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Chapter 5.2 - Causes and Outcome of Psychosis

Published online by Cambridge University Press:  04 April 2024

David Kingdon
Affiliation:
University of Southampton
Paul Rowlands
Affiliation:
Derbyshire Healthcare NHS foundation Trust
George Stein
Affiliation:
Emeritus of the Princess Royal University Hospital
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Summary

Psychosis is characterized by distortions in thinking (e.g. fixed, false beliefs), in perception (e.g. hearing voices or less commonly seeing things that are not there), emotions, language, sense of self and behaviour. Although it used to be thought that schizophrenia was a discrete entity, much recent evidence has shown that this is not so. Schizophrenia does not have clear boundaries; rather, it merges into schizoaffective disorder and bipolar disorder on the one hand and into schizotypal and paranoid personality on the other. It is best considered as the severe form of psychosis. The different psychotic disorders share some of the same risk factors and are sometimes associated with cognitive impairments, co-existing mental health conditions, substance misuse and physical health problems; the latter often develop over the course of the illness.

In this chapter, we review genetic and then environmental risk factors for psychosis. Much knowledge has accumulated regarding both in the last two decades. We now know that the aetiology of psychosis is multifactorial. Genetic and environmental factors occasionally act alone but usually in combination as well as operate at a number of levels and over time to influence an individual’s likelihood of developing psychotic symptoms.

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Publisher: Cambridge University Press
Print publication year: 2024

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References

Gottesman, II, Shields, J. Schizophrenia and Genetics: A Twin Study Vantage Point. New York, NY: Academic Press; 1972.Google Scholar
Cardno, AG, Marshall, EJ, Coid, B, et al. Heritability estimates for psychotic disorders: the Maudsley twin psychosis series. Archives of General Psychiatry 1999;56(2):162–8.CrossRefGoogle ScholarPubMed
Ingraham, LJ, Kety, SS. Adoption studies of schizophrenia. American Journal of Medical Genetics 2000;97(1):1822.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Gottesman, II, Shields, J. A polygenic theory of schizophrenia. Proceedings of the National Academy of Sciences of the United States of America 1967;58(1):199205.CrossRefGoogle ScholarPubMed
Duncan, LE, Ostacher, M, Ballon, J. How genome-wide association studies (GWAS) made traditional candidate gene studies obsolete. Neuropsychopharmacology 2019;44(9):1518–23.CrossRefGoogle ScholarPubMed
Horwitz, T, Lam, K, Chen, Y, et al. A decade in psychiatric GWAS research. Molecular Psychiatry 2019;24(3):378–89.CrossRefGoogle ScholarPubMed
Watson, HJ, Yilmaz, Z, Sullivan, PF. The Psychiatric Genomics Consortium: history, development, and the future. In: Baune, BT (ed.) Personalized Psychiatry. London, San Diego, CA, Cambridge, MA, Oxford: Academic Press; 2020:91101.CrossRefGoogle Scholar
Ripke, S, Walters, JT, O’Donovan, MC. Mapping genomic loci prioritises genes and implicates synaptic biology in schizophrenia. medRxiv 2020. DOI: 2020.09.12.20192922.Google Scholar
Schizophrenia Working Group of the Psychiatric Genomics Consortium. Biological insights from 108 schizophrenia-associated genetic loci. Nature 2014;511 :421–7.Google Scholar
Legge, SE, Santoro, ML, Periyasamy, S, et al. Genetic architecture of schizophrenia: a review of major advancements. Psychological Medicine 2021;51(13):110.CrossRefGoogle ScholarPubMed
Visscher, PM, Wray, NR, Zhang, Q, et al. 10 years of GWAS discovery: biology, function, and translation. American Journal of Human Genetics 2017;101(1):522.CrossRefGoogle ScholarPubMed
Vassos, E, Di Forti, M, Coleman, J, et al. An examination of polygenic score risk prediction in individuals with first-episode psychosis. Biological Psychiatry 2017;81(6):470–7.CrossRefGoogle ScholarPubMed
Murray, GK, Lin, T, Austin, J, et al. Could polygenic risk scores be useful in psychiatry? A review. JAMA Psychiatry 2021;78(2):210–9.CrossRefGoogle ScholarPubMed
Legge, SE, Cardno, AG, Allardyce, J, et al. Associations between schizophrenia polygenic liability, symptom dimensions, and cognitive ability in schizophrenia. JAMA Psychiatry 2021;78(2021):1143–51.CrossRefGoogle ScholarPubMed
Socrates, A, Maxwell, J, Glanville, KP, et al. Investigating the effects of genetic risk of schizophrenia on behavioural traits. NPJ Schizophrenia 2021;7(1):2.CrossRefGoogle ScholarPubMed
Ruderfer, DM, Fanous, AH, Ripke, S, et al. Polygenic dissection of diagnosis and clinical dimensions of bipolar disorder and schizophrenia. Molecular Psychiatry 2014;19 :1017–24.CrossRefGoogle Scholar
Bipolar Disorder and Schizophrenia Working Group of the Psychiatric Genomics Consortium. Genomic dissection of bipolar disorder and schizophrenia, including 28 subphenotypes. Cell 2018;173(7):1705–15.e16.Google Scholar
Quattrone, D, Reininghaus, U, Richards, AL, et al. The continuity of effect of schizophrenia polygenic risk score and patterns of cannabis use on transdiagnostic symptom dimensions at first-episode psychosis: findings from the EU-GEI study. Translational Psychiatry 2021;11(1):423.CrossRefGoogle ScholarPubMed
Singh, T, Kurki, MI, Curtis, D, et al. Rare loss-of-function variants in SETD1A are associated with schizophrenia and developmental disorders. Nature Neuroscience 2016;19(4):571–7.CrossRefGoogle ScholarPubMed
Rees, E, Kirov, G. Copy number variation and neuropsychiatric illness. Current Opinion in Genetics & Development 2021;68 :5763.CrossRefGoogle ScholarPubMed
Rogdaki, M, Gudbrandsen, M, Daly, E, et al. 142. State or trait? Investigation of dopamine function in individuals with 22q11 deletion. Schizophrenia Bulletin 2017;43 :S75.CrossRefGoogle Scholar
Hubbard, L, Rees, E, Morris, DW, et al. Rare copy number variants are associated with poorer cognition in schizophrenia. Biological Psychiatry 2021;90(1):2834.CrossRefGoogle ScholarPubMed
Kendall, KM, Bracher-Smith, M, Fitzpatrick, H, et al. Cognitive performance and functional outcomes of carriers of pathogenic copy number variants: analysis of the UK Biobank. British Journal of Psychiatry 2019;214(5):297304.CrossRefGoogle ScholarPubMed
Bergen, SE, Ploner, A, Howrigan, D, et al. Joint contributions of rare copy number variants and common SNPs to risk for schizophrenia. American Journal of Psychiatry 2019;176(1):2935.CrossRefGoogle ScholarPubMed
Lam, M, Chen, CY, Li, Z, et al. Comparative genetic architectures of schizophrenia in East Asian and European populations. Nature Genetics 2019;51(12):1670–8.CrossRefGoogle ScholarPubMed
Mills, MC, Rahal, C. A scientometric review of genome-wide association studies. Communications Biology 2019;2 :9.CrossRefGoogle ScholarPubMed
Alameda, L, Trotta, G, Quigley, H, et al. Can epigenetics shine a light on the biological pathways underlying major mental disorders? Psychological Medicine 2022;52(9):1645–65.CrossRefGoogle Scholar
Dempster, EL, Pidsley, R, Schalkwyk, LC, et al. Disease-associated epigenetic changes in monozygotic twins discordant for schizophrenia and bipolar disorder. Human Molecular Genetics 2011;20(24):4786–96.CrossRefGoogle ScholarPubMed
Hannon, E, Dempster, EL, Mansell, G, et al. DNA methylation meta-analysis reveals cellular alterations in psychosis and markers of treatment-resistant schizophrenia. eLife 2021;10:e58430.CrossRefGoogle ScholarPubMed
Murray, RM, Lewis, SW. Is schizophrenia a neurodevelopmental disorder? British Medical Journal (Clinical research ed.) 1987;295(6600):681–2.CrossRefGoogle ScholarPubMed
Cannon, M, Jones, PB, Murray, RM. Obstetric complications and schizophrenia: historical and meta-analytic review. American Journal of Psychiatry 2002;159(7):1080–92.CrossRefGoogle ScholarPubMed
Davies, C, Segre, G, Estradé, A, et al. Prenatal and perinatal risk and protective factors for psychosis: a systematic review and meta-analysis. The lancet. Psychiatry 2020;7(5):399410.CrossRefGoogle ScholarPubMed
Wortinger, LA, Engen, K, Barth, C, et al. Asphyxia at birth affects brain structure in patients on the schizophrenia-bipolar disorder spectrum and healthy participants. Psychological Medicine 2022;52(6):1050–59.CrossRefGoogle ScholarPubMed
Wortinger, LA, Engen, K, Barth, C, et al. Obstetric complications and intelligence in patients on the schizophrenia-bipolar spectrum and healthy participants. Psychological Medicine 2020;50(11):1914–22.CrossRefGoogle ScholarPubMed
Brown, AS, Derkits, EJ. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. American Journal of Psychiatry 2010 167(3):261–80.CrossRefGoogle ScholarPubMed
Malaspina, D, Corcoran, C, Fahim, C, et al. Paternal age and sporadic schizophrenia: evidence for de novo mutations. American Journal of Medical Genetics 2002;114(3):299303.CrossRefGoogle ScholarPubMed
Petersen, L, Mortensen, PB, Pedersen, CB. Paternal age at birth of first child and risk of schizophrenia. American Journal of Psychiatry 2011;168(1):82–8.CrossRefGoogle ScholarPubMed
Varese, F, Smeets, F, Drukker, M, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 2012;38(4),661–71.CrossRefGoogle ScholarPubMed
Bentall, RP, de Sousa, P, Varese, F, et al. From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology 2014;49(7):1011–22.CrossRefGoogle ScholarPubMed
Cullen, AE, Fisher, HL, Gullet, N, et al. Cortisol levels in childhood associated with emergence of attenuated psychotic symptoms in early adulthood. Biological Psychiatry 2022;91(2):226–35.CrossRefGoogle ScholarPubMed
Alameda, L, Rodriguez, V, Carr, E, et al. A systematic review on mediators between adversity and psychosis: potential targets for treatment. Psychological Medicine 2020;50(12):1966–76.CrossRefGoogle ScholarPubMed
Beards, S, Gayer-Anderson, C, Borges, S, et al. Life events and psychosis: a review and meta-analysis. Schizophrenia Bulletin 2013;39(4):740–47.CrossRefGoogle ScholarPubMed
Stilo, SA, Gayer-Anderson, C, Beards, S, et al. Further evidence of a cumulative effect of social disadvantage on risk of psychosis. Psychological Medicine 2017;47(5):913–24.CrossRefGoogle ScholarPubMed
Castle, DJ, Scott, K, Wessely, S, et al. Does social deprivation during gestation and early life predispose to later schizophrenia? Social Psychiatry and Psychiatric Epidemiology 1993;28(1):14.CrossRefGoogle ScholarPubMed
Morgan, C, Kirkbride, J, Leff, J, et al. Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychological Medicine 2007;37(4):495503.CrossRefGoogle ScholarPubMed
Bourque, F, van der Ven, E, Malla, A. A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 2011;41(5):897910.CrossRefGoogle ScholarPubMed
Jongsma, HE, Turner, C, Kirkbride, JB, et al. International incidence of psychotic disorders, 2002–17: a systematic review and meta-analysis. The Lancet. Public health 2019;4(5):e229e244.CrossRefGoogle ScholarPubMed
Tortelli, A, Errazuriz, A, Croudace, T, et al. Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950–2013. Social Psychiatry and Psychiatric Epidemiology 2015;50(7):1039–55.CrossRefGoogle ScholarPubMed
Selten, JP, Veen, N, Feller, W, et al. Incidence of psychotic disorders in immigrant groups to The Netherlands. British Journal of Psychiatry: The Journal of Mental Science 2001;178 :367–72.CrossRefGoogle ScholarPubMed
Hollander, AC, Dal, H, Lewis, G, et al. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ (Clinical research ed.) 2016;352 :i1030.Google ScholarPubMed
Oduola, S, Das-Munshi, J, Bourque, F, et al. Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. Psychological Medicine 2021;51(2):300–9.CrossRefGoogle ScholarPubMed
Boydell, J, van Os, J, McKenzie, K, et al. Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ (Clinical research ed.) 2001;323(7325):1336–8.CrossRefGoogle ScholarPubMed
Tarricone, I, D’Andrea, G, Jongsma, HE, et al. Migration history and risk of psychosis: results from the multinational EU-GEI study. Psychological Medicine 2022;52(14):113.CrossRefGoogle ScholarPubMed
Selten, JP, van Os, J, Cantor-Graae, E. The social defeat hypothesis of schizophrenia: issues of measurement and reverse causality. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) 2016;15(3):294–5.CrossRefGoogle ScholarPubMed
Morgan, C, Charalambides, M, Hutchinson, G, et al. Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 2010;36(4):655–64.CrossRefGoogle Scholar
Vassos, E, Pedersen, CB, Murray, RM, et al. Meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 2012;38(6):1118–23.CrossRefGoogle ScholarPubMed
Engemann, K, Pedersen, CB, Arge, L, et al. Childhood exposure to green space – A novel risk-decreasing mechanism for schizophrenia? Schizophrenia Research 2018;199 :142–8.CrossRefGoogle ScholarPubMed
Sara, GE, Large, MM, Matheson, SL, et al. Stimulant use disorders in people with psychosis: a meta-analysis of rate and factors affecting variation. Australian and New Zealand Journal of Psychiatry 2015;49(2):106–17.CrossRefGoogle ScholarPubMed
Gurillo, P, Jauhar, S, Murray, RM, et al. Does tobacco use cause psychosis? Systematic review and meta-analysis. The lancet. Psychiatry 2015;2(8):718–25.CrossRefGoogle ScholarPubMed
Di Forti, M, Marconi, A, Carra, E, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. The lancet. Psychiatry 2015;2(3):233–8.CrossRefGoogle ScholarPubMed
Di Forti, M, Morgan, C, Dazzan, P, et al. High-potency cannabis and the risk of psychosis. British Journal of Psychiatry: The Journal of Mental Science 2009;195(6):488–91.CrossRefGoogle ScholarPubMed
Marconi, A, Di Forti, M, Lewis, CM, et al. Meta-analysis of the association between the level of cannabis use and risk of psychosis. Schizophrenia Bulletin 2016;42(5):1262–9.CrossRefGoogle ScholarPubMed
Sherif, M, Radhakrishnan, R, D’Souza, DC, et al. Human laboratory studies on cannabinoids and psychosis. Biological Psychiatry 2016;79(7):526–38.CrossRefGoogle ScholarPubMed
Di Forti, M, Quattrone, D, Freeman, TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The lancet. Psychiatry 2019;6(5):427–36.CrossRefGoogle ScholarPubMed
Schoeler, T, Monk, A, Sami, MB, et al. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. The lancet. Psychiatry 2016;3(3):215–25.CrossRefGoogle ScholarPubMed
Cougnard, A, Marcelis, M, Myin-Germeys, I, et al. Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 2007;37(4):513–27.CrossRefGoogle ScholarPubMed
Stepniak, B, Papiol, S, Hammer, C, et al. Accumulated environmental risk determining age at schizophrenia onset: a deep phenotyping-based study. The lancet. Psychiatry 2014;1(6):444–53.CrossRefGoogle ScholarPubMed
Verdoux, H, van Os, J. Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research 2002;54(1–2):5965.CrossRefGoogle ScholarPubMed
Vassos, E, Sham, P, Kempton, M, et al. The Maudsley environmental risk score for psychosis. Psychological Medicine 2020;50(13):2213–20.CrossRefGoogle ScholarPubMed
Murray, RM, Ajnakina, O, David, A. Prevention of psychosis: moving on from the at-risk mental state to universal primary prevention. Psychological Medicine 2020;51(2):15Google ScholarPubMed
Murray, RM, Cannon, M. Public health psychiatry: an idea whose time has come. World Psychiatry: Official Journal of the World Psychiatric Association (WPA) 2021;20(2):222–3.CrossRefGoogle ScholarPubMed
Morgan, C, Lappin, J, Heslin, M, et al. Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychological Medicine 2014;44(13):2713–26. DOI: 10.1017/S0033291714000282. Erratum in: Psychological Medicine 2014;44(13):2727.Google ScholarPubMed
Lally, J, Ajnakina, O, Stubbs, B, et al. Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. British Journal of Psychiatry 2017;211(6):350–8. DOI: 10.1192/bjp.bp.117.201475.CrossRefGoogle ScholarPubMed
Demjaha, A, Morgan, K, Morgan, C, et al. Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? Psychological Medicine 2009;39(12):1943–55. DOI: 10.1017/S0033291709990651.CrossRefGoogle ScholarPubMed
Murray, RM, Mondelli, V, Stilo, SA, et al. The influence of risk factors on the onset and outcome of psychosis: What we learned from the GAP study. Schizophrenia Research 2020;225:63–8. DOI: 10.1016/j.schres.2020.01.011.CrossRefGoogle ScholarPubMed
Ajnakina, O, Lally, J, Di Forti, M, et al. Utilising symptom dimensions with diagnostic categories improves prediction of time to first remission in first-episode psychosis. Schizophrenia Research 2018;193:391–8. DOI: 10.1016/j.schres.2017.07.042.CrossRefGoogle ScholarPubMed
Kotov, R, Fochtmann, L, Li, K, et al. Declining clinical course of psychotic disorders over the two decades following first hospitalization: evidence from the Suffolk County Mental Health Project. American Journal of Psychiatry 2017;174(11):1064–74. DOI: 10.1176/appi.ajp.2017.16101191.CrossRefGoogle ScholarPubMed
Velthorst, E, Fett, AJ, Reichenberg, A, et al. The 20-year longitudinal trajectories of social functioning in individuals with psychotic disorders. American Journal of Psychiatry 2017;174(11):1075–85. DOI: 10.1176/appi.ajp.2016.15111419.CrossRefGoogle ScholarPubMed
Melau, M, Jeppesen, P, Thorup, A, et al. The effect of five years versus two years of specialised assertive intervention for first episode psychosis – OPUS II: study protocol for a randomized controlled trial. Trials 2011;12:72. DOI: 10.1186/1745-6215-12-72.CrossRefGoogle ScholarPubMed
Cotton, SM, Filia, KM, Ratheesh, A, et al. Early psychosis research at Orygen, The National Centre of Excellence in Youth Mental Health. Social Psychiatry and Psychiatric Epidemiology 2016;51(1):113. DOI: 10.1007/s00127-015-1140-0.CrossRefGoogle ScholarPubMed
Harrow, M, Jobe, TH, Faull, RN. Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multifollow-up study. Psychological Medicine 2014;44 :3007–16.CrossRefGoogle ScholarPubMed
Hjorthøj, C, Stürup, AE, McGrath, JJ, et al. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017;4(4):295301CrossRefGoogle ScholarPubMed
Caponnetto, P, Polosa, R, Robson, D, et al. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychological Research 2020;8(1):9042. DOI:10.4081/hpr.2020.9042CrossRefGoogle ScholarPubMed
Schoenbaum, M, Sutherland, JM, Chappel, A, et al. Twelve-month health care use and mortality in commercially insured young people with incident psychosis in the United States. Schizophrenia Bulletin 2017;43(6):1262–72. DOI: 10.1093/schbul/sbx009.CrossRefGoogle ScholarPubMed
Challis, S, Nielssen, O, Harris, A, et al. Systematic meta-analysis of the risk factors for deliberate self-harm before and after treatment for first-episode psychosis. Acta Psychiatrica Scandinavica 2013;127(6):442–54. DOI: 10.1111/acps.12074.CrossRefGoogle ScholarPubMed
Ajnakina, O, Stubbs, B, Francis, E, et al. Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies. Psychological Medicine 2020;50(6):9911001. DOI: 10.1017/S0033291719000904.CrossRefGoogle ScholarPubMed
Leucht, S, Tardy, M, Komossa, K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012;379(9831):2063–71. DOI: 10.1016/S0140-6736(12)60239-6.CrossRefGoogle ScholarPubMed
Volavka, J, Vevera, J. Very long-term outcome of schizophrenia. International Journal of Clinical Practice 2018;72(7):e13094. DOI: 10.1111/ijcp.13094.CrossRefGoogle ScholarPubMed
Murray, RM, Quattrone, D, Natesan, S, et al. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? British Journal of Psychiatry 2016;209(5):361–5. DOI: 10.1192/bjp.bp.116.182683.CrossRefGoogle ScholarPubMed
Taipale, H, Tanskanen, A, Mehtälä, J, et al. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020;19(1):61–8. DOI: 10.1002/wps.20699.CrossRefGoogle Scholar
Whitaker, R. Viewpoint: do antipsychotics protect against early death? A critical view. Psychological Medicine 2020,50(16):2643–52. DOI: 10.1017/S003329172000358X.CrossRefGoogle Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, et al. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 2013;70(9):913–20.CrossRefGoogle ScholarPubMed
Wils, RS, Gotfredsen, DR, Hjorthøj, C, et al. Antipsychotic medication and remission of psychotic symptoms 10years after a first-episode psychosis. Schizophrenia Research 2017;182:42–8. DOI: 10.1016/j.schres.2016.10.030.CrossRefGoogle ScholarPubMed
Gafoor, R, Nitsch, D, McCrone, P, et al. Effect of early intervention on 5-year outcome in non-affective psychosis. British Journal of Psychiatry 2010;196(5):372–6. DOI:10.1192/bjp.bp.109.066050CrossRefGoogle ScholarPubMed
Schoeler, T, Monk, A, Sami, MB, et al. Continued versus discontinued cannabis use in patients with psychosis: a systematic review and meta-analysis. Lancet Psychiatry 2016;3(3):215–25. DOI: 10.1016/S2215-0366(15)00363-6.CrossRefGoogle ScholarPubMed
Schoeler, T, Petros, N, Di Forti, M, et al. Association between continued cannabis use and risk of relapse in first-episode psychosis: a quasi-experimental investigation within an observational study. JAMA Psychiatry 2016;73(11):1173–79. DOI: 10.1001/jamapsychiatry.2016.2427.CrossRefGoogle ScholarPubMed
Agid, O, Arenovich, T, Sajeev, G, et al. An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. Journal of Clinical Psychiatry 2011;72(11):1439–44. DOI: 10.4088/JCP.09m05785yel.Google ScholarPubMed
Kahn, RS, Winter van Rossum, I, Leucht, S, et al. Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching study. Lancet Psychiatry 2018;5(10):797807. DOI: 10.1016/S2215-0366(18)30252-9.CrossRefGoogle ScholarPubMed
Howes, OD, McCutcheon, R, Agid, O, et al. Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. American Journal of Psychiatry 2017;174(3):216–29.CrossRefGoogle Scholar
Lally, J, Tully, J, Robertson, D, et al. Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: a systematic review and meta-analysis. Schizophrenia Research 2016;171(1–3):215–24. DOI: 10.1016/j.schres.2016.01.024.CrossRefGoogle ScholarPubMed
Demjaha, A, Lappin, JM, Stahl, D, et al. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychological Medicine 2017;47(11):1981–9. DOI: 10.1017/S0033291717000435.CrossRefGoogle ScholarPubMed
Mizrahi, R, Addington, J, Rusjan, PM, et al. Increased stress-induced dopamine release in psychosis. Biological Psychiatry 2012;71(6):561–67.CrossRefGoogle ScholarPubMed
Legge, SE, Dennison, CA, Pardiñas, AF, et al. Clinical indicators of treatment-resistant psychosis. British Journal of Psychiatry 2020;216(5):259–66. DOI: 10.1192/bjp.2019.120.CrossRefGoogle ScholarPubMed
van Erp, TGM, Walton, E, Hibar, DP, et al. Cortical brain abnormalities in 4474 indviduals with schizophrenia and 5098 control subjects via the enhancing neuro imaging genetics through meta analysis (ENIGMA) consortium. Biological Psychiatry 2018;84(9):644–54.CrossRefGoogle Scholar
Keshavan, MS, Anderson, S, Pettegrew, M. Is schizophrenia due to excessive synaptic pruning in the prefrontal cortex? The Feinberg hypothesis revisited. Journal of Psychiatric Research 1994;28(3):239–65.CrossRefGoogle ScholarPubMed
Stone, WS, Phillip, MR, Yang, LH, et al. Neurodegenerative model of schizophrenia: growing evidence to support a revisit. Schizophrenia Research 2022;243:154–62CrossRefGoogle ScholarPubMed
Murray, RM, Bora, E, Modinos, E, et al. Schizophrenia: a developmental disorder with risk of non-specific and avoidable decline. Schizophrenia Research 2022;243:181–6.CrossRefGoogle ScholarPubMed
Jablensky, A, Sartorius, N, Ernberg, G, et al. Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 1992;20:197.CrossRefGoogle ScholarPubMed
Asher, L, Fekadu, A, Hanlon, C. Global mental health and schizophrenia. Current Opinion in Psychiatry 2018;31(3):193–9.CrossRefGoogle ScholarPubMed
Cohen, A, Patel, V, Thara, R, et al. Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophrenia Bulletin 2008;34(2):229–44.Google ScholarPubMed
Stubbs, B, Koyanagi, A, Veronese, N, et al. Physical multimorbidity and psychosis: comprehensive cross sectional analysis including 242,952 people across 48 low- and middle-income countries. BMC Medicine 2016;14(1):189.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Carta, MG, Matschinger, H, et al. Cultural differences in stigma surrounding schizophrenia: comparison between Central Europe and North Africa. British Journal of Psychiatry 2016;208(4):389–97.CrossRefGoogle ScholarPubMed
Lora, A, Kohn, R, Levav, I, et al. Service availability and utilization and treatment gap for schizophrenic disorders: a survey in 50 low- and middle-income countries. Bulletin of the World Health Organization 2012;90(1):4754, 54a-54b.CrossRefGoogle ScholarPubMed
Labys, CA, Susser, E, Burns, JK. Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights. International Journal of Mental Health Systems 2016;10:57.CrossRefGoogle ScholarPubMed
Lilford, P, Wickramaseckara Rajapakshe, OB, Singh, SP. A systematic review of care pathways for psychosis in low-and middle-income countries. Asian Journal of Psychiatry 2020;54:102237. DOI: 10.1016/j.ajp.2020.102237.CrossRefGoogle ScholarPubMed
Barbui, C, Purgato, M, Abdulmalik, J, et al. Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review. Lancet Psychiatry 2020;7(2):162–72. DOI: 10.1016/S2215-0366(19)30511-5.CrossRefGoogle ScholarPubMed

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