseline0.93 (0.88 to 0.98)0.012
    • BDNF = brain-derived neurotrophic factor; CI = confidence interval; OR = odds ratio.

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Journal of Psychiatry and Neuroscience: 47 (1)
J Psychiatry Neurosci
Vol. 47, Issue 1
23 Feb 2022
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Multidimensional predictors of negative symptoms in antipsychotic-naive first-episode psychosis
Alba Toll, Laura Blanco-Hinojo, Daniel Bergé, Xavier Duran, Irene Canosa, Teresa Legido, Federico Marmol, Víctor Pérez-Solà, Emilio Fernández-Egea, Anna Mané
J Psychiatry Neurosci Jan 2022, 47 (1) E21-E31; DOI: 10.1503/jpn.210138

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Multidimensional predictors of negative symptoms in antipsychotic-naive first-episode psychosis
Alba Toll, Laura Blanco-Hinojo, Daniel Bergé, Xavier Duran, Irene Canosa, Teresa Legido, Federico Marmol, Víctor Pérez-Solà, Emilio Fernández-Egea, Anna Mané
J Psychiatry Neurosci Jan 2022, 47 (1) E21-E31; DOI: 10.1503/jpn.210138
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