Background:Little is known about changes in brain functioning after first-episode psychosis (FEP). Such knowledge is important for predicting the course of disease and adapting interventions. Functional magnetic resonance imaging has become a promising tool for exploring brain function at the time of symptom onset and at follow-up.Method:A systematic review of longitudinal fMRI studies with FEP patients according to PRISMA guidelines. Resting-state and task-activated studies were considered together.Results:Eleven studies were included. These reported on a total of 236 FEP patients were evaluated by two fMRI scans and clinical assessments. Five studies found hypoactivation at baseline in prefrontal cortex areas, two studies found hypoactivation in the amygdala and hippocampus, and three others found hypoactivation in the basal ganglia. Other hypoactivated areas were the anterior cingulate cortex, thalamus and posterior cingulate cortex. Ten out of eleven studies reported (partial) normalization by increased activation after antipsychotic treatment. A minority of studies observed hyperactivation at baseline.Conclusions:This review of longitudinal FEP samples studies reveals a pattern of predominantly hypoactivation in several brain areas at baseline that may normalize to a certain extent after treatment. The results should be interpreted with caution given the small number of studies and their methodological and clinical heterogeneity.

BackgroundSome studies of first psychotic episodes have suggested the association between childhood trauma, such as sexual abuse, and the risk of hallucinations.1 Furthermore, other studies indicated that environment can alter the phenomenological presentation of first psychotic episodes.2However, there are no studies about the association between hallucinations in first psychotic episodes and the prognosis of the disease. This is the main objective of this study. We also compared the phenomenological differences between hallucinations in first episode psychosis and persistent hallucinations in patients with chronic psychosis.MethodsNaturalistic, longitudinal follow-up study in a sample of 173 patients of first psychotic episode attending public mental health service in Area 5 of Valencia region (Spain) in a period between 2010–2017.We compared first-episode patients with hallucinations (N=38) with two samples: A) First-episode patients without hallucinations (N=137). B) Chronic patients with persistent hallucinations (N=45) from a previous study.3In the first comparison we used the following variables: sociodemographic data, risk factors (such as cannabis consume and immigration), psychiatric pathology (CIE-10), psicopathology (including clinical scales GAF, CGI and PANSS), number of emercengy visits and number of hospitalization after the first psychotic episode.In the second one, we use the PSYRATS scale to compare both groups.ResultsIn the first comparison, First Episode Psychotic patients with and without hallucinations,we only found significant differences in the number of hospital income, with more hospitalizations in the non hallucinating group (P= 0.001).In the second comparison, First Episode Hallucinations versus Chronic Persistent Hallucinations, significant differences were only found in the duration of the hallucinations, which was much higher in chronic persistent hallucinations group (P= 0.001)DiscussionConsequently, it seems that first psychotic episode patients without hallucinations have more hospitalizations than first-episode patients with hallucinations. Moreover, we can conclude that the duration of voices is higher in chronic patients with persistent hallucinations than in first psychotic episode hallucinations.Both results have practical implications in the prognostic importance of hallucinations in first psychotic episodes.References1. Misiak, B. et al “Childhood traumatic events and types of auditory verbal hallucinations in first-episode schizophrenia patients”, Comprehensive Psychiatry 66 (2016) 17–22.2. Oher, F.J. et al “The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study”, Psychological Medicine 44 (2014) 2419–2430.3. González, J.C. et al J., “Persistent Auditory Hallucinations”, Psychopathology 39 (2006) 120–125.

BackgroundSome naturalistic longitudinal studies of first psychotic episodes of the last 50 years have suggested associations between psychopathology and the remission of symptoms and the clinical course of disease.1 A recent study in a large sample of patients with schizophrenia has obtained significant results using the number of hospitalizations as outcome variable.2The main objective of this study is to know if clinical and sociodemographic variables predict the number of hospitalizations after the first psychotic episodeMethodsNaturalistic, longitudinal follow-up study in a sample of 212 patients of first-episode psychosis attending public mental health service in Area 5 of Valencia (Spain) in a period between 2010–2017. Of 212 patients, a total of135 were included, excluding patients lost due to abandonment and death.The study included a) baseline variables: sociodemographic, risk factors (Cannnabis use), clinical scales; PANSS, CGI (clinical global impression) and GAF (global assessment of functioning scale) and kind of treatment (oral versus injectable). b) outcome variables: number of visits to the emergency room, hospitalizations, and outpatient consultations.ResultsNone of the psychopathological or treatment variables at baseline were significantly associated with the outcome variables.The younger patients have a significant (p < 0.01) higher number of emergencies room visit in the follow up.DiscussionIn contrast with previous reports1,2 Tihonen J et al2017)) we were not able to find any relationship between severity of illness (at baseline) or the kind of treatment (oral versus injectable) with the emergency rooms visits or number of hospitalizations.The only significant result was related with the age of the patients. Younger patients have more probability of having more visit to the emergency room.References1. Capdeville D. A multi-dimensional approach to insight and its evolution in first- episode psychosis: a 1 -year outcome naturalistic study. Psychiatry Res. 2013 dec 30;210(3):835–412. Tihonen J.Real-World effectiveness of antipsychotic treatments in a Nation wide Cohort of 29.823 patients with schizophrenia. Jamapsych.2017;74(7)686–693

BackgroundThere are many studies using structural MRI to explore the longitudinal course of F Episode Psychosis (FEP).2 On the other hand, there is a lack of functional MRI studies examining the longitudinal course of FEP. The aim of this work is to make a literature systematic review of these studies, to summarize the knowledge about longitudinal course of functional brain activity in FEP.MethodsWe followed the PRISMA guidelines for conducting systematic reviews and combined the use of electronic and manual systematic search methods, in the principal databases (MedLine, PubMed and Web of Science) using the query “longitudinal” AND “fMRI” AND “first episode psychosis” OR “first episode schizophrenia”. This search included (PERIODO). The inclusion criteria were: a) FEP diagnose; b) at least 2 functional MRI scans (pre-post); c) both task and resting-state scans were included. The exclusion criteria were: a) chronic patients in the studied sample; b) structural imaging results; c) just 1 fMRI scan; d) reviews and metaanalysis.Results202 records were identified through database searching. A total of 10 articles were selected. From them, a total of 276 FES patients were examined by fMRI. In all of these studies patients were diagnosed by structured interviews according to DSM-IV-TR or ICD-10 criteria. The average age of the FES sample was 26.64 years old. Nine of the 10 studies involved 2 scans with a mean interval between them of 7 months. Six of the 10 studies did the first scan without any antipsychotic treatment, but all of them had medication at follow-up scan. Most of the studies used a region of interest (ROI) approach, and examined the role mainly of these areas: limbic system, hippocampus, striatum and prefrontal cortex.Five of the studies used a resting-state paradigm. The other 5 works implemented some cognitive or emotional task using some visual stimuli.Attending to the imaging results at baseline, most of studies found an hypoactivation of several brain areas, specially the limbic areas, like thalamus, amygdala and hippocampus. There are some other areas less activated compared to controls, including striatum, anterior cingulated cortex, orbitofrontal cortex, temporal gyrus and cerebellum posterior lobe.At follow-up, almost all studies reported normalization of the hypoactivation levels found at baseline in the same regions. When the results at baseline were an increased activation, it also normalized at follow-up. There is only one study reporting an increased activity at baseline comparing to healthy volunteers which is still increased at follow-up scans.DiscussionThere are very few studies exploring fMRI longitudinal course of FEP patients.Our results in FEP are similar with other recent reviews in chronic schizophrenia samples,1 finding normalization (increase) of brain activity after antipsychotic treatment.There are only visual or resting-state paradigms during scanning, which could explain some of the results. More investigations, involving other paradigms and related with psychopathologi...