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Transl Psychiatry. 2019 Jan 17;9(1):20. doi: 10.1038/s41398-018-0366-5.

Stratification and prediction of remission in first-episode psychosis patients: the OPTiMiSE cohort study.

Author information

1
Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France.
2
Université Paris Est Créteil, Faculté de Medicine Institut, National de la Santé et de la Recherche Médicale, Créteil, France.
3
Université Côte d'Azur, Centre National de la Recherche Scientifique, Laboratoire Informatique Signaux et Systèmes de Sophia Antipolis, Sophia Antipolis, France.
4
Assistance Publique Hôpitaux de Marseille, Marseille, France.
5
Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands.
6
Department of Medical and Biological Psychology, University of Bergen, Bergen, Norway.
7
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany.
8
Department of Psychosis Studies, Institute of Psychiatry, National Institute for Health Research, Mental Health Biomedical Research Centre, King's College London, London, UK.
9
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
10
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Medical University Innsbruck, Innsbruck, Austria.
11
Department of Psychiatry, University of Halle, Halle, Germany.
12
Faculty of Health and Medical Sciences, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, University of Copenhagen, Copenhagen, Denmark.
13
Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
14
John Hopkins School of Medicine, The John Hopkins Hospital, Baltimore, USA.
15
Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic. Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.
16
Université Paris Est Créteil, Faculté de Medicine Institut, National de la Santé et de la Recherche Médicale, Créteil, France. marion.leboyer@inserm.fr.
17
Assistance Publique Hôpitaux de Paris, Pole de Psychiatrie et Addictologie, Hopitaux Universitaires Henri Mondor, Créteil, France. marion.leboyer@inserm.fr.
18
Fondation Fondamental, Hôpital Albert Chenevier Pôle de Psychiatrie, Créteil, France. marion.leboyer@inserm.fr.
19
Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France. nicolas.glaichenhaus@unice.fr.
20
Fondation Fondamental, Hôpital Albert Chenevier Pôle de Psychiatrie, Créteil, France. nicolas.glaichenhaus@unice.fr.

Abstract

Early response to first-line antipsychotic treatments is strongly associated with positive long-term symptomatic and functional outcome in psychosis. Unfortunately, attempts to identify reliable predictors of treatment response in first-episode psychosis (FEP) patients have not yet been successful. One reason for this could be that FEP patients are highly heterogeneous in terms of symptom expression and underlying disease biological mechanisms, thereby impeding the identification of one-size-fits-all predictors of treatment response. We have used a clustering approach to stratify 325 FEP patients into four clinical subtypes, termed C1A, C1B, C2A and C2B, based on their symptoms assessed using the Positive and Negative Syndrome Scale (PANSS) scale. Compared to C1B, C2A and C2B patients, those from the C1A subtype exhibited the most severe symptoms and were the most at risk of being non-remitters when treated with the second-generation antipsychotic drug amisulpride. Before treatment, C1A patients exhibited higher serum levels of several pro-inflammatory cytokines and inflammation-associated biomarkers therefore validating our stratification approach on external biological measures. Most importantly, in the C1A subtype, but not others, lower serum levels of interleukin (IL)-15, higher serum levels of C-X-C motif chemokine 12 (CXCL12), previous exposure to cytomegalovirus (CMV), use of recreational drugs and being younger were all associated with higher odds of being non-remitters 4 weeks after treatment. The predictive value of this model was good (mean area under the curve (AUC) = 0.73 ± 0.10), and its specificity and sensitivity were 45 ± 0.09% and 83 ± 0.03%, respectively. Further validation and replication of these results in clinical trials would pave the way for the development of a blood-based assisted clinical decision support system in psychosis.

PMID:
30655509
PMCID:
PMC6336802
DOI:
10.1038/s41398-018-0366-5
[Indexed for MEDLINE]
Free PMC Article

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