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Husain MO, Hawke LD, Lu Y, Kozloff N, Strudwick G, Kiang M, Wang W, Castle D, Foussias G. A mixed-methods study to evaluate the feasibility and preliminary efficacy of delivering the optimal health program (OHP) for youth at clinical high risk (CHR) for psychosis: A study protocol. PLoS One 2024; 19:e0306968. [PMID: 39024237 PMCID: PMC11257342 DOI: 10.1371/journal.pone.0306968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Individuals with clinical high risk (CHR) for psychosis experience significant distress, impaired general functioning and a high lifetime risk of self-harm and attempted suicide. The CHR period is an important phase in an individual's mental health where appropriate interventions may reduce the risk of progression to several negative outcomes, including the development of schizophrenia. Given that up to 80% of individuals with CHR have another diagnosable mental illness and almost half experience poor psychosocial functioning, developing interventions that address psychosocial functioning in young people with CHR is of great importance. This mixed-methods study aims to employ qualitative and quantitative methods to adapt an evidence-based comprehensive psychosocial and mental health self-efficacy program, the Optimal Health Program (OHP), and evaluate the feasibility, acceptability and preliminary clinical efficacy in young people with CHR. We aim to recruit 30 CHR participants (age 16-29 years) in a single-arm 12-week exploratory clinical trial. Feasibility metrics will include recruitment, retention, and data completion rates. Acceptability will be informed by the Client Satisfaction Questionnaire. Clinical assessments (psychosis spectrum symptoms, depression, and anxiety), functional measures, and cognitive outcomes will be completed at study entry and repeated post-intervention at 12-weeks. We will run pre-post test data analysis to examine changes following engagement in the OHP intervention. Qualitative interviews will be conducted post-intervention to further evaluate the acceptability of the intervention and the trial design, and will be analyzed using thematic analysis. OHP may enhance the long-term mental health, well-being and functioning of CHR youth. However, the intervention must first be adapted to a CHR population; then, the feasibility and preliminary efficacy of delivering an intervention tailored around the varied needs of the CHR group must be established before a larger-scale appropriately powered study is pursued. Trial registration: The trial is registered with ClinicalTrials.gov NCT05757128.
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Affiliation(s)
- Muhammad. Omair Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa D. Hawke
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Yun Lu
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Kiang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- Department of Psychiatry, University of Tasmania, Tasmania, Australia
- Centre for Mental Health Service Innovation, Statewide Mental Health Service, Tasmania, Australia
| | - George Foussias
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Lo Buglio G, Boldrini T, Polari A, Fiorentino F, Nelson B, Solmi M, Lingiardi V, Tanzilli A. Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder. Front Psychol 2024; 15:1381864. [PMID: 38966724 PMCID: PMC11223645 DOI: 10.3389/fpsyg.2024.1381864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/06/2024] Open
Abstract
Aims To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations. Methods We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023. Results 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting "clinical high at risk mental state" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders. Conclusion The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries. Systematic Review Registration https://osf.io/8mz7a.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Byrne JF, Healy C, Föcking M, Susai SR, Mongan D, Wynne K, Kodosaki E, Heurich M, de Haan L, Hickie IB, Smesny S, Thompson A, Markulev C, Young AR, Schäfer MR, Riecher-Rössler A, Mossaheb N, Berger G, Schlögelhofer M, Nordentoft M, Chen EYH, Verma S, Nieman DH, Woods SW, Cornblatt BA, Stone WS, Mathalon DH, Bearden CE, Cadenhead KS, Addington J, Walker EF, Cannon TD, Cannon M, McGorry P, Amminger P, Cagney G, Nelson B, Jeffries C, Perkins D, Cotter DR. Proteomic Biomarkers for the Prediction of Transition to Psychosis in Individuals at Clinical High Risk: A Multi-cohort Model Development Study. Schizophr Bull 2024; 50:579-588. [PMID: 38243809 PMCID: PMC11059811 DOI: 10.1093/schbul/sbad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Psychosis risk prediction is one of the leading challenges in psychiatry. Previous investigations have suggested that plasma proteomic data may be useful in accurately predicting transition to psychosis in individuals at clinical high risk (CHR). We hypothesized that an a priori-specified proteomic prediction model would have strong predictive accuracy for psychosis risk and aimed to replicate longitudinal associations between plasma proteins and transition to psychosis. This study used plasma samples from participants in 3 CHR cohorts: the North American Prodrome Longitudinal Studies 2 and 3, and the NEURAPRO randomized control trial (total n = 754). Plasma proteomic data were quantified using mass spectrometry. The primary outcome was transition to psychosis over the study follow-up period. Logistic regression models were internally validated, and optimism-corrected performance metrics derived with a bootstrap procedure. In the overall sample of CHR participants (age: 18.5, SD: 3.9; 51.9% male), 20.4% (n = 154) developed psychosis within 4.4 years. The a priori-specified model showed poor risk-prediction accuracy for the development of psychosis (C-statistic: 0.51 [95% CI: 0.50, 0.59], calibration slope: 0.45). At a group level, Complement C8B, C4B, C5, and leucine-rich α-2 glycoprotein 1 (LRG1) were associated with transition to psychosis but did not surpass correction for multiple comparisons. This study did not confirm the findings from a previous proteomic prediction model of transition from CHR to psychosis. Certain complement proteins may be weakly associated with transition at a group level. Previous findings, derived from small samples, should be interpreted with caution.
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Affiliation(s)
- Jonah F Byrne
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Melanie Föcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Subash Raj Susai
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - David Mongan
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Kieran Wynne
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eleftheria Kodosaki
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK
| | - Meike Heurich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Jena, Germany
| | - Andrew Thompson
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Connie Markulev
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Alison Ruth Young
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Miriam R Schäfer
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | | | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Monika Schlögelhofer
- BioPsyC—Biopsychosocial Corporation, Non-profit Association for Research Funding Ltd, Vienna, Austria
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Research Unit (CORE), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eric Y H Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Swapna Verma
- Office of Education, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Psychosis & East Region, Institute of Mental Health, Singapore, Singapore
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Mental Health Service 116d, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Biobehavioral Sciences and Psychology, University of California, Los Angeles, CA, USA
| | | | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Pat McGorry
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Paul Amminger
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Gerard Cagney
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Clark Jeffries
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - David R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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Hou Y, Xia H, He T, Zhang B, Qiu G, Chen A. N2 Responses in Youths With Psychosis Risk Syndrome and Their Association With Clinical Outcomes: A Cohort Follow-Up Study Based on the Three-Stimulus Visual Oddball Paradigm. Am J Psychiatry 2024; 181:330-341. [PMID: 38419496 DOI: 10.1176/appi.ajp.20221013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Schizophrenia often occurs during youth, and psychosis risk syndrome occurs before the onset of psychosis. The aim of this study was to determine whether the visual event-related potential responses in youths with psychosis risk syndrome were defective in the presence of interference stimuli and associated with their clinical outcomes. METHODS A total of 223 participants, including 122 patients with psychosis risk syndrome, 50 patients with emotional disorders, and 51 healthy control subjects, were assessed. Baseline EEG was recorded during the three-stimulus visual oddball task. The event-related potentials induced by square pictures with different colors were measured. Almost all patients with psychosis risk syndrome were followed up for 12 months and were reclassified into three subgroups: conversion, symptomatic, and remission. The differences in baseline event-related potential responses were compared among the clinical outcome subgroups. RESULTS The average N2 amplitude of the psychosis risk syndrome group was significantly less negative than that in the healthy control group (d=0.53). The baseline average N2 amplitude in the conversion subgroup was significantly less negative than that in the symptomatic (d=0.58) and remission (d=0.50) subgroups and in the healthy control group (d=0.97). The average N2 amplitude did not differ significantly between the symptomatic and remission subgroups (d=0.02). However, it was significantly less negative in the symptomatic and remission subgroups than in the healthy control group (d=0.46 and d=0.38). No statistically significant results were found in the P3 response. CONCLUSIONS Youths with psychosis risk syndrome had significant N2 amplitude defects in attention processing with interference stimuli. N2 amplitude shows potential as a prognostic biomarker of clinical outcome in the psychosis risk syndrome.
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Affiliation(s)
- Yongqing Hou
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
| | - Haishuo Xia
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
| | - Tianbao He
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
| | - Bohua Zhang
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
| | - Guiping Qiu
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
| | - Antao Chen
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China (Hou, Xia, Zhang); Clinical Laboratory of Psychiatry, Mental Health Center of Guangyuan, Sichuan, China (Hou, He); College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia (Zhang); College of Teacher Education, Ningxia University, Yinchuan, China (Qiu); School of Psychology, Shanghai University of Sport, Shanghai, China (Chen)
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5
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Lepock JR, Sanches M, Ahmed S, Gerritsen CJ, Korostil M, Mizrahi R, Kiang M. N400 event-related brain potential index of semantic processing and two-year clinical outcomes in persons at high risk for psychosis: A longitudinal study. Eur J Neurosci 2024; 59:1877-1888. [PMID: 37386749 DOI: 10.1111/ejn.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
The N400 event-related brain potential (ERP) semantic priming effect reflects greater activation of contextually related versus unrelated concepts in long-term semantic memory. Deficits in this measure have been found in persons with schizophrenia and those at clinical high risk (CHR) for this disorder. In CHR patients, we previously found that these deficits predict poorer social functional outcomes after 1 year. In the present study, we tested whether these deficits predicted greater psychosis-spectrum symptom severity and functional impairment over 2 years. We measured N400 semantic priming effects at baseline in CHR patients (n = 47) who viewed prime words each followed by a related/unrelated target word at stimulus-onset asynchronies (SOAs) of 300 or 750 ms. We measured psychosis-spectrum symptoms using the Structured Interview for Prodromal Symptoms and role and social functioning with the Global Functioning: Role and Social scales, at baseline, 1 (n = 29) and 2 years (n = 25). There was a significant interaction between the N400 semantic priming effect at the 300-ms SOA and time on GF:Role scores, indicating that, contrary to expectations, smaller baseline N400 semantic priming effects were associated with more improvement in role functioning from baseline to Year 1, but baseline N400 priming effects did not predict role functioning at Year 2. N400 priming effects were not significantly associated with different trajectories in psychosis-spectrum symptoms or social functioning. Thus, CHR patients' N400 semantic priming effects did not predict clinical outcomes over 2 years, suggesting that this ERP measure may have greater value as a state or short-term prognostic neurophysiological biomarker.
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Affiliation(s)
| | - Marcos Sanches
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Ahmed
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Cory J Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michele Korostil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Romina Mizrahi
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Michael Kiang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Spiteri-Staines AE, Yung AR, Lin A, Hartmann JA, Amminger P, McGorry PD, Thompson A, Wood SJ, Nelson B. Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study. Schizophr Bull 2024:sbae005. [PMID: 38366898 DOI: 10.1093/schbul/sbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline. AIMS This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated. STUDY DESIGN The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline). RESULTS Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up. CONCLUSIONS The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.
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Affiliation(s)
- Anneliese E Spiteri-Staines
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, 161 Barry St, Carlton 3053, Australia
| | - Alison R Yung
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3320, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia
| | - Jessica A Hartmann
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Paul Amminger
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Patrick D McGorry
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Stephen J Wood
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
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7
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Şahin D, Kambeitz-Ilankovic L, Wood S, Dwyer D, Upthegrove R, Salokangas R, Borgwardt S, Brambilla P, Meisenzahl E, Ruhrmann S, Schultze-Lutter F, Lencer R, Bertolino A, Pantelis C, Koutsouleris N, Kambeitz J. Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis. Br J Psychiatry 2024; 224:55-65. [PMID: 37936347 DOI: 10.1192/bjp.2023.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce. AIMS To evaluate fairness in prediction models for development of psychosis and functional outcome. METHOD Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements. RESULTS Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions. CONCLUSIONS Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.
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Affiliation(s)
- Derya Şahin
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; and Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Dominic Dwyer
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; and Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, UK; and Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Stefan Borgwardt
- Department of Psychiatry (University Psychiatric Clinics, UPK), University of Basel, Basel, Switzerland; and Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; and University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; and Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Nikolaos Koutsouleris
- Department of Psychology, Faculty of Psychology and Educational Sciences, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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8
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Krcmar M, Wannan CMJ, Lavoie S, Allott K, Davey CG, Yuen HP, Whitford T, Formica M, Youn S, Shetty J, Beedham R, Rayner V, Murray G, Polari A, Gawęda Ł, Koren D, Sass L, Parnas J, Rasmussen AR, McGorry P, Hartmann JA, Nelson B. The self, neuroscience and psychosis study: Testing a neurophenomenological model of the onset of psychosis. Early Interv Psychiatry 2024; 18:153-164. [PMID: 37394278 DOI: 10.1111/eip.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023]
Abstract
AIM Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12-month follow-up. METHODS SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months. RESULTS This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures. CONCLUSIONS The SNAP study will test whether neurophenomenological disturbances associated with basic self-disturbance predict persistence or intensification of UHR symptomatology over a 2-year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis.
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Affiliation(s)
- Marija Krcmar
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cassandra M J Wannan
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher G Davey
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Whitford
- School of Psychology, University of New South Wales (UNSW), Kensington, New South Wales, Australia
| | - Melanie Formica
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Youn
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jashmina Shetty
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Beedham
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Graham Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Polari
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Dan Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Louis Sass
- Department of Clinical Psychology, GSAPP-Rutgers University, Piscataway, New Jersey, USA
| | - Josef Parnas
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
| | - Andreas R Rasmussen
- Orygen, Parkville, Parkville, Victoria, Australia
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick McGorry
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica A Hartmann
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barnaby Nelson
- Orygen, Parkville, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Hou Y, Qiu G, Xia H, He T, Liu X, Chen A. The specificity of the auditory P300 responses and its association with clinical outcomes in youth with psychosis risk syndrome. Int J Clin Health Psychol 2024; 24:100437. [PMID: 38292829 PMCID: PMC10825643 DOI: 10.1016/j.ijchp.2024.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Schizophrenia often occurs in youth, and psychosis risk syndrome (PRS) occurs before the onset of psychosis. Assessing the neuropsychological abnormalities of PRS individuals can help in early identification and active intervention of mental illness. Auditory P300 amplitude defect is an important manifestation of attention processing abnormality in PRS, but it is still unclear whether there are abnormalities in the attention processing of rhythmic compound tone stimuli in PRS individuals, and whether the P300 amplitude induced by these stimuli is specific to PRS individuals and related to their clinical outcomes. Methods In total, 226 participants, including 122 patients with PRS, 51 patients with emotional disorders (ED), and 53 healthy controls (HC) were assessed. Baseline electroencephalography was recorded during the compound tone oddball task. The event-related potentials (ERPs) induced by rhythmic compound tone stimuli of two frequencies (20-Hz, 40-Hz) were measured. Almost all patients with PRS were followed up for 12 months and reclassified into four groups: PRS-conversion, PRS-symptomatic, PRS-emotional disorder, and PRS-complete remission. The differences in baseline ERPs were compared among the clinical outcome groups. Results Regardless of the stimulation frequency, the average P300 amplitude were significantly higher in patients with PRS than in those with ED (p = 0.003, d = 0.48) and in HC (p = 0.002, d = 0.44) group. The average P300 amplitude of PRS-conversion group was significantly higher than that of the PRS-complete remission (p = 0.016, d = 0.72) and HC group (p = 0.001, d = 0.76), and the average P300 amplitude of PRS-symptomatic group was significantly higher than that of the HC group (p = 0.006, d = 0.48). Regardless of the groups (PRS, ED, HC) or the PRS clinical outcome groups, the average P300 amplitude induced by 20-Hz tone stimulation was significantly higher than that induced by 40-Hz stimulation (ps < 0.001, Ƞ2 = 0.074-0.082). The average reaction times of PRS was significantly faster than that of ED (p = 0.01, d = 0.38), and the average reaction times of the participants to 20-Hz target stimulation was significantly faster than that to 40-Hz target stimulation (p < 0.001, d = 0.21). Conclusion The auditory P300 amplitude induced by rhythmic compound tone stimuli is a specific electrophysiological manifestation of PRS, and the auditory P300 amplitude induced by compound tone stimuli shows promise as a putative prognostic biomarker for PRS clinical outcomes, including conversion to psychosis and clinical complete remission.
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Affiliation(s)
- Yongqing Hou
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
- Mental Health Center of Guangyuan, Sichuan, China
| | - Guiping Qiu
- College of Teacher Education, Ningxia University, Yinchuan, China
| | - Haishuo Xia
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, China
| | - Tianbao He
- Mental Health Center of Guangyuan, Sichuan, China
| | - Xiaoxian Liu
- Faculty of Education, Henan Normal University, Xinxiang, China
| | - Antao Chen
- School of Psychology, Research Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai, China
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10
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Kapler S, Adery L, Hoftman GD, Amir CM, Grigoryan V, Cooper ZD, Bearden CE. Assessing evidence supporting cannabis harm reduction practices for adolescents at clinical high-risk for psychosis: a review and clinical implementation tool. Psychol Med 2024; 54:245-255. [PMID: 37882050 DOI: 10.1017/s0033291723002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Cannabis use is consistently associated with both increased incidence of frank psychotic disorders and acute exacerbations of psychotic symptoms in healthy individuals and people with psychosis spectrum disorders. Although there is uncertainty around causality, cannabis use may be one of a few modifiable risk factors for conversion to psychotic disorders in individuals with Clinical High Risk for Psychosis (CHR-P) syndromes, characterized by functionally impairing and distressing subthreshold psychotic symptoms. To date, few recommendations beyond abstinence to reduce adverse psychiatric events associated with cannabis use have been made. This narrative review synthesizes existing scientific literature on cannabis' acute psychotomimetic effects and epidemiological associations with psychotic disorders in both CHR-P and healthy individuals to bridge the gap between scientific knowledge and practical mental health intervention. There is compelling evidence for cannabis acutely exacerbating psychotic symptoms in CHR-P, but its impact on conversion to psychotic disorder is unclear. Current evidence supports a harm reduction approach in reducing frequency of acute psychotic-like experiences, though whether such interventions decrease CHR-P individuals' risk of conversion to psychotic disorder remains unknown. Specific recommendations include reducing frequency of use, lowering delta-9-tetrahydrocannabinol content in favor of cannabidiol-only products, avoiding products with inconsistent potency like edibles, enhancing patient-provider communication about cannabis use and psychotic-like experiences, and utilizing a collaborative and individualized therapeutic approach. Despite uncertainty surrounding cannabis' causal association with psychotic disorders, cautious attempts to reduce acute psychosis risk may benefit CHR-P individuals uninterested in abstinence. Further research is needed to clarify practices associated with minimization of cannabis-related psychosis risk.
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Affiliation(s)
- Simon Kapler
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura Adery
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Gil D Hoftman
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Carolyn M Amir
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Vardui Grigoryan
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
| | - Ziva D Cooper
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
- UCLA Center for Cannabis and Cannabinoids, University of California, Los Angeles, CA, USA
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
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11
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Michel C, Lerch S, Büetiger JR, Flückiger R, Cavelti M, Koenig J, Kaess M, Kindler J. An ecological momentary assessment study of age effects on perceptive and non-perceptive clinical high-risk symptoms of psychosis. Eur Child Adolesc Psychiatry 2023; 32:1841-1852. [PMID: 35585271 PMCID: PMC9116495 DOI: 10.1007/s00787-022-02003-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/30/2022] [Indexed: 11/15/2022]
Abstract
Among individuals with clinical high risk for psychosis (CHR), perceptive symptoms are more frequent but have less clinical significance in children/adolescents compared to adults. However, findings are based on clinical interviews relying on patient's recall capacity. Ecological momentary assessment (EMA) can be used to explore experiences in real-time in the subject's daily life. The aim of this study was to assess frequency and stability of (perceptive and non-perceptive) CHR symptoms and to explore potential age effects. EMA was used in a sample of an early detection for psychosis service in Bern, Switzerland (N = 66; 11-36 years). CHR symptoms were recorded in random time intervals for seven days: eight assessments per day per subject, minimum time between prompts set at 25 min. CHR symptoms were additionally assessed with semi-structured interviews including the 'Structured Interview for Psychosis-Risk Syndromes' and the 'Schizophrenia Proneness Instruments'. Mixed-effects linear regression analysis on the frequency of CHR symptoms revealed a significant effect of age group, and the interaction CHR symptoms x age group for both perceptive and non-perceptive symptoms. Further, regarding stability of CHR symptoms, there was a significant effect of the interaction CHR symptoms x age group for perceptive symptoms only. Based on EMA, perceptive CHR symptoms were more frequently reported but less stable in children/adolescents compared with adults. Together with previous findings, our finding of higher instability/variability of perceptive symptoms in younger persons might suggest that with advancing age and more stability of CHR symptoms, clinical relevance (reduced psychosocial functioning) may increase.
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Affiliation(s)
- C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - S Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - J R Büetiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - R Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - M Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - J Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - J Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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12
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Magnani L, Carmisciano L, dell'Orletta F, Bettinardi O, Chiesa S, Imbesi M, Limonta G, Montagna E, Turone I, Martinasso D, Aguglia A, Serafini G, Amore M, Amerio A, Costanza A, Sibilla F, Calcagno P, Patti S, Molino G, Escelsior A, Trabucco A, Marzano L, Brunato D, Ravelli AA, Cappucciati M, Fiocchi R, Guerzoni G, Maravita D, Macchetti F, Mori E, Paglia CA, Roscigno F, Saginario A. Linguistic profile automated characterisation in pluripotential clinical high-risk mental state (CHARMS) conditions: methodology of a multicentre observational study. BMJ Open 2023; 13:e066642. [PMID: 36948562 PMCID: PMC10040055 DOI: 10.1136/bmjopen-2022-066642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Language is usually considered the social vehicle of thought in intersubjective communications. However, the relationship between language and high-order cognition seems to evade this canonical and unidirectional description (ie, the notion of language as a simple means of thought communication). In recent years, clinical high at-risk mental state (CHARMS) criteria (evolved from the Ultra-High-Risk paradigm) and the introduction of the Clinical Staging system have been proposed to address the dynamicity of early psychopathology. At the same time, natural language processing (NLP) techniques have greatly evolved and have been successfully applied to investigate different neuropsychiatric conditions. The combination of at-risk mental state paradigm, clinical staging system and automated NLP methods, the latter applied on spoken language transcripts, could represent a useful and convenient approach to the problem of early psychopathological distress within a transdiagnostic risk paradigm. METHODS AND ANALYSIS Help-seeking young people presenting psychological distress (CHARMS+/- and Clinical Stage 1a or 1b; target sample size for both groups n=90) will be assessed through several psychometric tools and multiple speech analyses during an observational period of 1-year, in the context of an Italian multicentric study. Subjects will be enrolled in different contexts: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Mental Health Department-territorial mental services (ASL 3-Genoa), Genoa, Italy; and Mental Health Department-territorial mental services (AUSL-Piacenza), Piacenza, Italy. The conversion rate to full-blown psychopathology (CS 2) will be evaluated over 2 years of clinical observation, to further confirm the predictive and discriminative value of CHARMS criteria and to verify the possibility of enriching them with several linguistic features, derived from a fine-grained automated linguistic analysis of speech. ETHICS AND DISSEMINATION The methodology described in this study adheres to ethical principles as formulated in the Declaration of Helsinki and is compatible with International Conference on Harmonization (ICH)-good clinical practice. The research protocol was reviewed and approved by two different ethics committees (CER Liguria approval code: 591/2020-id.10993; Comitato Etico dell'Area Vasta Emilia Nord approval code: 2022/0071963). Participants will provide their written informed consent prior to study enrolment and parental consent will be needed in the case of participants aged less than 18 years old. Experimental results will be carefully shared through publication in peer-reviewed journals, to ensure proper data reproducibility. TRIAL REGISTRATION NUMBER DOI:10.17605/OSF.IO/BQZTN.
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Affiliation(s)
- Luca Magnani
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Felice dell'Orletta
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Ornella Bettinardi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Silvia Chiesa
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Massimiliano Imbesi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Giuliano Limonta
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Elisa Montagna
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Ilaria Turone
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Dario Martinasso
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Andrea Aguglia
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Mario Amore
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Andrea Amerio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Department of Psychiatry, Service of Adult Psychiatry (SPA), University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Francesca Sibilla
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Pietro Calcagno
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Sara Patti
- Department of Mental Health and Pathological Addictions, Genoa Local Authority, Genoa, Liguria, Italy
| | - Gabriella Molino
- Department of Mental Health and Pathological Addictions, Genoa Local Authority, Genoa, Liguria, Italy
| | - Andrea Escelsior
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alice Trabucco
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Lisa Marzano
- Departement of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Dominique Brunato
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Andrea Amelio Ravelli
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Marco Cappucciati
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Roberta Fiocchi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Gisella Guerzoni
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Davide Maravita
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Fabio Macchetti
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Elisa Mori
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Chiara Anna Paglia
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Federica Roscigno
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Antonio Saginario
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
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Sefik E, Boamah M, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan MS, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Woods SW, Cannon TD, Walker EF. Sex- and Age-Specific Deviations in Cerebellar Structure and Their Link With Symptom Dimensions and Clinical Outcome in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:350-363. [PMID: 36394426 PMCID: PMC10016422 DOI: 10.1093/schbul/sbac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical high-risk (CHR) period offers a temporal window into neurobiological deviations preceding psychosis onset, but little attention has been given to regions outside the cerebrum in large-scale studies of CHR. Recently, the North American Prodrome Longitudinal Study (NAPLS)-2 revealed altered functional connectivity of the cerebello-thalamo-cortical circuitry among individuals at CHR; however, cerebellar morphology remains underinvestigated in this at-risk population, despite growing evidence of its involvement in psychosis. STUDY DESIGN In this multisite study, we analyzed T1-weighted magnetic resonance imaging scans obtained from N = 469 CHR individuals (61% male, ages = 12-36 years) and N = 212 healthy controls (52% male, ages = 12-34 years) from NAPLS-2, with a focus on cerebellar cortex and white matter volumes separately. Symptoms were rated by the Structured Interview for Psychosis-Risk Syndromes (SIPS). The outcome by two-year follow-up was categorized as in-remission, symptomatic, prodromal-progression, or psychotic. General linear models were used for case-control comparisons and tests for volumetric associations with baseline SIPS ratings and clinical outcomes. STUDY RESULTS Cerebellar cortex and white matter volumes differed between the CHR and healthy control groups at baseline, with sex moderating the difference in cortical volumes, and both sex and age moderating the difference in white matter volumes. Baseline ratings for major psychosis-risk dimensions as well as a clinical outcome at follow-up had tissue-specific associations with cerebellar volumes. CONCLUSIONS These findings point to clinically relevant deviations in cerebellar cortex and white matter structures among CHR individuals and highlight the importance of considering the complex interplay between sex and age when studying the neuromaturational substrates of psychosis risk.
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Affiliation(s)
- Esra Sefik
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Human Genetics, Emory University, Atlanta, GA, USA
| | - Michelle Boamah
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- Mental Health Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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14
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Loch AA, Lopes-Rocha AC, Fekih-Romdhane F, van de Bilt MT, Salazar de Pablo G, Fusar-Poli P. Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries. Front Psychiatry 2023; 14:1148862. [PMID: 37113551 PMCID: PMC10126325 DOI: 10.3389/fpsyt.2023.1148862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Background The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC. Methods A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT. Results A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll. Discussion Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
- *Correspondence: Alexandre Andrade Loch,
| | - Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Psychiatry Ibn Omrane, The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Tunis, Tunisia
| | - Martinus Theodorus van de Bilt
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Gonzalo Salazar de Pablo
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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15
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Identification of texture MRI brain abnormalities on first-episode psychosis and clinical high-risk subjects using explainable artificial intelligence. Transl Psychiatry 2022; 12:481. [PMID: 36385133 PMCID: PMC9668814 DOI: 10.1038/s41398-022-02242-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Structural MRI studies in first-episode psychosis and the clinical high-risk state have consistently shown volumetric abnormalities. Aim of the present study was to introduce radiomics texture features in identification of psychosis. Radiomics texture features describe the interrelationship between voxel intensities across multiple spatial scales capturing the hidden information of underlying disease dynamics in addition to volumetric changes. Structural MR images were acquired from 77 first-episode psychosis (FEP) patients, 58 clinical high-risk subjects with no later transition to psychosis (CHR_NT), 15 clinical high-risk subjects with later transition (CHR_T), and 44 healthy controls (HC). Radiomics texture features were extracted from non-segmented images, and two-classification schemas were performed for the identification of FEP vs. HC and FEP vs. CHR_NT. The group of CHR_T was used as external validation in both schemas. The classification of a subject's clinical status was predicted by importing separately (a) the difference of entropy feature map and (b) the contrast feature map, resulting in classification balanced accuracy above 72% in both analyses. The proposed framework enhances the classification decision for FEP, CHR_NT, and HC subjects, verifies diagnosis-relevant features and may potentially contribute to identification of structural biomarkers for psychosis, beyond and above volumetric brain changes.
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16
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Lo Buglio G, Pontillo M, Cerasti E, Polari A, Schiano Lomoriello A, Vicari S, Lingiardi V, Boldrini T, Solmi M. A network analysis of anxiety, depressive, and psychotic symptoms and functioning in children and adolescents at clinical high risk for psychosis. Front Psychiatry 2022; 13:1016154. [PMID: 36386985 PMCID: PMC9650363 DOI: 10.3389/fpsyt.2022.1016154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Youths at clinical high risk for psychosis (CHR-P) are characterized by a high prevalence of anxiety and depressive disorders. The present study aimed at developing and analyzing a network structure of CHR-P symptom domains (i.e., positive, negative, disorganization, and general subclinical psychotic symptoms), depressive and anxiety symptoms, and general functioning. Methods Network analysis was applied to data on 111 CHR-P children and adolescents (M age = 14.1), who were assessed using the Structured Interview for Prodromal Syndromes, the Children's Depression Inventory, the Children's Global Assessment Scale, and the Multidimensional Anxiety Scale for Children. Results In the network, negative and disorganization symptoms showed the strongest association (r = 0.71), and depressive and anxiety symptoms showed dense within-domain connections, with a main bridging role played by physical symptoms of anxiety. The positive symptom cluster was not associated with any other node. The network stability coefficient (CS) was slightly below 0.25, and observed correlations observed ranged from 0.35 to 0.71. Conclusion The lack of association between subclinical positive symptoms and other network variables confirmed the independent nature of subclinical positive symptoms from comorbid symptoms, which were found to play a central role in the analyzed network. Complex interventions should be developed to target positive and comorbid symptoms, prioritizing those with the most significant impact on functioning and the most relevance for the young individual, through a shared decision-making process. Importantly, the results suggest that negative and disorganization symptoms, as well as depressive and anxiety symptoms, may be targeted simultaneously.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Erika Cerasti
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Istituto Nazionale di Statistica (Istat), Rome, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Stefano Vicari
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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17
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Cheng N, Lin A, Bowden S, Gao C, Yung AR, Nelson B, Thompson A, Yuen HP, Brewer WJ, Cagliarini D, Bruxner A, Simmons M, Broussard C, Pantelis C, McGorry PD, Allott K, Wood SJ. Intelligence trajectories in individuals at ultra-high risk for psychosis: An 8-year longitudinal analysis. Schizophr Res 2022; 248:140-148. [PMID: 36055017 DOI: 10.1016/j.schres.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/29/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Cognitive impairment is a well-documented predictor of transition to a full-threshold psychotic disorder amongst individuals at ultra-high risk (UHR) for psychosis. However, less is known about whether change in cognitive functioning differs between those who do and do not transition. Studies to date have not examined trajectories in intelligence constructs (e.g., acquired knowledge and fluid intelligence), which have demonstrated marked impairments in individuals with schizophrenia. This study aimed to examine intelligence trajectories using longitudinal data spanning an average of eight years, where some participants completed assessments over three time-points. Participants (N = 139) at UHR for psychosis completed the Wechsler Abbreviated Scale of Intelligence (WASI) at each follow-up. Linear mixed-effects models mapped changes in WASI Full-Scale IQ (FSIQ) and T-scores on Vocabulary, Similarities, Block Design, and Matrix Reasoning subtests. The sample showed stable and improving trajectories for FSIQ and all subtests. There were no significant differences in trajectories between those who did and did not transition to psychosis and between individuals with good and poor functional outcomes. However, although not significant, the trajectories of the acquired knowledge subtests diverged between transitioned and non-transitioned individuals (β = -0.12, 95 % CI [-0.29, 0.05] for Vocabulary and β = -0.14, 95 % CI [-0.33, 0.05] for Similarities). Overall, there was no evidence for long-term deterioration in intelligence trajectories in this UHR sample. Future studies with a larger sample of transitioned participants may be needed to explore potential differences in intelligence trajectories between UHR transition groups and other non-psychosis outcomes.
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Affiliation(s)
- Nicholas Cheng
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Caroline Gao
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison R Yung
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England, UK; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew Thompson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Warrick J Brewer
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Annie Bruxner
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Magenta Simmons
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christina Broussard
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology, University of Birmingham, Edgbaston, UK.
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18
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Diamond A, Silverstein SM, Keane BP. Visual system assessment for predicting a transition to psychosis. Transl Psychiatry 2022; 12:351. [PMID: 36038544 PMCID: PMC9424317 DOI: 10.1038/s41398-022-02111-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 01/19/2023] Open
Abstract
The field of psychiatry is far from perfect in predicting which individuals will transition to a psychotic disorder. Here, we argue that visual system assessment can help in this regard. Such assessments have generated medium-to-large group differences with individuals prior to or near the first psychotic episode or have shown little influence of illness duration in larger samples of more chronic patients. For example, self-reported visual perceptual distortions-so-called visual basic symptoms-occur in up to 2/3rds of those with non-affective psychosis and have already longitudinally predicted an impending onset of schizophrenia. Possibly predictive psychophysical markers include enhanced contrast sensitivity, prolonged backward masking, muted collinear facilitation, reduced stereoscopic depth perception, impaired contour and shape integration, and spatially restricted exploratory eye movements. Promising brain-based markers include visual thalamo-cortical hyperconnectivity, decreased occipital gamma band power during visual detection (MEG), and reduced visually evoked occipital P1 amplitudes (EEG). Potentially predictive retinal markers include diminished cone a- and b-wave amplitudes and an attenuated photopic flicker response during electroretinography. The foregoing assessments are often well-described mechanistically, implying that their findings could readily shed light on the underlying pathophysiological changes that precede or accompany a transition to psychosis. The retinal and psychophysical assessments in particular are inexpensive, well-tolerated, easy to administer, and brief, with few inclusion/exclusion criteria. Therefore, across all major levels of analysis-from phenomenology to behavior to brain and retinal functioning-visual system assessment could complement and improve upon existing methods for predicting which individuals go on to develop a psychotic disorder.
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Affiliation(s)
- Alexander Diamond
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
- Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA
| | - Brian P Keane
- Department of Psychiatry, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA.
- Department of Neuroscience, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, USA.
- Center for Visual Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA.
- Department of Brain & Cognitive Sciences, University of Rochester, 358 Meliora Hall, NY, Rochester, USA.
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Kiyono T, Ando S, Morishima R, Fujikawa S, Kanata S, Morimoto Y, Endo K, Yamasaki S, Usami S, Hiraiwa-Hasegawa M, Nishida A, Kasai K. Sex-based differences in the longitudinal association between autistic traits and positive psychotic experiences in adolescents: A population-based cohort study. Schizophr Res 2022; 246:1-6. [PMID: 35696856 DOI: 10.1016/j.schres.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/11/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Previous reports have suggested a cross-sectional association between autistic traits and psychotic experiences (PEs) in adolescents. However, while both autistic traits and PEs show sex-related differences, no studies have directly assessed whether such differences exist in the longitudinal association between autistic traits and PEs. Using a population-based adolescent cohort sample (n = 3007), we tested whether the longitudinal association between autistic traits and positive PEs was affected by sex-based differences using regression analyses. Autistic traits were assessed at 12 years old (timepoint 1 [T1]), and PEs were assessed at 12 and 14 years old (T1 and T2). Subsequently, we tested whether subdomains of autistic traits (difficulties in social interaction, communication, imagination, attention to detail, and attention switching) were associated with subtypes of PEs (auditory hallucinations, visual hallucinations, and delusions) using structural equation modeling, after controlling for PEs at T1, socio-economic status, school performance and parents' psychiatric disorders. After controlling for PEs at T1, we did not find any associations between autistic traits at T1 and PEs at T2 in both sexes. There was no significant positive or negative association between all subdomains of autistic traits and subtypes of PEs in both sexes. Autistic traits do not seem to predict future PEs in general adolescents regardless of sex.
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Affiliation(s)
- Tomoki Kiyono
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ryo Morishima
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; The Health Care Science Institute, Tokyo, Japan
| | - Shinya Fujikawa
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuko Morimoto
- Department of Psychology, Ube Frontier University, Yamaguchi, Japan
| | - Kaori Endo
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Usami
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), Japan
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20
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Carpenter JS, Scott J, Iorfino F, Crouse JJ, Ho N, Hermens DF, Cross SPM, Naismith SL, Guastella AJ, Scott EM, Hickie IB. Predicting the emergence of full-threshold bipolar I, bipolar II and psychotic disorders in young people presenting to early intervention mental health services. Psychol Med 2022; 52:1990-2000. [PMID: 33121545 DOI: 10.1017/s0033291720003840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of 'at-risk' cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population. METHOD Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12-30) presenting to mental health services. RESULTS Of 2330 individuals assessed longitudinally, 4.3% (n = 100) met criteria for new-onset FT BD and 2.2% (n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression. CONCLUSIONS Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.
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Affiliation(s)
- Joanne S Carpenter
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jan Scott
- Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, England
- Diderot University, Sorbonne City, Paris, France
| | - Frank Iorfino
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Jacob J Crouse
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Shane P M Cross
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
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Further evidence that antipsychotic medication does not prevent long-term psychosis in higher-risk individuals. Eur Arch Psychiatry Clin Neurosci 2022; 272:591-602. [PMID: 34536114 DOI: 10.1007/s00406-021-01331-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/09/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Although existing guidelines have discouraged use of antipsychotics for general clinical high-risk (CHR) individuals, it is unclear if antipsychotics can prevent psychosis in higher-risk population. We aimed to study the comparative real-world effectiveness of antipsychotic treatments for preventing psychosis in higher-risk CHR individuals. METHODS A total of 300 CHR individuals were identified using the structured interview for prodromal syndromes (SIPS) and followed the participants for 3 years. In total, 228(76.0%) individuals completed baseline assessments using the NAPLS-2 risk calculator (NAPLS-2-RC), and 210(92.1%) completed the follow-up. The sample was further stratified according to risk level. "Higher-risk" was defined based on the NAPLS-2-RC risk score (≥ 20%) and SIPS positive symptom total scores (≥ 10). The main outcome was conversion to psychosis and poor functional outcomes, defined as a global assessment of function (GAF) score lower than 60 at follow-up. RESULTS In higher-risk CHR individuals, we found no significant difference in the rate of conversion to psychosis or poor functional outcomes between the antipsychotic and no-antipsychotic groups. Low-risk individuals treated with antipsychotic drugs were more likely exhibit poor functional outcomes compared with the no-antipsychotics group(NAPLS-2-RC estimated risk: χ2 = 8.330, p = 0.004; Positive symptom severity: χ2 = 12.997, p < 0.001). No significant effective factors were identified for prevention of the conversion to psychosis; conversely, CHR individuals who were treated with high dose antipsychotics (olanzapine, aripiprazole) showed a significantly increased risk of poor functional outcomes. CONCLUSIONS In CHR individuals, antipsychotic treatment should be provided with caution because of the risk of poor functional outcomes. Further, antipsychotic treatment does not appear to prevent onset of psychosis in real-world settings.
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22
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Amminger GP, Lin A, Kerr M, Weller A, Spark J, Pugh C, O'Callaghan S, Berger M, Clark SR, Scott JG, Baker A, McGregor I, Cotter D, Sarnyai Z, Thompson A, Yung AR, O'Donoghue B, Killackey E, Mihalopoulos C, Yuen HP, Nelson B, McGorry PD. Cannabidiol for at risk for psychosis youth: A randomized controlled trial. Early Interv Psychiatry 2022; 16:419-432. [PMID: 34190422 DOI: 10.1111/eip.13182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND No biological treatment has been firmly established for the at-risk stage of psychotic disorder. In this study we aim to test if subthreshold psychotic symptoms can be effectively treated with cannabidiol (CBD), a non-psychoactive compound of the plant Cannabis sativa. The question has taken on increased importance in the wake of evidence questioning both the need and efficacy of specific pharmacological interventions in the ultra-high risk (UHR) for psychosis group. METHODS Three-arm randomized controlled trial of 405 patients (135 per arm) aged 12-25 years who meet UHR for psychosis criteria. The study includes a 6-week lead-in phase during which 10% of UHR individuals are expected to experience symptom remission. Participants will receive CBD (per oral) at doses 600 or 1000 mg per day (fixed schedule) for 12 weeks. Participants in the third arm of the trial will receive matching placebo capsules. Primary outcome is severity of positive psychotic symptoms as measured by the Comprehensive Assessment of At-Risk Mental States at 12 weeks. We hypothesize that CBD will be significantly more effective than placebo in improving positive psychotic symptoms in UHR patients. All participants will also be followed up 6 months post baseline to evaluate if treatment effects are sustained. CONCLUSION This paper reports on the rationale and protocol of the Cannabidiol for At Risk for psychosis Youth (CanARY) study. This study will test CBD for the first time in the UHR phase of psychotic disorder.
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Affiliation(s)
- G Paul Amminger
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Melissa Kerr
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Amber Weller
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jessica Spark
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Charlotte Pugh
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Sally O'Callaghan
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Maximus Berger
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Scott R Clark
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia.,Metro North Mental Health Service, Herston, Australia
| | - Andrea Baker
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia
| | | | | | - Andrew Thompson
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Alison R Yung
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,School of Health Science, University of Manchester, Manchester, UK
| | - Brian O'Donoghue
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Hok Pan Yuen
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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23
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Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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24
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Michel C, Kaess M, Flückiger R, Büetiger JR, Schultze-Lutter F, Schimmelmann BG, Gekle W, Jandl M, Hubl D, Kindler J. The Bern Early Recognition and Intervention Centre for mental crisis (FETZ Bern)-An 8-year evaluation. Early Interv Psychiatry 2022; 16:289-301. [PMID: 33960114 DOI: 10.1111/eip.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
AIM Early detection of, and intervention for, psychosis during its prodromal phase has the potential to alter the course of the disease and has therefore become a major objective of modern clinical psychiatry. An increasing number of early detection and intervention services have been established in Europe and worldwide. This study aims to describe and evaluate an early detection and intervention service for children, adolescents and adults (FETZ Bern) aged from eight to 40 years with a population catchment area of 1.035 million in Bern, Switzerland. METHODS Routine demographic, diagnostic and service usage data were collected upon admission to the service. Using a retrospective, descriptive and naturalistic study design, data was analysed for different age groups (children, adolescents and adults) and where available, outcome data after 12 and 24 months was evaluated. RESULTS The FETZ Bern has received 827 referrals with full diagnostic data available for 353 patients. The majority of the assessed patients were young males. While 40% met criteria for a clinical high-risk state of psychosis, 20% were diagnosed with fully manifest psychosis at time of admission, and another 40% had one or more non-psychotic axis-I diagnoses. CONCLUSIONS The FETZ Bern is the first early detection centre worldwide assessing children aged younger than 12 years, as well as adolescents and young adults in one service. Given that developmental peculiarities are important in understanding and ultimately treating psychosis, the FETZ Bern, with its emphasis on developmental peculiarities, should be considered as a model for other similar services.
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Affiliation(s)
- Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Psychobiology in Child and Adolescent Psychiatry, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jessica R Büetiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Walter Gekle
- Soteria Bern, Centre for Psychiatric Rehabilitation, Bern, Switzerland
| | - Martin Jandl
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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25
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Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e9. [PMID: 35042573 PMCID: PMC8786617 DOI: 10.1017/s2045796021000639] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. METHODS "Preferred Reporting Items for Systematic reviews and Meta-Analyses" and "Meta-analysis Of Observational Studies in Epidemiology"-compliant meta-analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs. those who did transition to psychosis at follow-up. We conducted random-effects model meta-analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). RESULTS Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β = -0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β = -0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. CONCLUSIONS Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.
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26
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Basic self-disturbance trajectories in clinical high risk for psychosis: a one-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2022; 272:1007-1019. [PMID: 34783878 PMCID: PMC9388413 DOI: 10.1007/s00406-021-01349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15-30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline (n = 5) and in SSDs at follow-up (n = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.
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27
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress Related to Attenuated Psychotic Symptoms: Static and Dynamic Association With Transition to Psychosis, Nonremission, and Transdiagnostic Symptomatology in Clinical High-Risk Patients in an International Intervention Trial. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgaa006. [PMID: 39144772 PMCID: PMC11205873 DOI: 10.1093/schizbullopen/sgaa006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the "Neurapro" clinical trial of omega-3 fatty acids. Three hundred and four UHR patients were recruited across 10 early intervention services. Data from baseline assessment, regular assessments over 12 months, and medium term follow-up (mean = 3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and nonremission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioral case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modeling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- Barnaby Nelson
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - G Paul Amminger
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gregor Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | - Jessica A Hartmann
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Suzie Lavoie
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Connie Markulev
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Andrea Polari
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Miriam R Schäfer
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monika Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | | | - Amy Tedja
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Alison R Yung
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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28
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Paetzold I, Hermans KSFM, Schick A, Nelson B, Velthorst E, Schirmbeck F, van Os J, Morgan C, van der Gaag M, de Haan L, Valmaggia L, McGuire P, Kempton M, Myin-Germeys I, Reininghaus U. Momentary Manifestations of Negative Symptoms as Predictors of Clinical Outcomes in People at High Risk for Psychosis: Experience Sampling Study. JMIR Ment Health 2021; 8:e30309. [PMID: 34807831 PMCID: PMC8663470 DOI: 10.2196/30309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/02/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. OBJECTIVE This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. METHODS Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. RESULTS Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=-4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=-0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). CONCLUSIONS Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis.
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Karlijn S F M Hermans
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Arkin, Institute for Mental Health, Amsterdam, Netherlands
| | -
- See Acknowledgments, Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, London, United Kingdom
| | - Matthew Kempton
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Inez Myin-Germeys
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
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Kristensen TD, Glenthøj LB, Raghava JM, Syeda W, Mandl RCW, Wenneberg C, Krakauer K, Fagerlund B, Pantelis C, Glenthøj BY, Nordentoft M, Ebdrup BH. Changes in negative symptoms are linked to white matter changes in superior longitudinal fasciculus in individuals at ultra-high risk for psychosis. Schizophr Res 2021; 237:192-201. [PMID: 34543833 DOI: 10.1016/j.schres.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 01/23/2023]
Abstract
AIM Growing evidence suggests that subtle white matter (WM) alterations are associated with psychopathology in individuals at ultra-high risk for psychosis (UHR). However, the longitudinal relationship between symptom progression and WM changes over time remains under-explored. Here, we examine associations between changes in clinical symptoms and changes in WM over six months in a large UHR-cohort. METHODS 110 UHR-individuals and 59 healthy controls underwent diffusion weighted imaging at baseline and after six months. Group × time effects on fractional anisotropy (FA) were tested globally and in four predefined regions of interest (ROIs) bilaterally using linear modelling with repeated measures. Correlations between the changes in clinical symptoms and FA changes in the ROIs were examined with Pearson's correlation. A partial least squares correlation-technique (PLS-C) explored multivariate associations between patterns of changes in psychopathology, regional FA and additional WM indices. RESULTS At baseline, UHR-individuals displayed significantly lower FA globally (p = 0.018; F = 12.274), in right superior longitudinal fasciculus (p = 0.02; Adj R2 = 0.07) and in left uncinate fasciculus (p = 0.048; Adj R2 = 0.058) compared to controls (corrected). We identified a group × time interaction in global FA and right superior longitudinal fasciculus, but the finding did not survive multiple comparisons. However, an increase of negative symptoms in UHR-individuals correlated with FA increase in right superior longitudinal fasciculus (p = 0.048, corrected, r = 0.357), and this finding was supported by the multivariate PLS-C. CONCLUSION We found a positive correlation with a moderate effect between change in negative symptoms and FA change over 6 months in right superior longitudinal fasciculus. This link appeared mainly to reflect a subgroup of UHR-individuals, which already at baseline presented as vulnerable.
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Affiliation(s)
- Tina D Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Denmark.
| | - Louise B Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Denmark
| | - Jayachandra M Raghava
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Glostrup, Denmark
| | - Warda Syeda
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, and Melbourne Health, Carlton South, Victoria, Australia
| | - Rene C W Mandl
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Christina Wenneberg
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Denmark
| | - Kristine Krakauer
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Denmark
| | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christos Pantelis
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, and Melbourne Health, Carlton South, Victoria, Australia
| | - Birte Y Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn H Ebdrup
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark; Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, and Melbourne Health, Carlton South, Victoria, Australia; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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30
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Kristensen TD, Glenthøj LB, Ambrosen K, Syeda W, Raghava JM, Krakauer K, Wenneberg C, Fagerlund B, Pantelis C, Glenthøj BY, Nordentoft M, Ebdrup BH. Global fractional anisotropy predicts transition to psychosis after 12 months in individuals at ultra-high risk for psychosis. Acta Psychiatr Scand 2021; 144:448-463. [PMID: 34333760 DOI: 10.1111/acps.13355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Psychosis spectrum disorders are associated with cerebral changes, but the prognostic value and clinical utility of these findings are unclear. Here, we applied a multivariate statistical model to examine the predictive accuracy of global white matter fractional anisotropy (FA) for transition to psychosis in individuals at ultra-high risk for psychosis (UHR). METHODS 110 UHR individuals underwent 3 Tesla diffusion-weighted imaging and clinical assessments at baseline, and after 6 and 12 months. Using logistic regression, we examined the reliability of global FA at baseline as a predictor for psychosis transition after 12 months. We tested the predictive accuracy, sensitivity and specificity of global FA in a multivariate prediction model accounting for potential confounders to FA (head motion in scanner, age, gender, antipsychotic medication, parental socioeconomic status and activity level). In secondary analyses, we tested FA as a predictor of clinical symptoms and functional level using multivariate linear regression. RESULTS Ten UHR individuals had transitioned to psychosis after 12 months (9%). The model reliably predicted transition at 12 months (χ2 = 17.595, p = 0.040), accounted for 15-33% of the variance in transition outcome with a sensitivity of 0.70, a specificity of 0.88 and AUC of 0.87. Global FA predicted level of UHR symptoms (R2 = 0.055, F = 6.084, p = 0.016) and functional level (R2 = 0.040, F = 4.57, p = 0.036) at 6 months, but not at 12 months. CONCLUSION Global FA provided prognostic information on clinical outcome and symptom course of UHR individuals. Our findings suggest that the application of prediction models including neuroimaging data can inform clinical management on risk for psychosis transition.
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Affiliation(s)
- Tina D Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise B Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen Ambrosen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Warda Syeda
- Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Jayachandra M Raghava
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Glostrup, Denmark
| | - Kristine Krakauer
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Wenneberg
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christos Pantelis
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Melbourne Neuropsychiatry Center, Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Birte Y Glenthøj
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn H Ebdrup
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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31
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Allan SM, Hodgekins J, Beazley P, Oduola S. Pathways to care in at-risk mental states: A systematic review. Early Interv Psychiatry 2021; 15:1092-1103. [PMID: 33047505 DOI: 10.1111/eip.13053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
AIM Pathways to care are well studied in the First Episode Psychosis field, but less attention has been given to At-Risk Mental States or prodromal psychosis. This is important because accessing appropriate help at the earliest opportunity is likely to improve outcomes, particularly for those who make transition to psychosis. The present systematic review aimed to synthesize the available literature on pathways to care in ARMS or prodromal psychosis, and investigate the barriers and facilitators to receiving care for ARMS. METHODS The CINAHL Complete, EMBASE, Medline Complete, PsycINFO and PubMED databases were searched. Studies were included if they were published in English between 1985 and 2019, where reported data came exclusively from an At-Risk Mental State population, and the study described or related to pathways to care. RESULTS Ten studies met the inclusion criteria, of which 8 were quantitative. Screening tools and pathways to care instruments varied. Mental health professionals, and general practitioners played a key role in help seeking. Family involvement was also found to be an important factor. CONCLUSIONS Pathways to care research in At-Risk Mental States are more scarce than in the field of First Episode Psychosis. More research is warranted, especially concerning the role of patient-level characteristics on pathways to care. A validated measure of pathways to care may also be of benefit.
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Affiliation(s)
- Sophie M Allan
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Cambridgeshire, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Peter Beazley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
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32
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Prevention of Depression in Children, Adolescents, and Young Adults: The Role of Teachers and Parents. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Major depressive disorder (MDD) and other affective disorders may surreptitiously arise in children and adolescents during their school period and impair their social and educational functioning. Besides the social and personal burden, which are increased during the SARS-CoV-2 pandemic, the onset of depression may compromise the future of the growing person with chronicity and recurrence. In this context, educators’ training is essential to detect early the onset of a depressive disorder, to spare later consequences through the timely establishment of adequate treatment. The educational staff should receive adequate training to be able to work closely with healthcare providers and parents, thus directing the young person with an affective disorder to the right psychological and pharmacological treatment provider, i.e., a specialized psychologist or psychiatrist. The first approach should be to establish a trustful relationship with the adolescent and his/her classmates, to reduce social and self-stigma and inform about mental illness. If symptoms do not subside and the suffering child or adolescent fails to reintegrate within his/her school environment, cognitive–behavioral interventions are recommended that are individual, group, or computer-based. When needed, these should be implemented with individualized pharmacotherapy.
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33
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Salazar de Pablo G, Radua J, Pereira J, Bonoldi I, Arienti V, Besana F, Soardo L, Cabras A, Fortea L, Catalan A, Vaquerizo-Serrano J, Coronelli F, Kaur S, Da Silva J, Shin JI, Solmi M, Brondino N, Politi P, McGuire P, Fusar-Poli P. Probability of Transition to Psychosis in Individuals at Clinical High Risk: An Updated Meta-analysis. JAMA Psychiatry 2021; 78:970-978. [PMID: 34259821 PMCID: PMC8281006 DOI: 10.1001/jamapsychiatry.2021.0830] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research. OBJECTIVE To quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P. DATA SOURCES PubMed and Web of Science databases until November 1, 2020. Manual search of references from previous articles. STUDY SELECTION Longitudinal studies reporting transition risks in individuals at CHR-P. DATA EXTRACTION AND SYNTHESIS Meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines; independent data extraction, manually and through digitalization of Kaplan-Meier curves. MAIN OUTCOME AND MEASURES Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years' follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. These analyses were complemented by meta-analytical Kaplan-Meier curves and speed of transition to psychosis (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, and meta-regressions were conducted. RESULTS A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male. The cumulative transition risk was 0.09 (95% CI, 0.07-0.10; k = 37; n = 6485) at 0.5 years, 0.15 (95% CI, 0.13-0.16; k = 53; n = 7907) at 1 year, 0.20 (95% CI, 0.17-0.22; k = 30; n = 5488) at 1.5 years, 0.19 (95% CI, 0.17-0.22; k = 44; n = 7351) at 2 years, 0.25 (95% CI, 0.21-0.29; k = 19; n = 3114) at 2.5 years, 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) at 3 years, 0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) at 4 years, and 0.28 (95% CI, 0.20-0.37; k = 14; n = 2301) at more than 4 years. The cumulative Kaplan-Meier transition risk was 0.08 (95% CI, 0.08-0.09; n = 4860) at 0.5 years, 0.14 (95% CI, 0.13-0.15; n = 3408) at 1 year, 0.17 (95% CI, 0.16-0.19; n = 2892) at 1.5 years, 0.20 (95% CI, 0.19-0.21; n = 2357) at 2 years, 0.25 (95% CI, 0.23-0.26; n = 1444) at 2.5 years, 0.27 (95% CI, 0.25-0.28; n = 1029) at 3 years, 0.28 (95% CI, 0.26-0.29; n = 808) at 3.5 years, 0.29 (95% CI, 0.27-0.30; n = 737) at 4 years, and 0.35 (95% CI, 0.32-0.38; n = 114) at 10 years. The hazard rate only plateaued at 4 years' follow-up. Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%). CONCLUSIONS AND RELEVANCE In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Joana Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Ilaria Bonoldi
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Bizkaia, Spain
| | - Julio Vaquerizo-Serrano
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Francesco Coronelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Josette Da Silva
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Neurosciences Department, University of Padova, Padova, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Vissink CE, Winter-van Rossum I, Cannon TD, Fusar-Poli P, Kahn RS, Bossong MG. Structural brain volumes of individuals at clinical high risk for psychosis: a meta-analysis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 2:147-152. [PMID: 36325161 PMCID: PMC9616363 DOI: 10.1016/j.bpsgos.2021.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Structural magnetic resonance imaging studies in individuals at clinical high risk (CHR) for psychosis have yielded conflicting results. Methods The aims of this study were to compare intracranial and structural brain volumes and variability of CHR individuals with those of healthy control (HC) subjects and to investigate brain volume differences and variability in CHR subjects with and without transition to psychosis. The PubMed and Embase databases were searched for relevant studies published before June 1, 2020. Results A total of 34 studies were deemed eligible, which included baseline data of 2111 CHR and 1472 HC participants. In addition, data were included for 401 CHR subjects who subsequently transitioned to psychosis and 1023 nontransitioned CHR participants. Whole-brain and left, right, and bilateral hippocampal volume were significantly smaller in CHR subjects than in HC subjects. Cerebrospinal fluid and lateral ventricle volumes were significantly larger in CHR subjects than in HC subjects. Variability was not significantly different in CHR subjects compared with HC subjects. CHR individuals with and without subsequent transition to psychosis did not show significant differences in any of the volumetric assessments or in variability. Conclusions This meta-analysis demonstrates reduced whole-brain and hippocampal volumes and increased cerebrospinal fluid and lateral ventricle volumes in CHR individuals. However, no significant differences were observed in any of the volumetric assessments between CHR individuals with and without subsequent transition to psychosis. These findings suggest that although structural brain alterations are present before the onset of the disorder, they may not significantly contribute to the identification of CHR individuals at the highest risk for the development of psychosis.
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Affiliation(s)
- Conrad E. Vissink
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Address correspondence to Conrad E. Vissink, M.Sc.
| | - Inge Winter-van Rossum
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Tyrone D. Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection Laboratory, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rene S. Kahn
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthijs G. Bossong
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Matthijs G. Bossong, Ph.D.
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Li W, Mao Z, Bo Q, Sun Y, Wang Z, Wang C. Pre-pulse inhibition deficits in individuals at clinical high-risk for psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2021; 15:794-806. [PMID: 32705810 DOI: 10.1111/eip.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
AIM Neurophysiological markers of schizophrenia may help identify individuals who are at an increased risk of developing psychosis. As an operational measure of sensorimotor gating, pre-pulse inhibition (PPI) deficit has been investigated in clinical high-risk (CHR) individuals. In this study, we performed a systematic review and meta-analysis of studies that investigated PPI in CHR individuals. METHODS Relevant studies published as of July 2019 were retrieved from the PubMed, Cochrane, Embase, PscyINFO, EBSCO and Chinese databases. PPI was evaluated by calculating the standard mean differences (SMDs) between CHR individuals and healthy controls (HC) in meta-analysis. Quality of studies was assessed using the Newcastle-Ottawa Scale. I2 index was used to assess heterogeneity and Egger's test was used to assess publication bias. RESULTS Eight studies were found to be eligible. The meta-analysis included five studies with a combined study population of 184 CHR subjects and 161 HC. CHR individuals showed lower PPI levels compared to HC in 120 ms inter-stimulus interval or stimulus onset asynchrony paradigm (P = .491, SMD = -0.62). No significant heterogeneity was observed in 120 ms PPI paradigm (χ2 = 3.41, P = .491, I2 = 0.0%). CONCLUSION CHR individuals had lower PPI level compared to HC in 120 ms paradigm, which were relatively stable and significant. The results indicate the presence of information processing and inhibitory problems prior to the development of full-blown psychosis. PPI may be clinically used as an objective indicator to supplement the understanding of CHR individuals.
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Affiliation(s)
- Weidi Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhen Mao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qijing Bo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yue Sun
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhimin Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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36
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Janssen H, Maat A, Slot MIE, Scheepers F. Efficacy of psychological interventions in young individuals at ultra-high risk for psychosis: A naturalistic study. Early Interv Psychiatry 2021; 15:1019-1027. [PMID: 32945145 DOI: 10.1111/eip.13048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
AIM Early detection and intervention in individuals at risk for developing psychosis have become a priority for many clinical services around the world. Limited naturalistic evidence is available on whether detection and intervention for ultra-high risk (UHR) is effective by means of reducing psychosis risk and improving functioning. METHODS We compared functioning scores over 5.9 (±7.7) months of time between UHR individuals (n = 61) and help-seeking adolescents without a specific UHR profile (general adolescent help-seeking population [HSP]; n = 82) aged 12 to 25 years receiving psychological interventions at a specialized UHR service in the Netherlands. Attenuated psychotic symptoms (APS) were evaluated over time within the UHR group. In addition, the impact of duration of treatment, <7 sessions, 8 to 21 sessions and >20 sessions, as well as treatment type, that is, cognitive behavioural therapy (CBT) and CBT + add on treatment, were evaluated. RESULTS Both UHR and HSP showed an increase in functioning over time (P < .001), with no difference between these groups. The UHR group showed a reduction of APS over time (P < .001). More than 20 treatment sessions was more effective than 1 to 6 treatment sessions (P < .01, partial eta squared = .08) and CBT was equally effective as CBT-add on in improving functioning. CONCLUSIONS The findings of this study suggest that psychological treatment is just as effective in improving functioning in UHR as in HSP. Moreover, it decreases APS in UHR. Improvement in functioning is not affected by treatment type, but positively affected by the duration of treatment.
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Affiliation(s)
- Hella Janssen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Arija Maat
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margot I E Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floortje Scheepers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Gold JM, Millman ZB, Dickinson D. Enhancing Prediction of Psychosis Risk With Cognitive Measures: How Do We Get to There From Here? JAMA Psychiatry 2021; 78:2781292. [PMID: 34132755 PMCID: PMC9594979 DOI: 10.1001/jamapsychiatry.2021.0847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Zachary B Millman
- Center of Excellence in Psychotic Disorders, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Dwight Dickinson
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Bethesda, Maryland
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38
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Polari A, Yuen HP, Amminger P, Berger G, Chen E, deHaan L, Hartmann J, Markulev C, McGorry P, Nieman D, Nordentoft M, Riecher-Rössler A, Smesny S, Stratford J, Verma S, Yung A, Lavoie S, Nelson B. Prediction of clinical outcomes beyond psychosis in the ultra-high risk for psychosis population. Early Interv Psychiatry 2021; 15:642-651. [PMID: 32558302 DOI: 10.1111/eip.13002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Abstract
AIM Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes. METHODS Several evidence-based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra-high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors. RESULTS When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes. CONCLUSION The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.
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Affiliation(s)
| | - Hok Pan Yuen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Amminger
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Lieuwe deHaan
- Academic Medical Centre, University of Amsterdam and Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Connie Markulev
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Dorien Nieman
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | - Stefan Smesny
- Department of Psychiatry, Universitätsklinikum Jena, Jena, Germany
| | | | - Swapna Verma
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
| | - Alison Yung
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Salazar de Pablo G, Besana F, Arienti V, Catalan A, Vaquerizo-Serrano J, Cabras A, Pereira J, Soardo L, Coronelli F, Kaur S, da Silva J, Oliver D, Petros N, Moreno C, Gonzalez-Pinto A, Díaz-Caneja CM, Shin JI, Politi P, Solmi M, Borgatti R, Mensi MM, Arango C, Correll CU, McGuire P, Fusar-Poli P. Longitudinal outcome of attenuated positive symptoms, negative symptoms, functioning and remission in people at clinical high risk for psychosis: a meta-analysis. EClinicalMedicine 2021; 36:100909. [PMID: 34189444 PMCID: PMC8219991 DOI: 10.1016/j.eclinm.2021.100909] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Little is known about clinical outcomes other than transition to psychosis in people at Clinical High-Risk for psychosis (CHR-P). Our aim was to comprehensively meta-analytically evaluate for the first time a wide range of clinical and functional outcomes beyond transition to psychosis in CHR-P individuals. METHODS PubMed and Web of Science were searched until November 2020 in this PRISMA compliant meta-analysis (PROSPERO:CRD42020206271). Individual longitudinal studies conducted in individuals at CHR-P providing data on at least one of our outcomes of interest were included. We carried out random-effects pairwise meta-analyses, meta-regressions, and assessed publication bias and study quality. Analyses were two-tailed with α=0.05. FINDINGS 75 prospective studies were included (n=5,288, age=20.0 years, females=44.5%). Attenuated positive symptoms improved at 12 (Hedges' g=0.753, 95%CI=0.495-1.012) and 24 (Hedges' g=0.836, 95%CI=0.463-1.209), but not ≥36 months (Hedges' g=0.315. 95%CI=-0.176-0.806). Negative symptoms improved at 12 (Hedges' g=0.496, 95%CI=0.315-0.678), but not 24 (Hedges' g=0.499, 95%CI=-0.137-1.134) or ≥36 months (Hedges' g=0.033, 95%CI=-0.439-0.505). Depressive symptoms improved at 12 (Hedges' g=0.611, 95%CI=0.441-0.782) and 24 (Hedges' g=0.583, 95%CI=0.364-0.803), but not ≥36 months (Hedges' g=0.512 95%CI=-0.337-1.361). Functioning improved at 12 (Hedges' g=0.711, 95%CI=0.488-0.934), 24 (Hedges' g=0.930, 95%CI=0.553-1.306) and ≥36 months (Hedges' g=0.392, 95%CI=0.117-0.667). Remission from CHR-P status occurred in 33.4% (95%CI=22.6-44.1%) at 12 months, 41.4% (95%CI=32.3-50.5%) at 24 months and 42.4% (95%CI=23.4-61.3%) at ≥36 months. Heterogeneity across the included studies was significant and ranged from I2=53.6% to I2=96.9%. The quality of the included studies (mean±SD) was 4.6±1.1 (range=2-8). INTERPRETATION CHR-P individuals improve on symptomatic and functional outcomes over time, but these improvements are not maintained in the longer term, and less than half fully remit. Prolonged duration of care may be needed for this patient population to optimize outcomes. FUNDING None.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ana Catalan
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, UPV/EHU, Vizcaya, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Julio Vaquerizo-Serrano
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Joana Pereira
- Lisbon Psychiatric Hospital Centre, Lisbon, Portugal
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesco Coronelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Josette da Silva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Carmen Moreno
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Ana Gonzalez-Pinto
- Hospital Universitario Araba, Servicio de Psiquiatria, UPV/EHU, Bioaraba, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Covadonga M Díaz-Caneja
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Neurosciences Department, University of Padova, Italy
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Child and Adolescent Neuropsychiatric Unit, Italy
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Child and Adolescent Neuropsychiatric Unit, Italy
| | - Celso Arango
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- OASIS Service, South London and Maudsley National Health Service Foundation Trust, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley National Health Service Foundation Trust, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Værnes TG, Røssberg JI, Melle I, Nelson B, Romm KL, Møller P. Basic self-disturbance in subjects at clinical high risk for psychosis: Relationship with clinical and functional outcomes at one year follow-up. Psychiatry Res 2021; 300:113942. [PMID: 33940444 DOI: 10.1016/j.psychres.2021.113942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
Basic self-disturbance (BSD) is assumed to drive symptom development in schizophrenia spectrum disorders and in clinical high-risk (CHR) for psychosis. We investigated the relationship between BSD at baseline, assessed with the Examination of Anomalous Self-Experience (EASE), and symptoms and functional outcome after one year in 32 patients, including 26 CHR and six with non-progressive attenuated psychotic symptoms. Correlations between baseline BSD levels and positive, negative and disorganization symptoms, and global functioning level at follow-up were significant. Hierarchical regression analyses revealed that higher levels of baseline BSD predicted more severe positive symptoms and lower global functioning at follow-up, after adjusting for baseline positive symptoms and functioning. Subjects who were not in symptomatic and functional remission after one year had higher levels of BSD and negative symptoms, and lower functioning level, at baseline. Baseline BSD in participants with schizophrenia spectrum diagnoses at follow-up (9 of 12 were schizotypal personality disorder) were at the levels seen in schizotypal disorders in previous studies, but not significantly different from the other participants. Early identification and assessment of BSD may constitute a useful prognostic tool and a signal for therapeutic targets in CHR conditions. Further CHR studies investigating these relationships with larger samples are recommended.
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Affiliation(s)
- Tor Gunnar Værnes
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Jan Ivar Røssberg
- Psychiatric Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Victoria, Australia
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul Møller
- Department for Mental Health Research and Development, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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Mei C, van der Gaag M, Nelson B, Smit F, Yuen HP, Berger M, Krcmar M, French P, Amminger GP, Bechdolf A, Cuijpers P, Yung AR, McGorry PD. Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis. Clin Psychol Rev 2021; 86:102005. [PMID: 33810885 DOI: 10.1016/j.cpr.2021.102005] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.
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Affiliation(s)
- Cristina Mei
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Mental Health and Prevention, Utrecht, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Maximus Berger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Marija Krcmar
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul French
- School of Health Sciences, University of Manchester, Manchester, UK
| | - G Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Charite-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison R Yung
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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43
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Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Predictors of remission from the ultra-high risk state for psychosis. Early Interv Psychiatry 2021; 15:104-112. [PMID: 31910496 DOI: 10.1111/eip.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 12/14/2019] [Indexed: 02/07/2023]
Abstract
AIM A significant proportion of individuals at Ultra-High Risk (UHR) for psychosis do not transition to manifest psychosis. Many non-transitioning UHR individuals do, however, display poor long-term outcomes such as persistence of attenuated psychotic symptoms. Evidence is scarce on which variables may predict a better clinical and functional prognosis such as remission from the UHR state. METHODS A total of 146 UHR individuals were enrolled in a randomized clinical trial (RCT), with this being analyses secondary to the RCT. Participants were assessed on multiple domains of symptoms, functioning, neuro- and social cognition. Regression analyses elucidated on the predictive power of these measures to remission from the UHR status (ie, not meeting UHR criteria) at 12-month follow-up. RESULTS Of the 91 UHR individuals attending 12-month follow-up, 33 (36%) exhibited remission from the UHR state. Regression analyses revealed baseline functioning to be a significant predictor of risk remission, and this was maintained when controlling for the effect of antipsychotic medication, gender and estimated IQ. The individuals with remission from the UHR state showed lower attenuated psychotic- and depressive symptoms along with better functioning at 12-month follow-up. CONCLUSION Our findings indicate functioning to be a contributor to the symptomatic recovery of UHR individuals, but a large amount of the variance on risk remission is, however, explained by other factors. Additionally, our findings suggest that UHR individuals with better functioning at ascertainment may present with a better clinical and functional prognosis, which may inform on the need for monitoring and intervention in this subgroup.
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Affiliation(s)
- Louise B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Tina D Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
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44
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McGorry PD, Mei C, Hartmann J, Yung AR, Nelson B. Intervention strategies for ultra-high risk for psychosis: Progress in delaying the onset and reducing the impact of first-episode psychosis. Schizophr Res 2021; 228:344-356. [PMID: 33545668 DOI: 10.1016/j.schres.2020.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 12/26/2022]
Abstract
Over a quarter of a century ago, the formulation of the "at risk mental state" and operational criteria to prospectively identify individuals at "clinical" or "ultra-high risk" (UHR) for psychosis created a global wave of research momentum aimed at predicting and preventing first-episode psychosis. A substantial number of randomized controlled trials (RCTs) were conducted to determine if transition to psychosis could be delayed or even prevented. The efficacy of a range of interventions was examined, with standard meta-analyses clearly indicating that these could at least delay transition for 1-2 years and that outcomes improve. Recently, network meta-analyses have attempted to identify the most effective intervention. These highlighted the fact that no one form of intervention is superior to the rest, a finding interpreted in such a way as to create doubts concerning the value of intervening. These doubts have been reinforced by a subsequent Cochrane review which judged the quality of the evidence as low or very low. Here, we report a narrative review of findings from RCTs and meta-analyses on the efficacy of interventions in UHR. We also critique the network meta-analyses and the Cochrane review, and indicate that many of the trials were of the highest possible quality for such research, and were published in top ranked psychiatry journals, which demand such quality. Although outcomes vary, and the UHR group is clearly heterogeneous, we highlight the clinical benefits of psychosocial treatment. The next generation of clinical trials seek to elucidate the optimal type, duration and sequence of interventions.
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Affiliation(s)
- Patrick D McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison R Yung
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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45
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Vargas T, Damme KSF, Ered A, Capizzi R, Frosch I, Ellman LM, Mittal VA. Neuroimaging Markers of Resiliency in Youth at Clinical High Risk for Psychosis: A Qualitative Review. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:166-177. [PMID: 32788085 PMCID: PMC7725930 DOI: 10.1016/j.bpsc.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/26/2022]
Abstract
Psychotic disorders are highly debilitating and constitute a major public health burden. Identifying markers of psychosis risk and resilience is a necessary step toward understanding etiology and informing prevention and treatment efforts in individuals at clinical high risk (CHR) for psychosis. In this context, it is important to consider that neural risk markers have been particularly useful in identifying mechanistic determinants along with predicting clinical outcomes. Notably, despite a growing body of supportive literature and the promise of recent findings identifying potential neural markers, the current work on CHR resilience markers has received little attention. The present review provides a brief overview of brain-based risk markers with a focus on predicting symptom course. Next, the review turns to protective markers, examining research from nonpsychiatric and schizophrenia fields to build an understanding of framing, priorities, and potential, applying these ideas to contextualizing a small but informative body of resiliency-relevant CHR research. Four domains (neurocognition, emotion regulation, allostatic load, and sensory and sensorimotor function) were identified and are discussed in terms of behavioral and neural markers. Taken together, the literature suggests significant predictive value for brain-based markers for individuals at CHR for psychosis, and the limited but compelling resiliency work highlights the critical importance of expanding this promising area of inquiry.
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Affiliation(s)
- Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois.
| | | | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Riley Capizzi
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Isabelle Frosch
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois; Department of Psychiatry, Northwestern University, Evanston, Illinois; Department of Medical Social Sciences, Northwestern University, Evanston, Illinois; Institute for Policy Research, Northwestern University, Evanston, Illinois; Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, Illinois
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46
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Hartmann JA, McGorry PD, Destree L, Amminger GP, Chanen AM, Davey CG, Ghieh R, Polari A, Ratheesh A, Yuen HP, Nelson B. Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Front Psychiatry 2021; 11:553578. [PMID: 33488413 PMCID: PMC7819892 DOI: 10.3389/fpsyt.2020.553578] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
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Affiliation(s)
- Jessica A. Hartmann
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick D. McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Louise Destree
- BrainPark, The Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - G. Paul Amminger
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M. Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G. Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Rachid Ghieh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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47
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Andreou C, Borgwardt S. Structural and functional imaging markers for susceptibility to psychosis. Mol Psychiatry 2020; 25:2773-2785. [PMID: 32066828 PMCID: PMC7577836 DOI: 10.1038/s41380-020-0679-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
The introduction of clinical criteria for the operationalization of psychosis high risk provided a basis for early detection and treatment of vulnerable individuals. However, about two-thirds of people meeting clinical high-risk (CHR) criteria will never develop a psychotic disorder. In the effort to increase prognostic precision, structural and functional neuroimaging have received growing attention as a potentially useful resource in the prediction of psychotic transition in CHR patients. The present review summarizes current research on neuroimaging biomarkers in the CHR state, with a particular focus on their prognostic utility and limitations. Large, multimodal/multicenter studies are warranted to address issues important for clinical applicability such as generalizability and replicability, standardization of clinical definitions and neuroimaging methods, and consideration of contextual factors (e.g., age, comorbidity).
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.
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Nelson B. The challenges of neuroimaging the self, perspective-taking and psychosis risk. Aust N Z J Psychiatry 2020; 54:1037-1038. [PMID: 32594754 DOI: 10.1177/0004867420937802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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49
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McGorry PD, Nelson B, Wood SJ, Shah JL, Malla A, Yung A. Transcending false dichotomies and diagnostic silos to reduce disease burden in mental disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1095-1103. [PMID: 32683471 DOI: 10.1007/s00127-020-01913-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Patrick D McGorry
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Canada
| | - Alison Yung
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,School of Health Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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50
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Individualized Diagnostic and Prognostic Models for Patients With Psychosis Risk Syndromes: A Meta-analytic View on the State of the Art. Biol Psychiatry 2020; 88:349-360. [PMID: 32305218 DOI: 10.1016/j.biopsych.2020.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The clinical high risk (CHR) paradigm has facilitated research into the underpinnings of help-seeking individuals at risk for developing psychosis, aiming at predicting and possibly preventing transition to the overt disorder. Statistical methods such as machine learning and Cox regression have provided the methodological basis for this research by enabling the construction of diagnostic models (i.e., distinguishing CHR individuals from healthy individuals) and prognostic models (i.e., predicting a future outcome) based on different data modalities, including clinical, neurocognitive, and neurobiological data. However, their translation to clinical practice is still hindered by the high heterogeneity of both CHR populations and methodologies applied. METHODS We systematically reviewed the literature on diagnostic and prognostic models built on Cox regression and machine learning. Furthermore, we conducted a meta-analysis on prediction performances investigating heterogeneity of methodological approaches and data modality. RESULTS A total of 44 articles were included, covering 3707 individuals for prognostic studies and 1052 individuals for diagnostic studies (572 CHR patients and 480 healthy control subjects). CHR patients could be classified against healthy control subjects with 78% sensitivity and 77% specificity. Across prognostic models, sensitivity reached 67% and specificity reached 78%. Machine learning models outperformed those applying Cox regression by 10% sensitivity. There was a publication bias for prognostic studies yet no other moderator effects. CONCLUSIONS Our results may be driven by substantial clinical and methodological heterogeneity currently affecting several aspects of the CHR field and limiting the clinical implementability of the proposed models. We discuss conceptual and methodological harmonization strategies to facilitate more reliable and generalizable models for future clinical practice.
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