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Premorbid and Prodromal Functioning As Predictors at Onset of Psychosis: a First-Episode Study

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Premorbid and Prodromal Functioning As Predictors at Onset of Psychosis: a First-Episode Study Premorbid and Prodromal Functioning as Predictors at Onset of Psychosis: A First-Episode Study Ana Barajas Vélez The work described in this thesis was performed at the Parc Sanitari Sant Joan de Déu of Sant Boi de Llobregat (Barcelona, Spain), at the Hospital Sant Joan de Déu of Esplugues de Llobregat (Barcelona, Spain) and at the Department of Clinical and Health Psychology of the Faculty of Psychology, Universitat Autònoma de Barcelona of Cerdanyola del Vallès (Barcelona, Spain). It was financially supported by Fondo de Investigaciones Sanitarias (FIS PI05/1115) Instituto de Salud Carlos III (Spain), Centro de Investigación en Red de Salud Mental (CIBERSAM) (Spain), Caja Navarra (Spain) and Fundació Marató de TV3 (Catalonia, Spain). Moreover, two grants were awarded to the author of this thesis to carry out stays in several centers of reference for research in first-episode psychosis. One of them was at the Birmingham Early Intervention Service (EIS) of Birmingham and Solihull Mental Health NHS Foundation Trust (Birmingham, United Kingdom), and at the School of Psychology, University of Birmingham (Birmingham, United Kingdom), financed by Fondo de Investigación Sanitaria del Instituto Carlos III, Ministerio de Investigación e Innovación (Spain). Another was at the Department of Research of the Adolescent Psychiatry Unit, University Hospital Gregorio Marañón (Madrid, Spain), financed by Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Premorbid and Prodromal Functioning as Predictors at Onset of Psychosis: A First-Episode Study Doctoral Thesis ANA BARAJAS VELEZ Directors: Prof. Dr. Jordi E. Obiols Llandrich Dr. Susana Ochoa Güerre Barcelona, December 2015 Doctorat en Psicopatologia de l’infant, l’adolescent i l’adult Departament de Psicologia Clínica i de la Salut. Facultat de Psicologia Universitat Autònoma de Barcelona To my family and especially David and Unai In memory of Marta Barceló and Jaume Autonell Acknowledgments Hace 9 años, tal día como hoy, llamaba a la puerta del despacho del Prof. J.E. Obiols para informarme acerca de un programa de doctorado con la idea de continuar mis estudios de Psicología. Aquel día no era consciente de que estaba empezando una ‘carrera de fondo’, que iba a suponerme momentos de gran satisfacción, pero también otros de cierto sacrificio y esfuerzo. El desarrollo de esta tesis doctoral ha seguido un camino paralelo al desarrollo de otros acontecimientos vitales de gran importancia para mí. Esta tesis ha sido testigo de algunos cambios, por ejemplo, a nivel laboral con mi incorporación al mundo laboral en el área de la salud mental o, ya en la última etapa, a nivel personal con el nacimiento de Unai. Haciendo balance, todos estos años han supuesto un período de gran enriquecimiento no sólo a nivel intelectual sino también a nivel personal, puesto que me ha permitido conocer y compartir esta experiencia con personas de gran valía. Gracias por vuestro tiempo, conocimiento, comprensión, paciencia, amistad, entusiasmo y apoyo. Tras estos años tan intensos, y después de coger aliento en varias ocasiones para poder continuar en esta carrera de fondo, parece que ha llegado ese momento tan esperado, ‘la meta’. En cierto modo, supone cerrar un capítulo para continuar avanzando. Es ahora cuando realmente siento la satisfacción del trabajo realizado, de los fines de semanas en casa y de las veces que he tenido que decir ‘no puedo, tengo tesis’. No obstante, todo el esfuerzo realizado ha valido la pena, pues me ha permitido vivir experiencias que de otro modo no hubiera sido posible, cómo aproximarme a la mente humana y conocer de cerca algunas experiencias vitales de los pacientes y sus familias. A ellos quiero dedicar especialmente esta tesis doctoral, pues sin su colaboración y generosidad no hubiera sido posible realizar este trabajo que supone una pequeña contribución al entendimiento del desarrollo de los trastornos psicóticos. A mis directores de tesis… Jordi, gracias por estar siempre ahí, por la confianza depositada y por darme la oportunidad de iniciar mi carrera investigadora. Te agradezco que hayas aceptado dirigir esta tesis doctoral. Es un placer haber podido contar en este trabajo con alguien de tu nivel y experiencia profesional. Gracias por compartir una parte conmigo. Susana, gracias por tantas y tantas cosas… pero sobretodo por tu apoyo y generosidad. Has sido y eres un referente para mí. Gracias por abrirme las puertas al mundo laboral, por compartir conmigo parte de tu experiencia profesional, por tu sentido común, por tu paciencia, por tener siempre un momento y, por supuesto,… por tu amistad. To international researchers that have contributed in some way at the devolopment of this thesis… I would like to thank the Birmingham Early Intervention Service (EIS) of the Birmingham and Solihull Mental Health NHS Foundation Trust, in particular its clinical director, Prof. Max Birchwood, for giving me the opportunity to conduct a training period with two of their clinical teams: Birmingham East and North (BEN) Team and Early Detection & Intervention (ED:IT) Team. I want to emphasize not only his professional quality and talent, which have been instrumental in my development as a researcher and which have served me as a guide and inspiration for the development of this thesis, but also for his kindness, time and support. To Chris Jackson, who was my supervisor in research topics during the stay in the EIS of Birmingham, I thank you for your interest in my thesis and suggestions made concerning some of the articles. By the way, whenever you want please repeat your visit to Barcelona with your family; it was very nice! To the BEN Team, especially Mark Bernard, for his patience, generosity and invaluable help in the day-to-day activities during the stay, as well as, for sharing moments of his family life. To Amanda Skeate and her ED:IT team for their dedication, support and giving me the opportunity to share the daily clinical work in patients’ follow-up. Thanks to Linda Mcarthy, who was always available with a smile when sought. Finally, for his great human qualities, the admiration that he engenders in me, and his selfless disposition I would like to thank Prof. Heinz Häfner for his advice during my training career as a researcher. Thank you for being my inspiration from the beginning of the thesis. It has been a real pleasure to count on your collaboration and I hope that it continues for a long time. Al tribunal de la tesis doctoral… Prof. Vázquez-Barquero, Dra. Modinos, Dr. Penadés, Dra. Pousa y Dra. Ruíz, gracias por mostrar interés en este trabajo de investigación y por formar parte del tribunal de esta tesis. Sin duda este trabajo de investigación adquiere mayor rigurosidad gracias a vuestra experiencia y prestigio. A las distintas fuentes de financiación… Gracias al Fondo de Investigaciones Sanitarias del Instituto de Salud Carlos III, al Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), a Caja Navarra y a la Fundació Marató de TV3, por apoyar este tipo de investigación y permitir que sea posible ampliar la evidencia científica en esta área de conocimiento. A los profesionales de la Unitat de Docència, Recerca i Innovació del Parc Sanitari Sant Joan de Déu, y especialmente … A Judith Usall, perquè has estat no només una gran mestra per mi, sinó també una gran consellera i amiga. Admiro els teus valors, la teva energia i l’entusiasme per les coses en les que realment creus. A Josep Maria Haro, perquè has estat un referent des dels meus inicis en la recerca en salut mental, a qui sempre he tingut gran admiració per la seva capacitat de treball. A Aida Farreny, Victoria Villalta, Raquel Iniesta, Vanesa Carral, Ana Fernández, Marcelo Pezzimenti, David Suárez, Elena Romero, Janina Carlson, Alexandrina Foix, Jaume Autonell, Montserrat Fusté, Elena Rubio, Raquel López,… (y una larga lista de compañeros/as con los que he compartido algún momento en mis primeros años como investigadora en el Parc Sanitari Sant Joan de Déu),… y muy especialmente a Marta Barceló (siempre en mi mente!), Helena Huerta (un gran descubrimiento!) y Iris Baños (compañera de batalla!). Al grupo GENIPE del estudio de “Diferencias de género en primeros episodios psicóticos”, y en especial a Trini Peláez, Maria Arteaga y Olga González. Gracias por vuestro tesón y esfuerzo para sacar adelante uno de los artículos de esta tesis. Vuestra experiencia clínica ha sido de gran ayuda. A los profesionales del servicio de Psiquiatría/Psicología del Hospital Infanto-Juvenil de Sant Joan de Déu y especialmente … A Bernardo Sánchez, Montserrat Dolz, Daniel Muñoz, Marta Pardo y Ana Torres. Vosotros habéis sido testigos de mis primeros pasos en este mundo de la investigación y con vosotros me he formado. Gracias por esas sesiones clínicas con las que tanto he aprendido. Y gracias por vuestra colaboración e implicación en el proyecto y por hacer la investigación algo más fácil. A los profesionales del Centre d’Higiene Mental Les Corts y especialmente … A Lluís Lalucat, por compartir parte de su conocimiento y experiencia día tras día, lo que me ha permitido crecer como profesional. Gracias por apostar por la investigación y dar continuidad a mi trayectoria profesional en el campo de la psicosis. Gracias por hacer la vida laboral más sencilla! A los profesionales del equipo de psicosis incipiente (PAE-TPI), Maite San Emeterio, Maite Carbonero, Carolina Franco, Elena Sánchez, Amparo Escudero, Natalia Mantecón, Juanjo Gil, Mercè Teixidó, Elisenda Conesa, Irene Álvarez, Mª Antonia Argany, Judith Anglès, Isabel Cebrià, Elena González, Francisco Villegas, Ana Aznar, Raquel Rubio y … al resto de profesionales que se han ido añadiendo al equipo posteriormente. Gracias por compartir vuestra práctica clínica y por lo que cada uno de vosotros me enseñáis en el día a día. Os agradezco vuestro apoyo en las tareas de investigación! A los profesionales de la Unidad de Investigación y Docencia, Àngels Ciutat, Rocío Casañas, Laia Mas, Gemma Boix, Noemí Riera, Rosa Muriente y Aida Valls.
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