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German psychiatrist Kurt Schneider proposed the concept of first-rank symptoms (FRS) of schizophrenia in 1959. However, their relevance for diagnosis and prediction of treatment response are still unclear. Most studies have investigated FRS in chronic or medicated patients. The present study sought to evaluate whether FRS predict remission, response, or improvement in functionality in antipsychotic-naive first-episode psychosis. Methods: Follow-up study of 100 patients at first episode of psychosis (FEP), with no previous treatment, assessed at baseline and after 2 months of treatment. The participants were evaluated with the standardized Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) and for presence of FRS. Results: Logistic regression analysis showed that, in this sample, up to three individual FRS predicted remission: voices arguing, voices commenting on one's actions, and thought broadcasting. Conclusion: Specific FRS may predict remission after treatment in FEP patients. This finding could give new importance to Kurt Schneider's classic work by contributing to future updates of diagnostic protocols and improving estimation of prognosis.

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Background: There is a growing interest in environmental and social determinants of mental health. However, how distance to healthcare and public transportation affect illness is neglected in schizophrenia research. Here, we are interested in how the availability of mental healthcare and the ways to reach it may be associated with psychosis. Aims: We aim to investigate the association between distances to healthcare units and subway stations and duration of untreated psychosis (DUP) and greater initial severity in an antipsychotic-naïve first episode of psychosis (FEP) sample. Method: Using 212 untreated FEP patients’ data, we calculated the distances from their residences to the places of interest. Diagnoses comprehended schizophrenia spectrum disorders, depressive and bipolar affective disorders, and substance-induced disorders. Linear regressions were performed with distances as independent variables, DUP and Positive and Negative Syndrome Scale (PANSS) scores as dependent variables. Results: Longer distance to emergency mental healthcare was related to longer DUP (95% CI: p = .034, B = 0.152) and higher total PANSS (95% CI: p = .007, B = 0.0189); longer distance to community mental healthcare units was related to longer DUP (95% CI: p = .004, B = 0.0204) and higher total PANSS (95% CI: p = .030, B = 0.152). Moreover, a longer distance to the closest subway station predicted longer DUP (95% CI: p = .019, B = 0.170). Conclusion: Our results indicate that poor healthcare access is related to longer DUP and higher initial PANSS scores. Future research should investigate how investments in mental health access and actions to improve public transport access could impact DUP and treatment outcomes in psychosis patients.

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BackgroundFormal thought disorder (FTD) is a multidimensional dysfunction characterized by inability to maintain a coherent speech in spoken or written language, poor social cognition and disorganized thought itself.Presence of formal thought disorder has been associated with poor prognosis in schizophrenia, but the association with treatment response is yet to be determinate. Formal thought disorder has a close relation to disorganized symptoms in schizophrenia, which were independently associated with treatment resistance and poor response to standard antipsychotics. Formal thought disorder investigation could provide a clinical construct better delimited to assess disorganized symptoms in schizophrenia.We investigated the association between FTD, remission and treatment resistance in patients with schizophrenia.MethodsThis study reunite a sample of 213 patients, between 14 and 69 years, who met DSM-IV criteria for schizophrenia.The analyses were conducted in two samples conducted independently. In both samples, Diagnostic evaluation was performed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), response to treatment was primarily assessed through PANSS, functional impairment was assessed by GAF and disease severity, by CGI. The first sample was a follow-up study that enrolled inpatients. Participants were rated at baseline and after four weeks of antipsychotic treatment. If the participant did not reduce a minimum of 40% of baseline PANSS, the antipsychotic was switched. If the participant did not reduce a minimum of 40% in total PANSS in the following antipsychotic trial, the participant was considered as treatment resistant schizophrenia (TRS) and clozapine, introduced. The second sample was enrolled in an outpatient clinic specialized in schizophrenia.Illness remission was defined as a severity of mild (score of 3 on a scale of 1 to 7) or less for P1, P2, P3, G9, G5, N1, N4 and N6 PANSS`s items.To stablish FTD severity, PANSS items related to high scores at the Thought and Language Index (TLI) were considered: P2, P6, N1, N2, N5, N6, G7 and G9.ResultsMost subjects were male (56.8%) and the mean age was 34.42 (±12.33 SD).The FTD failed to associate with remission (t = 4.007, p = 0,491) or treatment resistance (t = -3.768, p = 0.988) in both samples.FTD had a negative correlation with GAF (r = -0.473, p<0.01) and a positive correlation with CGI (r = 0.530, p<0.01).DiscussionFTD had a stronger association with global functioning and severity measures, rather than treatment symptomatic outcomes. In future studies, we will investigate whether FTD show distinctive clinical features commonly related to disorganized syndrome, i.e. earlier age of onset.