Elisa Rodríguez-Toscano’s research while affiliated with Complutense University of Madrid and other places

Early-onset psychosis (EOP) is a severe disorder which takes place before 18 years. It entails diverse clinical and functional implications, and it may lead to critical impairments in neurocognitive functions. Although deficits in memory are well described in adult populations and they appear to be clinically related with psychosis, impairments in memory in EOP show inconsistencies between studies. This study aimed to gain insight into the relationship between EOP and memory impairments, studying the potential contribution of moderators (storage source and memory content) on the observed memory deficits. This systematic review and meta-analysis was conducted following the PRISMA-2020 guidelines. Search was conducted in English and Spanish in five databases. Case–control studies which met all requirements were selected. Overall effect size was calculated under the random-effects model and Z-based tests were used. Heterogeneity was analysed by the I² statistic. Mixed-effects meta-regression analysis was used to study the influence of methodological quality of studies, mean age, proportion of female participants within sample, mean diagnosis, memory storage type, memory content as moderators on individual effect size variability. As a result, 32 articles were finally selected, pooling data from 2636 participants (49.29% EOP participants). Overall effect size was Hedges’ g = – 1.01, CI95 = [ – 1.35, – 0.67], p < .01, indicating lower memory performance in the EOP group in comparison to healthy controls. Diagnosis and memory storage were found as significant moderators in the memory performance variance: larger deficits were found in children with psychosis and in working memory tasks.

Background Cannabis use and familial vulnerability to psychosis have been associated with social cognition deficits. This study examined the potential relationship between cannabis use and cognitive biases underlying social cognition and functioning in patients with first episode psychosis (FEP), their siblings, and controls. Methods We analyzed a sample of 543 participants with FEP, 203 siblings, and 1168 controls from the EU-GEI study using a correlational design. We used logistic regression analyses to examine the influence of clinical group, lifetime cannabis use frequency, and potency of cannabis use on cognitive biases, accounting for demographic and cognitive variables. Results FEP patients showed increased odds of facial recognition processing (FRP) deficits (OR = 1.642, CI 1.123–2.402) relative to controls but not of speech illusions (SI) or jumping to conclusions (JTC) bias, with no statistically significant differences relative to siblings. Daily and occasional lifetime cannabis use were associated with decreased odds of SI (OR = 0.605, CI 0.368–0.997 and OR = 0.646, CI 0.457–0.913 respectively) and JTC bias (OR = 0.625, CI 0.422–0.925 and OR = 0.602, CI 0.460–0.787 respectively) compared with lifetime abstinence, but not with FRP deficits, in the whole sample. Within the cannabis user group, low-potency cannabis use was associated with increased odds of SI (OR = 1.829, CI 1.297–2.578, FRP deficits (OR = 1.393, CI 1.031–1.882, and JTC (OR = 1.661, CI 1.271–2.171) relative to high-potency cannabis use, with comparable effects in the three clinical groups. Conclusions Our findings suggest increased odds of cognitive biases in FEP patients who have never used cannabis and in low-potency users. Future studies should elucidate this association and its potential implications.

Background and objectives This study examined problematic video game use and its sociodemographic and clinical correlates in a sample of 1,410 Spanish video game players (33.6% women; mean age = 21.12 years, SD = 3.29). Methods The participants completed a comprehensive set of assessment scales to evaluate clinical features: a sociodemographic interview, problematic video gaming (using the GAS-7), emotional symptoms (with the Goldberg Anxiety and Depression scales), suicidal ideation (with the Paykel Suicidal Ideation Scale), loneliness (De Jong Gierveld Loneliness Scale) and impulsivity (UPPS-P scale). Participants were classified based on problematic gaming severity. Differences between groups were explored for the clinical features assessed. Results As a result, most participants showed a low-risk gaming pattern (88.2%), in comparison to those showing either excessive use of video games (10% of participants) or problematic (pathological) gaming use (almost 2%). Risk groups differed by sex (p < .01), but not age, education, or employment. Game time and frequency varied across risk groups, indicating higher use with greater risk. Clinical correlates were examined, with higher risk groups showing more depressive symptoms (p < .01), anxiety symptoms (p < .01), suicidal ideation (p < .01), and loneliness (p < .01). Impulsiveness dimensions also showed significant group differences, except for sensation seeking. In conclusion, problematic video game use was linked to higher levels of depressive symptoms, anxiety, suicidal ideation, loneliness, and impulsiveness. Conclusion This study sheds light on the clinical aspects associated with different levels of problematic gaming.

Introduction Extremely preterm newborns - EPTN (born ≤28 weeks gestational age) are at increased risk of developing autism spectrum disorders (ASD). Demographic and perinatal risk factors associated with ASD risk in EPTN are understudied. Objectives (i) In EPTN and born at full-term healthy controls (HC), to characterize the emergence of ASD traits and autistic symptom load at age 18 months; (ii) in EPTN, to identify the influence of perinatal characteristics such as sex and gestational age on autistic symptom load at corrected-age 18 months. Methods Observational, longitudinal, prospective, 18-month follow-up study. We recruited a cohort of n=113 EPTN and n=47 HC (the PremTEA cohort); n=57 EPTN and n=42 HC successfully completed the 18-month follow-up visit. We assessed autistic symptom load & risk at 18 months using the M-CHAT-R/F questionnaire. For all EPTN and HC, we collected demographic and perinatal data. Using GLMs, we assessed, in EPTN, the association between demographic/perinatal variables and 18-month autistic symptom levels. Results At 18 months, EPTN children showed higher autistic symptom levels than HC (M-CHAT-R/F score, mean (SD) [range] = 2.21 (3.23) [0-12] in EPTN vs. 0.33 (0.57) [0-2] in HC; d=.873, p=.001. In EPTN, we identified differences by gestational age and sex in autistic symptom levels at 18 months (aR ² =0.517, p=.006). In particular, female EPTNs born with lower gestational age showed higher autistic symptom load at age 18 months. Conclusions Our findings support the need for early screening of ASD symptomatology in EPTN infants, particularly in higher-risk subgroups, such as female patients born with lower gestational ages. Disclosure of Interest None Declared

Introduction Unplanned pregnancies are frequent in women with bipolar disorder (BD) while perinatal period is associated with a higher risk of relapse. Effective contraception during childbearing age in BD could reduce the risk of unplanned pregnancy and its consequences. The present study studied the prevalence of contraceptive use and which sociodemographic and clinical variables affect its use in women with BD. Methods 796 women (18-50 years old) with BD were recruited and evaluated by the MONTRA survey in France among hospital and consultant psychiatrists. Sociodemographic, clinical and treatment variables were compared between patients with and without contraception use. A logistic regression estimated which variables had a predictive effect on the use of contraception. Results A 61.2% reported the use of effective contraception. Women who use contraception were in 26-35 (OR=2.40,p<0.001) and 36-45 (OR=1.92,p<0.001) range age, displayed higher levels of education (OR= 5.07,p=0.003), were more active (OR=1.63,p=0.006), did not live alone (OR=1.41,p=0.033) and had fewer manic or mixed episodes (OR=0.50,p=0.007).No association was found with the nature of pharmacological treatment. Conclusion Sociodemographic variables were mainly associated with contraception use among BD women. As preventive measures for risk of relapse in BD, contraceptive counseling, including reduction of unplanned pregnancies, should be systematically ensured.

Theory of Mind (ToM) is a cognitive construct that involves different levels of complexity. Development of the different ToM skills follows an evolutionary course in line with the increasing requirements from environmental demands through childhood and adolescence to adulthood. Accordingly, ToM assessment should comprise the heterogeneity of the components – affective or cognitive – and the rising complexity of tasks according to the developmental course – first-order, second-order and higher-order beliefs. In this chapter, features of ToM assessment are presented with a compilation of the main useful tools. Furthermore, specific ToM deficits in neuropsychiatric disorders are collected. ToM impairments have been extensively studied in autism spectrum disorders and schizophrenia, but in recent years their study has been extended to many other clinical diagnoses and significant transversal problems in mental health such as suicidal behavior. As a result, this chapter outlines a comprehensive picture of ToM impairments in a broad range of neuropsychiatric disorders and the accurate assessment of the different deficits, to provide the reader an essential knowledge for understanding ToM impairments across neuropsychiatric disorders and assessment protocols in clinical practice.

Introduction Theory of Mind (ToM) is defined as the cognitive ability that infers other’s mental states (Premack & Woodruff. J Behav Brain Sci 1978; 1 515-526).The interest in the study of ToM distinguishing its affective and cognitive components has been growing. Its study in psychopathology has been evolved from its original studies in autism spectrum disorders (ASD), schizophrenia (SCZ) and, borderline personality disorder (BPD), to other mental disorders like major depressive disorder (MDD), bipolar disorder (BP), anorexia nervosa (AN) and social anxiety disorder (SAD). Objectives 1) review the most commonly used instruments for ToM assessment; 2) to compile the evidence on ToM deficits across mental disorders. For both objectives, target disorders are previously mentioned. Methods The search was carried out on the PubMed, PsycInfo and Scopus databases, using the terms “Theory of mind”, “Mentalization” and the previously mentioned mental disorders and pertinent thesaurus. Articles in English, published since 2010 were considered. A 2-step strategy (first, article screening and full reading) was followed to select articles of interest. Results Reading the Mind in the Eyes (Baron-Cohen et al., J Child Psychol Psychiatry 2001; 42 241-251) and Movie for the Assessment of Social Cognition (Dziobeck et al. J Autism Dev Disord 2006; 36 623-636) were the most commonly used tasks to assess ToM. Regarding mental disorders, studies showed deficits in cognitive and affective ToM skills in ASD, SCZ, BPD, MDD and BP. Hypomentalization was mainly observed in ASD and MDD, while BPD and SCZ were featured by errors associated with hypermentalization. Studies in AN and SAD are scarce, but they mainly highlight a cognitive ToM deficit, with hypomentalization in AN and hypermentalization in ASD. In all of them, depressive symptomatology seems to be a critical moderator of ToM performance. Conclusions Although ToM impairments are well described for some mental disorders, more research is needed to reach solid conclusions for others. The use of different and heterogeneous ToM assessment instruments can strongly influence the results of studies. The study of ToM is essential to gain a better understanding of the diseases and to develop effective treatments targeting specific ToM deficits. Disclosure of Interest None Declared

Background: Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP. Methods: We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP. Findings: Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries. Interpretation: Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.

Background Tobacco is a highly prevalent substance of abuse in patients with psychosis. Previous studies have reported an association between tobacco use and schizophrenia. The aim of this study was to analyze the relationship between tobacco use and first-episode psychosis (FEP), age at onset of psychosis, and specific diagnosis of psychosis. Methods The sample consisted of 1105 FEP patients and 1355 controls from the European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study. We assessed substance use with the Tobacco and Alcohol Questionnaire and performed a series of regression analyses using case-control status, age of onset of psychosis, and diagnosis as outcomes and tobacco use and frequency of tobacco use as predictors. Analyses were adjusted for sociodemographic characteristics, alcohol, and cannabis use. Results After controlling for cannabis use, FEP patients were 2.6 times more likely to use tobacco [ p ⩽ 0.001; adjusted odds ratio (AOR) 2.6; 95% confidence interval (CI) [2.1–3.2]] and 1.7 times more likely to smoke 20 or more cigarettes a day ( p = 0.003; AOR 1.7; 95% CI [1.2–2.4]) than controls. Tobacco use was associated with an earlier age at psychosis onset ( β = −2.3; p ⩽ 0.001; 95% CI [−3.7 to −0.9]) and was 1.3 times more frequent in FEP patients with a diagnosis of schizophrenia than in other diagnoses of psychosis (AOR 1.3; 95% CI [1.0–1.8]); however, these results were no longer significant after controlling for cannabis use. Conclusions Tobacco and heavy-tobacco use are associated with increased odds of FEP. These findings further support the relevance of tobacco prevention in young populations.