151
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Bang M, Park JY, Kim KR, Lee SY, Song YY, Kang JI, Lee E, An SK. Psychotic conversion of individuals at ultra-high risk for psychosis: The potential roles of schizotypy and basic symptoms. Early Interv Psychiatry 2019; 13:546-554. [PMID: 29218852 DOI: 10.1111/eip.12518] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/05/2017] [Accepted: 09/30/2017] [Indexed: 12/16/2022]
Abstract
AIM To improve strategies for the early identification of individuals at a heightened risk for the development of psychosis, we investigated the relationships and interactions between 3 psychosis-proneness dimensions for the development of schizophrenia spectrum psychosis: schizotypy, basic symptoms and the ultra-high risk (UHR) criteria. METHODS Seventy-seven UHR individuals and 79 healthy controls were assessed for schizotypy and basic symptoms using self-report questionnaires at baseline. UHR participants were monthly assessed for conversion to psychosis over a mean period of 25.8 months. RESULTS Sixteen UHR participants (20.8%) converted to schizophrenia spectrum psychosis. In stepwise Cox regression, the interaction between basic symptoms and physical anhedonia was selected as a sole predictor of conversion in UHR participants, whereby the self-reported number of the 8 basic symptoms significantly increased the risk for conversion in those with pronounced physical anhedonia. CONCLUSION Our findings suggest that questionnaire-assessed basic symptoms, irrespective of their predictive validity, may predict a psychotic breakdown in pre-identified UHR individuals who are with genetic vulnerability to schizophrenia. Including all 3 psychosis-proneness dimensions into prediction models might help establish a more valid pathogenetic model of schizophrenia, and moreover, may provide some clues about course alteration strategies in hopes of preventing UHR individuals from converting to psychosis.
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Affiliation(s)
- Minji Bang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Young Lee
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Yun Young Song
- Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea.,Section of Self, Affect, and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
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152
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Barajas A, Pelaez T, González O, Usall J, Iniesta R, Arteaga M, Jackson C, Baños I, Sánchez B, Dolz M, Obiols JE, Haro JM, Ochoa S, Arranz B, Arteaga M, Asensio R, Autonell J, Baños I, Bañuelos M, Barajas A, Barceló M, Blanc M, Borrás M, Busquets E, Carlson J, Carral V, Castro M, Corbacho C, Coromina M, Dachs I, De Miquel L, Dolz M, Domenech MD, Elias M, Espezel I, Falo E, Fargas A, Foix A, Fusté M, Godrid M, Gómez D, González O, Granell L, Gumà L, Haro JM, Herrera S, Huerta E, Lacasa F, Mas N, Martí L, Martínez R, Matalí J, Miñambres A, Muñoz D, Muñoz V, Nogueroles R, Ochoa S, Ortiz J, Pardo M, Planella M, Pelaez T, Peruzzi S, Rivero S, Rodriguez MJ, Rubio E, Sammut S, Sánchez M, Sánchez B, Serrano E, Solís C, Stephanotto C, Tabuenca P, Teba S, Torres A, Urbano D, Usall J, Vilaplana M, Villalta V. Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset. Early Interv Psychiatry 2019; 13:414-424. [PMID: 29116670 DOI: 10.1111/eip.12498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/16/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. AIM To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. METHODS Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. RESULTS Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. CONCLUSION In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.
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Affiliation(s)
- Ana Barajas
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain.,Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.,Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Trinidad Pelaez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Olga González
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raquel Iniesta
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Maria Arteaga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Chris Jackson
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Iris Baños
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi E Obiols
- Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep M Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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153
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Kırlı U, Binbay T, Drukker M, Elbi H, Kayahan B, Keskin Gökçelli D, Özkınay F, Onay H, Alptekin K, van Os J. DSM outcomes of psychotic experiences and associated risk factors: 6-year follow-up study in a community-based sample. Psychol Med 2019; 49:1346-1356. [PMID: 30101737 DOI: 10.1017/s0033291718001964] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators. METHODS Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis. RESULTS In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness. CONCLUSION The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.
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Affiliation(s)
- Umut Kırlı
- Education and Research Hospital,Van,Turkey
| | - Tolga Binbay
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Marjan Drukker
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
| | - Hayriye Elbi
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | - Bülent Kayahan
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | | | - Ferda Özkınay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Hüseyin Onay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Köksal Alptekin
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
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154
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Tiffin PA, Paton LW. The psychometrics of psychosis - assessing and rating perceptual and ideational disturbance in adolescents. Child Adolesc Ment Health 2019; 24:176-186. [PMID: 32677179 DOI: 10.1111/camh.12312] [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] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The early recognition and management of psychosis spectrum disorders is associated with superior outcomes in affected individuals. However, this can be challenging for numerous reasons. This article provides perspectives on the effective evaluation and rating of potentially psychotic phenomena young people. We compare and contrast two widely used instruments that can support this process. FINDINGS The Comprehensive Assessment for At-Risk Mental States (CAARMS) is used to explore potentially psychotic experiences in young people perceived to be at risk of an emerging or imminent psychosis. There is evidence to support its reliability and, to some extent, the predictive validity of the resultant scores. However, relatively low short-medium transition rates to psychosis in 'positive' cases suggest that its use as a screening instrument should be restricted to groups who show some indication of impending risk (e.g. help-seeking, distress, declining functioning, perceptual disturbance, etc.). In contrast, the Positive and Negative Syndrome Scale (PANSS) is calibrated to rate symptoms in those with an established psychosis, especially those with a diagnosis related to the schizophrenia spectrum. Consequently, the PANSS is useful for evaluating the clinical course and outcomes of psychotic illness. CONCLUSIONS Although neither instrument is designed specifically for use in those under 18, with care they can be used to effectively support the management of adolescents reporting perceptual and ideational disturbance. However, it is important that any instrument ratings are placed meaningfully in the context of the overall clinical picture and all available information.
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Affiliation(s)
- Paul A Tiffin
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, York, UK
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, UK
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155
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Schneider M, Armando M, Schultze-Lutter F, Pontillo M, Vicari S, Debbané M, Eliez S. Prevalence, course and psychosis-predictive value of negative symptoms in 22q11.2 deletion syndrome. Schizophr Res 2019; 206:386-393. [PMID: 30414720 DOI: 10.1016/j.schres.2018.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/05/2018] [Accepted: 10/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is one of the highest known risk factors for schizophrenia and recent findings have highlighted the clinical relevance of ultra-high risk (UHR) criteria in this population. However, studies in other at-risk populations have shown that the presence of negative symptoms (NS) is also of clinical relevance in predicting transition to psychosis. The present study examined in detail the presence and course of NS in 22q11DS, as well as their value in predicting transition to psychosis. METHODS A total of 111 participants aged between 8 and 33 years were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS). A follow-up assessment was available for 89 individuals. RESULTS Core NS of at least moderate severity were present in 50.5% of the sample and were more severe in individuals meeting UHR criteria. They predominantly remained stable over time and their emergence between baseline and follow-up assessment was associated with significant functional decline. Some NS were significant predictors of conversion to psychosis and the emergence/persistence of psychosis risk. CONCLUSIONS Altogether, these findings highlight that NS are core manifestations of psychosis in individuals with 22q11DS that strongly impact global functioning. The presence of NS should be a primary target of early therapeutic intervention in this population.
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Affiliation(s)
- Maude Schneider
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Marco Armando
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy.
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Martin Debbané
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stephan Eliez
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Geneva, Switzerland
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156
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Guccione C, di Scalea GL, Ambrosecchia M, Terrone G, Di Cesare G, Ducci G, Schimmenti A, Caretti V. Early Signs of Schizophrenia and Autonomic Nervous System Dysregulation: A Literature Review. CLINICAL NEUROPSYCHIATRY 2019; 16:86-97. [PMID: 34908942 PMCID: PMC8662712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recent research suggests that early signs of schizophrenia can be detected several years before its onset. Evidence suggests that the identification of at-risk individuals before the psychotic onset can significantly improve the course of the disorder. However, instruments employed for the detection of prodromal symptoms are far from being accurate in the prediction of a future transition to psychosis. The aim of the present review is to summarize literature on the early signs of schizophrenia and to identify physiological markers that may aid the identification of the disorder before psychotic transition. METHOD This critical review includes studies published between 1979 and 2018 that were indexed in major databases with the following keywords: schizophrenia, prodromal phase, basic symptoms, autonomic nervous system, heart rate variability. RESULTS The examination of the relevant literature showed that, despite recent progress in the identification of at-risk states, the currently employed instruments do not allow an effective prediction of a future psychotic onset. Also, evidence suggests a significant association between alterations in the autonomic nervous system (ANS) functioning and psychotic disorders. However, literature on the association between ANS functioning and at-risk states for psychosis is still scarce. The addition of physiological risk indicators may represent a step forward in the detection of at-risk individuals. CONCLUSIONS Overall, the present literature review highlights that a future schizophrenic onset cannot be strongly predicted with current available measures. Given the established correlation between schizophrenia and autonomic dysregulation, an investigation of the ANS functioning in individuals who are at increased risk of developing schizophrenia may be particularly useful to improve the quality of the assessment, to identify at an early stage the dysregulated physiological patterns that have been linked with schizophrenia, and therefore to develop tailored interventions. Accordingly, it is crucial that future research investigates the presence of autonomic deficits in individuals at risk for psychosis.
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Affiliation(s)
| | | | | | - Grazia Terrone
- Department of Humanities, Literature, and Cultural Heritage, University of Foggia
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157
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Fusar-Poli P, Oliver D, Spada G, Patel R, Stewart R, Dobson R, McGuire P. Real World Implementation of a Transdiagnostic Risk Calculator for the Automatic Detection of Individuals at Risk of Psychosis in Clinical Routine: Study Protocol. Front Psychiatry 2019; 10:109. [PMID: 30949070 PMCID: PMC6436079 DOI: 10.3389/fpsyt.2019.00109] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Primary indicated prevention in individuals at-risk for psychosis has the potential to improve the outcomes of this disorder. The ability to detect the majority of at-risk individuals is the main barrier toward extending benefits for the lives of many adolescents and young adults. Current detection strategies are highly inefficient. Only 5% (standalone specialized early detection services) to 12% (youth mental health services) of individuals who will develop a first psychotic disorder can be detected at the time of their at-risk stage. To overcome these challenges a pragmatic, clinically-based, individualized, transdiagnostic risk calculator has been developed to detect individuals at-risk of psychosis in secondary mental health care at scale. This calculator has been externally validated and has demonstrated good prognostic performance. However, it is not known whether it can be used in the real world clinical routine. For example, clinicians may not be willing to adhere to the recommendations made by the transdiagnostic risk calculator. Implementation studies are needed to address pragmatic challenges relating to the real world use of the transdiagnostic risk calculator. The aim of the current study is to provide in-vitro and in-vivo feasibility data to support the implementation of the transdiagnostic risk calculator in clinical routine. Method: This is a study which comprises of two subsequent phases: an in-vitro phase of 1 month and an in-vivo phase of 11 months. The in-vitro phase aims at developing and integrating the transdiagnostic risk calculator in the local electronic health register (primary outcome). The in-vivo phase aims at addressing the clinicians' adherence to the recommendations made by the transdiagnostic risk calculator (primary outcome) and other secondary feasibility parameters that are necessary to estimate the resources needed for its implementation. Discussion: This is the first implementation study for risk prediction models in individuals at-risk for psychosis. Ultimately, successful implementation is the true measure of a prediction model's utility. Therefore, the overall translational deliverable of the current study would be to extend the benefits of primary indicated prevention and improve outcomes of first episode psychosis. This may produce significant social benefits for many adolescents and young adults and their families.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Giulia Spada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Rashmi Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Robert Stewart
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Richard Dobson
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Institute of Health Informatics Research, University College London, London, United Kingdom
- Health Data Research UK London, University College London, London, United Kingdom
| | - Philip McGuire
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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158
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Andreou C, Bailey B, Borgwardt S. Assessment and treatment of individuals at high risk for psychosis. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYEarly detection and specialised early intervention for people at high risk for psychotic disorders have received growing attention in the past few decades, with the aim of delaying or preventing the outbreak of explicit psychotic symptoms and improving functional outcomes. This article summarises criteria for a diagnosis of high psychosis risk, the implications for such a diagnosis and recommendations for treatment.LEARNING OBJECTIVESAfter reading this article you will be able to:
•recognise signs and symptoms indicating increased psychosis risk•understand uses and limitations of screening for high psychosis risk, and interpretation of results•recognise evidence-based treatment options for patients at clinical high risk for psychosis.DECLARATION OF INTERESTC.A. has received non-financial support from Sunovion and Lundbeck in the past 36 months.
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159
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Trovão N, Prata J, VonDoellinger O, Santos S, Barbosa M, Coelho R. Peripheral Biomarkers for First-Episode Psychosis-Opportunities from the Neuroinflammatory Hypothesis of Schizophrenia. Psychiatry Investig 2019; 16:177-184. [PMID: 30836740 PMCID: PMC6444098 DOI: 10.30773/pi.2018.12.19.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Schizophrenia is a disabling disorder of unknown aetiology, lacking definite diagnostic method and cure. A reliable biological marker of schizophrenia is highly demanded, for which traceable immune mediators in blood could be promising candidates. We aimed to gather the best findings of neuroinflammatory markers for first-episode psychosis (FEP). METHODS We performed an extensive narrative review of online literature on inflammation-related markers found in human FEP patients only. RESULTS Changes to cytokine levels have been increasingly reported in schizophrenia. The peripheral levels of IL-1 (or its receptor antagonist), soluble IL-2 receptor, IL-4, IL-6, IL-8, and TNF-α have been frequently reported as increased in FEP, in a suggestive continuum from high-risk stages for psychosis. Microglia and astrocytes establish the link between this immune signalling and the synthesis of noxious tryptophan catabolism products, that cause structural damage and directly hamper normal neurotransmission. Amongst these, only 3-hydroxykynurenine has been consistently described in the blood of FEP patients. CONCLUSION Peripheral molecules stemming from brain inflammation might provide insightful biomarkers of schizophrenia, as early as FEP or even prodromal phases, although more time- and clinically-adjusted studies are essential for their validation.
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Affiliation(s)
- Nuno Trovão
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Joana Prata
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Orlando VonDoellinger
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Tâmega e Sousa Hospital Center, Penafiel, Portugal
| | - Susana Santos
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - Mário Barbosa
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Rui Coelho
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
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160
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Factor mixture analysis of paranoia in young people. Soc Psychiatry Psychiatr Epidemiol 2019; 54:355-367. [PMID: 30542959 DOI: 10.1007/s00127-018-1642-7] [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: 06/04/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Paranoid thoughts are relatively common in the general population and can increase the risk of developing mental health conditions. In this study, we investigate the latent structure of paranoia in a sample of young people. METHODS Cross-sectional survey; 243 undergraduate students (males: 44.9%) aged 24.3 years (SD 3.5). The participants completed the Green et al. Paranoid Thought Scales GPTS, a 32-item scale assessing ideas of social reference and persecution; the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Confirmatory factor analysis (CFA) was used to confirm the two-factor structure of the GPTS. Factor mixture modeling analysis (FMMA) was applied to map the best combination of factors and latent classes of paranoia. RESULTS The GPTS showed excellent internal reliability and test-retest stability. Convergent validity was good, with stronger links with measures of ideas of reference and of suspiciousness than with other measures of psychosis-proneness. CFA showed excellent fit for the two-factor solution. FMMA retrieved a three-class solution with 176 subjects (72.5%) assigned to a baseline class, 54 (22.2%) to a "suspicious and mistrustful" class, and 13 (5.3%) to a "paranoid thinking" class. Compared to the baseline class, the other two classes had a higher risk of psychological distress and psychosis-proneness. CONCLUSIONS The latent structure of paranoid thinking in young people appears dimensional. Although caution is advised when generalizing from studies on college students, screening for paranoid ideation in young people who complain about psychological distress might prove useful to prevent the development of severe and potentially debilitating conditions.
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161
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Michel C, Flückiger R, Kindler J, Hubl D, Kaess M, Schultze‐Lutter F. The trait-state distinction between schizotypy and clinical high risk: results from a one-year follow-up. World Psychiatry 2019; 18:108-109. [PMID: 30600631 PMCID: PMC6313228 DOI: 10.1002/wps.20595] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniela Hubl
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Frauke Schultze‐Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Department of Psychiatry and Psychotherapy, Heinrich‐Heine‐University, Düsseldorf, Germany
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162
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Raballo A, Cicero DC, Kerns JG, Sanna S, Pintus M, Agartz I, Pintus E, Corrias I, Lai V, Petretto DR, Carta MG, Preti A. Tracking salience in young people: A psychometric field test of the Aberrant Salience Inventory (ASI). Early Interv Psychiatry 2019; 13:64-72. [PMID: 28719056 DOI: 10.1111/eip.12449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/29/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
AIM To explore the prevalence of Aberrant Salience (AS, an alleged experiential feature of psychosis-proneness) in Italian young people and corroborate the transcultural validity of the Aberrant Salience Inventory (ASI). METHODS Young adults attending an Italian university (n = 649) underwent serial evaluations with the ASI together with psychometric proxies for help seeking General Health Questionnaire and attenuated positive and negative symptoms Schizotypal Personality Questionnaire (SPQ). The distribution of ASI scores was explored with latent class analysis (LCA). RESULTS Reliability of the Italian version of the ASI (I-ASI) was acceptable for all subscales (ordinal alpha >.70). Concurrent validity was in the expected direction, with higher correlations with measures of attenuated positive symptoms vs negative symptoms of psychosis (Steigers' z test, P < .005 in all comparisons). LCA identified three classes, with 217 (33.4%) participants in the "high aberrant salience" class. Gender and age were not related to class membership. Compared to the baseline class, SPQ scores in the schizotypy range were more likely in the "high aberrant salience" class (OR = 39.1; 95%confidence interval: 5.30-288.1). CONCLUSION AS is a relatively common experience among Italian young people. The study also confirmed the validity of field-testing ASI as a tool for the real-world characterization of people with vulnerability to psychosis, such as symptomatic help seekers with clinical high-risk states.
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Affiliation(s)
- Andrea Raballo
- Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Diakonjemmet Hospital, Oslo, Norway.,Department of Mental Health, Reggio Emilia, Reggio Emilia, Italy
| | - David C Cicero
- Department of Psychology, University of Hawai'i at Manoa, Honolulu, Hawaii
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Sara Sanna
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Mirra Pintus
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo and Diakonjemmet Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Elisa Pintus
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
| | - Irene Corrias
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
| | - Veronica Lai
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Donatella Rita Petretto
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Mauro G Carta
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy.,Department of Psychiatry, Genneruxi Medical Center, Cagliari, Italy
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163
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Theodoridou A, Hengartner MP, Heekeren K, Dvorsky D, Schultze-Lutter F, Gerstenberg M, Walitza S, Rössler W. Influence of demographic characteristics on attenuated positive psychotic symptoms in a young, help-seeking, at-risk population. Early Interv Psychiatry 2019; 13:53-56. [PMID: 28417595 DOI: 10.1111/eip.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/20/2017] [Accepted: 02/05/2017] [Indexed: 01/15/2023]
Abstract
AIM Presentation of attenuated positive psychotic symptoms (APS) was reported to be modestly influenced by age, sex and education in a psychosis-risk sample. We re-examined the influence of demographic variables on APS in an independent psychosis-risk sample. METHOD In a clinical high-risk-sample (N = 188; 13-35 years; 60.1% men), bivariate correlations were examined with Spearman correlations. All other associations were computed with generalized linear models. RESULTS Inter-correlations between positive symptoms were statistically significant for all but the smallest coefficient (range: r = 0.12-0.49). Age was negatively related to APS (range: OR = 0.53-0.78, all P < .01). Male sex was uniquely related to disorganized communication (OR = 1.46) and a high education-level related negatively to suspiciousness/persecutory ideas (OR = 0.64), perceptual abnormalities/hallucinations (OR = 0.57) and disorganized communication (OR = 0.54). The variance explained by age ranged from R 2 = 0.044 for unusual thought content to R 2 = 0.144 for perceptual abnormalities. CONCLUSION Our results highlighted the role of age and, thereby, neurodevelopment in psychosis-risk assessment.
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Affiliation(s)
- Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
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164
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Federated multi-site longitudinal study of at-risk mental state for psychosis in Japan. Schizophr Res 2019; 204:343-352. [PMID: 30219604 DOI: 10.1016/j.schres.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 09/01/2018] [Accepted: 09/01/2018] [Indexed: 11/22/2022]
Abstract
There has been recent accumulation of evidence and clinical guidance regarding the at-risk mental state (ARMS) for psychosis. However, most studies have been observational cohort and intervention studies of Western populations. To assess the validity of the ARMS concept and the transition rate to psychosis in a non-Western nation, we retrospectively combined and analyzed clinical data of individuals diagnosed with ARMS who were prospectively followed-up at three specialized clinical services for ARMS in Japan. In total, we included 309 individuals with ARMS, of whom 43 developed overt psychosis. We estimated cumulative transition rates to psychosis with the Kaplan-Meier method, obtaining rates of 12% at 12, 16% at 24, 19% at 36, and 20% at 48 months. Only two individuals reported past cannabis use. Despite several differences among the three sites, transition rates did not differ among them. Furthermore, the transition rate of children aged between 14 and 17 years did not differ from that of individuals aged 18 years or older. Regression analysis revealed that meeting the brief limited intermittent psychotic symptoms (BLIPS) criterion was associated with an increased risk of transition to psychosis, whereas genetic risk factors were not. Although antipsychotic prescription was relatively frequent in this cohort, there was no evidence supporting frequent use of antipsychotics for this population. In conclusion, our findings support the assertion that the current concept of ARMS is applicable in Japan. Development of local clinical guidelines and training for clinicians is necessary to disseminate this concept to more clinical settings.
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165
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Preti A, Carta MG, Petretto DR. Factor structure models of the SCL-90-R: Replicability across community samples of adolescents. Psychiatry Res 2019; 272:491-498. [PMID: 30611969 DOI: 10.1016/j.psychres.2018.12.146] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/01/2018] [Accepted: 12/28/2018] [Indexed: 11/28/2022]
Abstract
Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological distress in both the clinical and the research settings, although its factor structure is still debated. In this study, the factor structure of the SCL-90-R has been investigated in two independent samples of Italian adolescents. Two samples of 817 (urban sample) and 507 (rural sample) adolescents attending high schools were involved. Confirmatory factorial analysis (CFA) was used alongside hierarchical nested, progressively constrained models to assess configural, metric and scalar invariance of the best models fitted by CFA. The standard nine-factor structure of the SCL-90-R resulted reproducible and invariant between the two samples, in both its correlated and hierarchical second-order implementations. Estimated reliability of the nine scales of the SCL-90-R was optimal. This study also confirmed the reproducibility of the bifactor models of the SCL-90-R with nine orthogonally independent factors and with nine correlated primary factors, which have been tested in some recent studies. Overall, the SCL-90-R measures both common and unique features of psychological distress in community samples. The measurement invariance across different levels of psychological distress in the factor structure of the SCL-90-R is an issue deserving further testing and investigation.
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Affiliation(s)
- Antonio Preti
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy; Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
| | - Mauro Giovanni Carta
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
| | - Donatella Rita Petretto
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
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166
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Paust T, Theodoridou A, Müller M, Wyss C, Obermann C, Rössler W, Heekeren K. Borderline Personality Pathology in an At Risk Mental State Sample. Front Psychiatry 2019; 10:838. [PMID: 31798481 PMCID: PMC6874151 DOI: 10.3389/fpsyt.2019.00838] [Citation(s) in RCA: 5] [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: 03/07/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction: Transient psychotic symptoms in patients with borderline personality disorder seem to be similar to those in patients with psychotic disorders. Especially in the field of early detection of psychosis, this might lead to individuals with borderline personality disorder being wrongly classified as subjects at risk for developing a manifest psychosis. The aim of the present study was to investigate the occurrence of borderline symptoms in a sample of subjects at risk for psychosis as well as possible effects on the transition rate. Methods: Seventy help-seeking individuals of an early psychosis recognition center were additionally examined for borderline symptoms by the borderline symptom checklist. Results: We found a significant correlation between borderline symptomatology and positive symptoms assessed by the structured interview for prodromal symptoms. There were no associations between basic symptoms for psychosis and borderline symptoms. In addition, there was no influence of borderline symptomatology on the rate of transition into a manifest schizophrenic disease. Summary: In conclusion, borderline personality disorder should not be an exclusion criterion for the screening for psychosis or for an early intervention treatment. On the other hand, not every patient with borderline personality disorder, (especially those not suffering from hallucinations, unusual thought content, or persecutory ideas) should automatically be screened for the risk of developing a psychotic disorder.
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Affiliation(s)
- Tobias Paust
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Christine Wyss
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
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167
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Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.
Key learning aims
(1)
To understand CBT evidence and procedures for young individuals with ARMS.
(2)
To reflect on the current limitations in the literature on CBT for ARMS.
(3)
To understand the importance and clinical implications of assessing worry in ARMS.
(4)
To focus on changes in worry as an outcome after CBT for ARMS.
(5)
To reflect on future research directions on the role of worry in CBT for ARMS.
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168
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Urban-Kowalczyk M, Kotlicka-Antczak M, Strzelecki D, Rudecka E, Śmigielski J. The Relationship Between Course of Illness and β-Endorphin Plasma Levels in Patients with Schizophrenia. Neuropsychiatr Dis Treat 2019; 15:3609-3614. [PMID: 32099366 PMCID: PMC6997221 DOI: 10.2147/ndt.s225321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Extensive investigations have been conducted into predictors of schizophrenia outcome. The heterogeneity of the illness implies that many factors should be taken into account. Some studies have reported the relationship between increased β-endorphin concentration and predominant negative symptoms. METHODS We included 77 outpatients with schizophrenia and 74 healthy controls. Data referring to duration and course of illness, hospitalization number and treatment were collected on the basis of clinical interviews and medical documentation analysis. The β-endorphin concentrations were assessed once in all participants, at the onset of the study. RESULTS A chronic course of illness was found in 44 of the 77 schizophrenics. Patients with schizophrenia, especially those with a chronic course of illness, revealed significantly higher β-endorphin concentrations than those with an episodic course and controls (mean 29.70 vs 19.86 pmol/L; p=0.0001). Increased levels of β-endorphin were related to longer duration of illness (R=0.294, p=0.009) and frequent psychiatric hospitalization (R=0.346, p=-0.002). CONCLUSION Endorphins may be potential biological predictors of persistent negative symptoms and final outcome in schizophrenia.
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Affiliation(s)
| | | | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland
| | - Ewa Rudecka
- Babiński Memorial Hospital in Łódź, Łódź, Poland.,Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences SGGW, Warsaw, Poland
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169
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van der Gaag M, van den Berg D, Ising H. CBT in the prevention of psychosis and other severe mental disorders in patients with an at risk mental state: A review and proposed next steps. Schizophr Res 2019; 203:88-93. [PMID: 28869097 DOI: 10.1016/j.schres.2017.08.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023]
Abstract
Patients with an 'At risk mental state' (ARMS) for developing psychosis can be treated successfully with CBT to postpone and prevent the transition to a first psychotic episode. A characteristic of individuals that meet ARMS criteria is that they are still open for multiple explanations for extraordinary experiences. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. The treatment is not only effective, but also cost-saving in averting psychosis as well as in reducing disability adjusted life years at 18- and 48-month follow-up. Profiling within the ARMS group results in a personalized treatment. The screening and early treatment for ARMS fulfills all the criteria of the World Health Organization and is ready to be routine screening and treatment in mental health care. At the same time, ARMS patients are complex patients with multi-morbid disorders. Especially childhood trauma is associated to ARMS status, together with co-morbid PTSD, depression, substance abuse and anxiety disorders. Psychotic symptoms appear to be severity markers in other non-psychotic disorders. Preventing psychosis in ARMS patients should be broadened to also address other disorders and aim to reduce chronicity of psychopathology and improve social functioning in general. Several mechanisms play a part in psychopathology in ARMS patients such as stress sensitivity as a result of adverse experiences, dopamine sensitivity that is associated with salience and aggravates several cognitive biases, dissociation mediating between trauma and hallucinations, and low self-esteem and self-stigma. New avenues to treat the complexity of ARMS patients will be proposed.
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Affiliation(s)
- Mark van der Gaag
- Vrije Universiteit, Amsterdam Public Health Research, Parnassia Psychiatric Institute, Department of Clinical Psychology, Van der Boechorsttraat 1, 1081 BT Amsterdam, The Netherlands.
| | - David van den Berg
- Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands.
| | - Helga Ising
- Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands.
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170
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Kennedy L, Johnson KA, Cheng J, Woodberry KA. A Public Health Perspective on Screening for Psychosis Within General Practice Clinics. Front Psychiatry 2019; 10:1025. [PMID: 32082199 PMCID: PMC7006053 DOI: 10.3389/fpsyt.2019.01025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/24/2019] [Indexed: 12/24/2022] Open
Abstract
Screening for major mental illness in adolescents and young adults has lagged behind screening for physical illness for a myriad of reasons. Existing pediatric behavioral health screening tools screen primarily for disorders of attention, disruptive behaviors, depression, and anxiety. A few also screen for substance use and suicide risk. Although it is now possible to reliably identify young people at imminent risk for a psychotic disorder, arguably the most severe of mental illnesses, general practitioners (GP) rarely screen for psychotic symptoms or recognize when to refer patients for a specialized risk assessment. Research suggests that barriers such as inadequate knowledge or insufficient access to mental health resources can be overcome with intensive GP education and the integration of physical and mental health services. Under the lens of two public health models outlining the conditions under which disease screening is warranted, we examine additional evidence for and against population-based screening for psychosis in adolescents and young adults. We argue that systematic screening within general health settings awaits a developmentally well-normed screening tool that includes probes for psychosis, is written at a sufficiently low reading level, and has acceptable sensitivity and, in particular, specificity for detecting psychosis and psychosis risk in both adolescents and young adults. As integrated healthcare models expand around the globe and psychosis-risk assessments and treatments improve, a stratified screening and careful risk management protocol for GP settings could facilitate timely early intervention that effectively balances the benefit/risk ratio of employing such a screening tool at the population level.
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Affiliation(s)
- Leda Kennedy
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Columbia Irving Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Kelsey A Johnson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joyce Cheng
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Wellesley College, Wellesley, MA, United States
| | - Kristen A Woodberry
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Center for Psychiatric Research, Maine Medical Center, Portland, ME, United States
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171
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Moriyama TS, van Os J, Gadelha A, Pan PM, Salum GA, Manfro GG, Mari JDJ, Miguel EC, Rohde LA, Polanczyk GV, McGuire P, Bressan RA, Drukker M. Differences Between Self-Reported Psychotic Experiences, Clinically Relevant Psychotic Experiences, and Attenuated Psychotic Symptoms in the General Population. Front Psychiatry 2019; 10:782. [PMID: 31736802 PMCID: PMC6829673 DOI: 10.3389/fpsyt.2019.00782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child's report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents. Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6-14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents' information about the child's positive attributes and levels of psychopathology and psychologist assessment of blunted affect. Results: Most associations were qualitatively similar, and there was a dose-response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening. Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
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Affiliation(s)
- Tais Silveira Moriyama
- Centro de Atendimento Especializado, Instituto Bairral de Psiquiatria, Itapira, Brazil.,Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom.,Department of Psychiatry, UMC Utrecht Brain Centre, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Pedro Mario Pan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom
| | - Rodrigo Affonseca Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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172
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Hwang WJ, Lee TY, Shin WG, Kim M, Kim J, Lee J, Kwon JS. Global and Specific Profiles of Executive Functioning in Prodromal and Early Psychosis. Front Psychiatry 2019; 10:356. [PMID: 31178768 PMCID: PMC6537881 DOI: 10.3389/fpsyt.2019.00356] [Citation(s) in RCA: 5] [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: 12/20/2018] [Accepted: 05/07/2019] [Indexed: 01/31/2023] Open
Abstract
Objective: Numerous reports on neurocognitive functioning deficits in individuals at clinical high risk (CHR) and first-episode psychosis (FEP) patients suggest particular deficits in executive functioning (EF). However, to date, most of the studies have administered a single or a few EF tests to participants, and few investigations have examined the different components of EF to identify specific subdomains of relative strength and weakness. Method: Forty CHR subjects, 85 FEP patients, and 85 healthy controls (HCs) were assessed with a neuropsychological battery to elucidate the profiles of EF in the subdomains of shift, attention, fluency, and planning. Results: In the subdomains of shift, attention, and fluency, CHR individuals and FEP patients showed deficits compared to HC. The post hoc analysis revealed that CHR individuals had comparable attention shifting and phonemic fluency compared to FEP. CHR showed intermediate deficits between FEP and HCs in spatial working memory and semantic fluency, and the largest effect size was observed in semantic fluency both for CHR and FEP. Conclusion: Overall, the findings of this study, in addition to providing detailed profiles of EF in prodromal and early psychosis patients, highlight the informative value of the specific subdomains of semantic fluency and spatial working memory.
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Affiliation(s)
- Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, Seoul, South Korea
| | - Tae Young Lee
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
| | - Won-Gyo Shin
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, South Korea
| | - Minah Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jihyang Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
| | - Junhee Lee
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, Seoul, South Korea.,Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, South Korea
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173
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Armando M, Hutsebaut J, Debbané M. A Mentalization-Informed Staging Approach to Clinical High Risk for Psychosis. Front Psychiatry 2019; 10:385. [PMID: 31214062 PMCID: PMC6555089 DOI: 10.3389/fpsyt.2019.00385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
The practice of diagnosis is fundamentally designed to orient treatment. In the case of early diagnosis for schizophrenia spectrum disorders (SSP) risk, the empirical base for such a practice is still young, and many clinical questions arise in the everyday clinical application of risk algorithms and ensuing therapeutic options. One of the key questions that we will focus on is the following: in cases of SSP where symptoms are successfully treated, why does residual social functioning impairment remain the most serious obstacle to remission and reinsertion in society? We will present the evidence suggesting that the roots of residual social functioning impairment may, in many cases, come from thwarted or arrested development in the specialization of social cognition during adolescence and early adulthood. We will review the evidence suggesting that both during the premorbid phase and clinical high-risk phase, attenuated psychotic symptoms may impede the maturation of key social cognitive processes, particularly the suite of reflective thinking processes coming under the term of mentalization. From this evidence base, we will adapt the staging model of SSP progression in function of our mentalization-informed model, tailored to provide a coherent framework of care addressing the key clinical needs at every stage of psychosis progression.
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Affiliation(s)
- Marco Armando
- Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders (VISPD), MBT Netherlands, Amsterdam, Netherlands
| | - Martin Debbané
- Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.,Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
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174
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Grover S, Avasthi A. Clinical Practice Guidelines for the Management of Schizophrenia in Children and Adolescents. Indian J Psychiatry 2019; 61:277-293. [PMID: 30745703 PMCID: PMC6345123 DOI: 10.4103/psychiatry.indianjpsychiatry_556_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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175
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Albert U, Tomassi S, Maina G, Tosato S. Prevalence of non-psychotic disorders in ultra-high risk individuals and transition to psychosis: A systematic review. Psychiatry Res 2018; 270:1-12. [PMID: 30243126 DOI: 10.1016/j.psychres.2018.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/13/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022]
Abstract
Despite the growing interest in the prodromes of psychosis, the proper identification of those Ultra High Risk (UHR) subjects who will convert to psychosis remains an unresolved issue. It remains to be fully understood whether the risk of transition to psychosis is incremented by the concomitant presence of non-psychotic symptoms. We performed a systematic review in order to estimate: prevalence rates of non-psychotic disorders in UHR individuals and whether any comorbid disorder impacts on the risk of transition to frank psychosis. The review was conducted using the PRISMA guidelines by searching PubMed until August 2017. The inclusion criteria were: studies with appropriate definition of UHR/ ARMS (At Risk Mental States for psychosis); cross-sectional design (for prevalence rates) or longitudinal design (for transition rates to psychosis); adolescents and/or adults; specified instrument/interview for the diagnosis of mental disorder/symptoms. We included 46 English-language articles. We found that non-psychotic symptoms are a prevalent concern in UHR individuals, and this is true for all comorbid disorders examined. None of the mental disorder examined appear to be a marker for transition to psychosis. Our systematic review found that the great majority of UHR individuals actually has a highly prevalent clearly defined, above-the-threshold mental disorder that should constitute the primary focus of intervention.
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Affiliation(s)
- Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Simona Tomassi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Italy and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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176
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Ärmänen A, Lahti M, Therman S, Suvisaari J, Lindgren M. Psychological, social and role functioning as predictors of psychosis in an adolescent psychiatric sample. Early Interv Psychiatry 2018; 12:1064-1071. [PMID: 28124493 DOI: 10.1111/eip.12414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022]
Abstract
AIM Recent evidence from psychosis risk studies of preselected samples suggests that early functional impairment may be a vulnerability marker for psychosis. We investigated whether functional impairment predicted later risk of psychotic disorder and psychiatric hospitalizations in adolescents at entry to general psychiatric services. METHODS A total of 154 adolescents, aged 15 to 18 years, were recruited to the study at entry to general adolescent psychiatric services in Helsinki, Finland. Structured Interview for Prodromal Syndrome and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder for DSM-IV, Clinical version interviews were used to assess psychotic-like symptoms, psychosis risk and psychiatric diagnoses. Of the adolescents, 46 met the criteria for clinical high risk status. The level of functioning was assessed with Global Functioning Social, Role and Psychological scales. The adolescents were followed for 3 to 9 (median = 5) years via a hospital discharge register. Cox regression analyses were used to examine whether baseline functioning predicted psychotic disorders and psychiatric hospitalizations when controlling for the effect of psychosis risk symptoms. RESULTS Impairments in social, role or psychological functioning did not predict psychotic disorders beyond risk symptoms. Impairment in psychological functioning was the only significant predictor of any psychiatric hospitalization after adjusting for positive psychosis risk symptom severity and level of social and role functioning. CONCLUSIONS Psychosis was predicted by psychotic-like experiences at entry to psychiatric services. No aspect of functioning predicted psychosis in adolescents, which is likely to be explained by the low incidence of psychosis transitions. Severe mental disorders as assessed by psychiatric hospitalizations were predicted by more severe symptomatology as assessed by the psychological functioning scale.
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Affiliation(s)
- Anna Ärmänen
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.,The Endocrinology Unit, British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sebastian Therman
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
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177
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Raballo A, Monducci E, Ferrara M, Fiori Nastro P, Dario C. Developmental vulnerability to psychosis: Selective aggregation of basic self-disturbance in early onset schizophrenia. Schizophr Res 2018; 201:367-372. [PMID: 29804931 DOI: 10.1016/j.schres.2018.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/06/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022]
Abstract
Trait-like anomalies of subjective experience (aka, Basic Self-disturbance or Self-disorder, SD) have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. However, such specificity is still to be tested in developmental years, where emerging psychopathology is less crystallized and diagnostic boundaries more blurred. Thus, the current study explores the distribution of SD in adolescent help-seekers (age range 14 to 18) and tests the specificity of SD with respect to the severity of their diagnostic staging (Early Onset schizophrenia-spectrum psychosis [EOP], ultra high-risk [UHR] and clinical help-seeking controls [CHSC]). For this purpose, 96 help-seeking adolescents consecutively referred to specialized Child and Adolescent Units for diagnostic evaluation, underwent a comprehensive psychopathological examination including the specific interview for SD (i.e. the Examination of Anomalous Self-Experience, EASE). One-way ANOVA was used to test the diagnostic distribution of SD (EASE score), whereas multinomial logistic regression was used to test the effect of SD on the diagnostic outcome. SD frequency (both in terms of EASE total score and domain sub-scores) was decreasing progressively from EOP to CHSC, with intermediate levels in UHR. The EASE total score increased the risk of belonging to the more severe diagnostic stages (i.e, UHR and EOP vs CHSC as reference class) and allowed the correct reclassification of the 75% of the sample. The results confirm the schizophrenia-spectrum specificity of SD in adolescence, highlighting their potential value for early differential diagnosis and risk stratification.
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Affiliation(s)
- Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Psychopathology and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Elena Monducci
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Ferrara
- Pediatrics and Paediatric Neuropsychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Dario
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy; Psychiatric Center Hvidovre, University of Copenhagen, Denmark; Center for Subjectivity Research, University of Copenhagen, Denmark
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178
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Striatal cerebral blood flow, executive functioning, and fronto-striatal functional connectivity in clinical high risk for psychosis. Schizophr Res 2018; 201:231-236. [PMID: 29983268 DOI: 10.1016/j.schres.2018.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/22/2018] [Accepted: 06/09/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients at clinical high risk (CHR) for psychosis exhibit increased striatal cerebral blood flow (CBF) during the resting state and impaired cognitive function. However, the relation between CBF and cognitive impairment is unknown. We therefore studied the association between striatal CBF and executive functioning and evaluated the functional connectivity (FC) between dorsal striatum and the frontal cortex in CHR. METHODS In total, 47 participants [29 with CHR, 18 matched clinical controls (CC)] were assessed for ultra-high-risk criteria and basic symptoms and were tested for executive functioning using the trail making test-B (TMT-B). Resting state mean CBF and FC were calculated from arterial spin labeling 3T MRI data. RESULTS Striatal CBF was highest in CHR patients with TMT-B deficits and was significantly higher than that in CC with and without TMT-B impairment. Further, a significantly lower CBF FC between the dorsal striatum and the anterior cingulate cortex was revealed in CHR. CONCLUSIONS Our study suggests that higher striatal CBF might represent focal pathology in CHR and is associated with disrupted cingulo-striatal FC and executive dysfunctions.
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179
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Padula MC, Schaer M, Armando M, Sandini C, Zöller D, Scariati E, Schneider M, Eliez S. Cortical morphology development in patients with 22q11.2 deletion syndrome at ultra-high risk of psychosis. Psychol Med 2018; 48:2375-2383. [PMID: 29338796 DOI: 10.1017/s0033291717003920] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with 22q11.2 deletion syndrome (22q11DS) present a high risk of developing psychosis. While clinical and cognitive predictors for the conversion towards a full-blown psychotic disorder are well defined and largely used in practice, neural biomarkers do not yet exist. However, a number of investigations indicated an association between abnormalities in cortical morphology and higher symptoms severities in patients with 22q11DS. Nevertheless, few studies included homogeneous groups of patients differing in their psychotic symptoms profile. METHODS In this study, we included 22 patients meeting the criteria for an ultra-high-risk (UHR) psychotic state and 22 age-, gender- and IQ-matched non-UHR patients. Measures of cortical morphology, including cortical thickness, volume, surface area and gyrification, were compared between the two groups using mass-univariate and multivariate comparisons. Furthermore, the development of these measures was tested in the two groups using a mixed-model approach. RESULTS Our results showed differences in cortical volume and surface area in UHR patients compared with non-UHR. In particular, we found a positive association between surface area and the rate of change of global functioning, suggesting that higher surface area is predictive of improved functioning with age. We also observed accelerated cortical thinning during adolescence in UHR patients with 22q11DS. CONCLUSIONS These results, although preliminary, suggest that alterations in cortical volume and surface area as well as altered development of cortical thickness may be associated to a greater probability to develop psychosis in 22q11DS.
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Affiliation(s)
- Maria Carmela Padula
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Marie Schaer
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Marco Armando
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Corrado Sandini
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Daniela Zöller
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Elisa Scariati
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Maude Schneider
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory,Department of Psychiatry,University of Geneva School of Medicine,Geneva,Switzerland
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180
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Leanza L, Egloff L, Studerus E, Andreou C, Heitz U, Ittig S, Beck K, Uttinger M, Riecher-Rössler A. The relationship between negative symptoms and cognitive functioning in patients at clinical high risk for psychosis. Psychiatry Res 2018; 268:21-27. [PMID: 29986173 DOI: 10.1016/j.psychres.2018.06.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/28/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
Negative symptoms and neurocognitive performance have been reported to be negatively associated in patients with emerging psychosis. However, most previous studies focused on patients with frank psychosis and did not differentiate between subdomains of negative symptoms. Hence, we aimed to elucidate the specific relationship between negative symptoms and cognitive functioning in patients at clinical high risk (CHR) for psychosis. Data from 154 CHR patients collected within the prospective Früherkennung von Psychosen (FePsy) study were analyzed. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and cognitive functioning with an extensive neuropsychological test battery. Regression analyses revealed significant negative associations between negative symptoms and cognitive functioning, particularly in the domains of nonverbal intelligence and verbal fluency. When analyzing each negative symptom domain separately, alogia and asociality/anhedonia were significantly negatively associated with nonverbal intelligence and alogia additionally with verbal fluency. Overall, our results in CHR patients are similar to those reported in patients with frank psychosis. The strong negative association between verbal fluency and negative symptoms may be indicative of an overlap between these constructs. Verbal fluency might have a strong influence on the clinical impression of negative symptoms (particularly alogia) and vice versa.
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Affiliation(s)
- Letizia Leanza
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
| | - Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital (UPK), Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland.
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181
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Docherty AR, Fonseca-Pedrero E, Debbané M, Chan RCK, Linscott RJ, Jonas KG, Cicero DC, Green MJ, Simms LJ, Mason O, Watson D, Ettinger U, Waszczuk M, Rapp A, Grant P, Kotov R, DeYoung CG, Ruggero CJ, Eaton NR, Krueger RF, Patrick C, Hopwood C, O’Neill FA, Zald DH, Conway CC, Adkins DE, Waldman ID, van Os J, Sullivan PF, Anderson JS, Shabalin AA, Sponheim SR, Taylor SF, Grazioplene RG, Bacanu SA, Bigdeli TB, Haenschel C, Malaspina D, Gooding DC, Nicodemus K, Schultze-Lutter F, Barrantes-Vidal N, Mohr C, Carpenter WT, Cohen AS. Enhancing Psychosis-Spectrum Nosology Through an International Data Sharing Initiative. Schizophr Bull 2018; 44:S460-S467. [PMID: 29788473 PMCID: PMC6188505 DOI: 10.1093/schbul/sby059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The latent structure of schizotypy and psychosis-spectrum symptoms remains poorly understood. Furthermore, molecular genetic substrates are poorly defined, largely due to the substantial resources required to collect rich phenotypic data across diverse populations. Sample sizes of phenotypic studies are often insufficient for advanced structural equation modeling approaches. In the last 50 years, efforts in both psychiatry and psychological science have moved toward (1) a dimensional model of psychopathology (eg, the current Hierarchical Taxonomy of Psychopathology [HiTOP] initiative), (2) an integration of methods and measures across traits and units of analysis (eg, the RDoC initiative), and (3) powerful, impactful study designs maximizing sample size to detect subtle genomic variation relating to complex traits (the Psychiatric Genomics Consortium [PGC]). These movements are important to the future study of the psychosis spectrum, and to resolving heterogeneity with respect to instrument and population. The International Consortium of Schizotypy Research is composed of over 40 laboratories in 12 countries, and to date, members have compiled a body of schizotypy- and psychosis-related phenotype data from more than 30000 individuals. It has become apparent that compiling data into a protected, relational database and crowdsourcing analytic and data science expertise will result in significant enhancement of current research on the structure and biological substrates of the psychosis spectrum. The authors present a data-sharing infrastructure similar to that of the PGC, and a resource-sharing infrastructure similar to that of HiTOP. This report details the rationale and benefits of the phenotypic data collective and presents an open invitation for participation.
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Affiliation(s)
- Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT,Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA,To whom correspondence should be addressed; Department of Psychiatry, University of Utah School of Medicine, 501 Chipeta Way, Salt Lake City, UT 84110, US; tel: +1-801-213-6905, fax: +1-801-581-7109, e-mail:
| | | | - Martin Debbané
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK,Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, Chinese Academy of Sciences, Beijing, China
| | | | - Katherine G Jonas
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY
| | - Oliver Mason
- Department of Psychology, University of Surrey, Guildford, UK
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN
| | | | - Monika Waszczuk
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - Alexander Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Phillip Grant
- Department of Psychology, Justus-Liebig-University Giessen, Giessen, Germany,Technische Hochschule Mittelhessen, University of Applied Sciences, Giessen, Germany
| | - Roman Kotov
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Nicolas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | | | - F Anthony O’Neill
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, UK
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN,Department of Psychiatry, Vanderbilt University, Nashville, TN
| | | | - Daniel E Adkins
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT,Department of Sociology, University of Utah, Salt Lake City, UT
| | | | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands,King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,Department of Psychiatry, Brain Center Rudolf Magnus Institute, University Medical Center, Utrecht, The Netherlands
| | - Patrick F Sullivan
- Department of Psychiatry, University of North Carolina—Chapel Hill, Chapel Hill, NC,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - John S Anderson
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Andrey A Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott R Sponheim
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | | | - Silviu A Bacanu
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Tim B Bigdeli
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, UK
| | | | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Diane C Gooding
- Department of Psychology, University of Wisconsin—Madison, Madison, WI
| | - Kristin Nicodemus
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Dusseldorf, Germany
| | - Neus Barrantes-Vidal
- Department of Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain,Centre for Biomedical Research, University of North Carolina at Greensboro, Greensboro, NC,Sant Pere Claver—Fundació Sanitària, Barcelona, Spain
| | - Christine Mohr
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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Zhang T, Xu L, Tang Y, Cui H, Wei Y, Tang X, Hu Q, Wang Y, Zhu Y, Jiang L, Hui L, Liu X, Li C, Wang J. Isolated hallucination is less predictive than thought disorder in psychosis: Insight from a longitudinal study in a clinical population at high risk for psychosis. Sci Rep 2018; 8:13962. [PMID: 30228293 PMCID: PMC6143535 DOI: 10.1038/s41598-018-32215-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
Perceptual abnormalities (PAs) such as auditory hallucinations are one of the most common symptoms of psychotic patients. However, it remains unclear whether symptoms of sub-clinical PAs also play a key role in predicting psychosis. In an ongoing prospective follow-up study of individuals at a clinical high risk (CHR) of psychosis, we evaluated the potential of first-time experience of PAs and/or thought content disorders (TCDs) to predict psychosis. Conversion to psychosis was the major focus of this follow-up study. A total of 511 CHRs were recruited, of whom 443 (86.7%) completed the clinical follow-up of at least 6 months and up to 2 years. CHRs were divided into four groups according to the presence of PAs and/or TCDs. At the follow-up endpoint, 39 (19.9%) CHRs in the “TCDs-only” group, 2 (8.3%) in the “PAs-only” group, 45 (17.0%) in the “TCDs-and-PAs” group, and 1 (3.8%) in the “None” group converted to psychosis. Survival analysis revealed a higher conversion rate in CHRs with TCDs compared with those with PAs only. CHRs with isolated PAs had shown a higher level of dysphoric mood at baseline compared with those with TCDs. About 89% TCDs contents were related with their experienced PAs. Compared with TCDs, the isolated PAs are not strongly associated with increased susceptibility to psychosis.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Qiang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Yan Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YiKang Zhu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - LiJuan Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Li Hui
- Institute of Mental Health, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, 215137, Suzhou, P. R. China
| | - XiaoHua Liu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China.
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, P. R. China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China. .,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, P. R. China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, China.
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183
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de Jong Y, Mulder CL, Boon AE, Deen M, van 't Hof M, van der Gaag M. Screening for psychosis risk among adolescents in Child and Adolescent Mental Health Services: a description of the first step with the 16-item version of the Prodromal Questionnaire (PQ-16). Early Interv Psychiatry 2018; 12:669-676. [PMID: 27860294 DOI: 10.1111/eip.12362] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/15/2016] [Accepted: 06/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Although the 16-item version of the Prodromal Questionnaire (PQ-16) is used as a screener in the early detection of psychosis risk, little is known about PQ-16 scores among adolescents referred to the Child and Adolescent Mental Health Services. We assessed such scores in adolescents referred to these services in the Netherlands, and also their associations with age, gender, diagnosis and level of functioning. METHODS The PQ-16 was added to regular intake procedures. RESULTS The PQ-16 was completed by 176 adolescents (mean age 14.58 years; standard deviation = 1.50; 55.1% females), 34.7% of whom scored above the current cut-off score of ≥6 items. Positive item scores with the highest odds ratio for scoring above the cut-off were related to tasting or smelling things, seeing things and hearing thoughts out aloud. There were no age-, gender- or disorder-related differences in total scores on the PQ-16. Lower Global Assessment of Functioning scores were associated with higher total scores on the PQ-16. CONCLUSIONS The PQ-16 is easy to implement in routine assessment and can be useful to bring up potential psychotic symptoms for further exploration in an early stage, especially in adolescents with low Global Assessment of Functioning scores. The PQ-16 total scores were not confounded by differences in age, gender or disorder. Future research should investigate the true nature of PQ-16 items and whether the item scores and cut-off scores of the PQ-16 in adolescence have any predictive value regarding the development of an ultra high-risk status, a psychotic disorder or other mental disorders.
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Affiliation(s)
- Yvonne de Jong
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands.,Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Albert E Boon
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Oegstgeest, The Netherlands.,Lucertis Center for Child and Adolescence Psychiatry, Capelle a/d IJssel, The Netherlands
| | - Mathijs Deen
- Scientific research department, Parnassia Academy, The Hague, The Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Maarten van 't Hof
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands
| | - Mark van der Gaag
- VU University and, EMGO Mental Health and Care Research, Dept. of Clinical Psychology, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, Zoutkeetsingel, The Hague, The Netherlands
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184
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Zheng W, Zhang QE, Cai DB, Ng CH, Ungvari GS, Ning YP, Xiang YT. Neurocognitive dysfunction in subjects at clinical high risk for psychosis: A meta-analysis. J Psychiatr Res 2018; 103:38-45. [PMID: 29772485 DOI: 10.1016/j.jpsychires.2018.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023]
Abstract
Findings of neurocognitive dysfunction in subjects at Clinical High Risk for Psychosis (CHR-P) have been controversial. This meta-analysis systematically examined studies of neurocognitive functions using the MATRICS Consensus Cognitive Battery (MCCB) in CHR-P. An independent literature search of both English and Chinese databases was conducted by two reviewers. Standardized mean difference (SMD) was calculated using a random effects model to evaluate the effect size of the meta-analytic results. Six case-control studies (n = 396) comparing neurocognitive functions between CHR-P subjects (n = 197) and healthy controls (n = 199) using the MCCB were identified; 4 (66.7%) studies were rated as "high quality". Compared to healthy controls, CHR-P subjects showed impairment with large effect size in overall cognition (n = 128, SMD = -1.00, 95%CI: -1.38, -0.63, P < 0.00001; I2 = 2%), processing speed (SMD = -1.21) and attention/vigilance (SMD = -0.83), and with medium effect size in working memory (SMD = -0.76), reasoning and problem solving (SMD = -0.71), visual (SMD = -0.68) and verbal learning (SMD = -0.67). No significant difference between CHR-P subjects and controls was found regarding social cognition (SMD = -0.33, 95%CI: -0.76, 0.10, P = 0.14; I2 = 70%) with small effect size. Apart from social cognition, CHR-P subjects performed worse than healthy control in all MCCB cognitive domains, particularly in processing speed, attention/vigilance and working memory.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Qing-E Zhang
- The National Clinical Research Center for Mental Disorders, China &Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Dong-Bin Cai
- Clinics of Chinese Medicine, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Graylands Hospital, Perth, Australia
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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185
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Petruzzelli MG, Margari M, Peschechera A, de Giambattista C, De Giacomo A, Matera E, Margari F. Hyperprolactinemia and insulin resistance in drug naive patients with early onset first episode psychosis. BMC Psychiatry 2018; 18:246. [PMID: 30068291 PMCID: PMC6090964 DOI: 10.1186/s12888-018-1827-3] [Citation(s) in RCA: 15] [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: 05/07/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hyperprolactinemia and glucose and lipid metabolism abnormalities are often found in patients with schizophrenia and are generally considered secondary to the use of antipsychotic drugs. More recent studies have shown these same neuroendocrine and metabolic abnormalities in antipsychotic naïve patients with first episode psychosis (FEP), rising the hypothesis that schizophrenia itself may be related to an abnormal regulation of prolactin secretion and to impaired glucose tolerance. The aim of this study was to compare prolactin levels, glycometabolism parameters and lipid profile between a sample of 31 drug-naive adolescents in the acute phase of FEP and a control group of 23 subjects at clinical high risk (CHR) of developing psychosis. METHODS The assessment involved anthropometric data (weight, height, BMI index, pubertal stage) and blood tests (levels of glucose, glycated hemoglobin, serum insulin, triglycerides, total and fractionated cholesterol, prolactin). Insulin resistance (IR) was calculated through the homeostatic model of assessment (HOMA-IR), assuming a cut-off point of 3.16 for adolescent population. FEP patients and CHR controls were compared by using Student's t-distribution (t-test) for parametric data. P < 0.05 was considered significant. RESULTS Significant higher level of prolactin was found in FEP group than in CHR group (mean = 28.93 ± 27.16 vs 14.29 ± 7.86, P = 0.009), suggesting a condition of hyperprolactinemia (HPRL). Patients with FEP were more insulin resistant compared to patients at CHR, as assessed by HOMA-IR (mean = 3.07 ± 1.76 vs 2.11 ± 1.11, P = 0.043). Differences of fasting glucose (FEP = 4.82 ± 0.71, CHR = 4.35 ± 0.62, P = 0.016) and HbA1c (FEP = 25.86 ± 13.31, CHR = 33.00 ± 2.95, P = 0.013), were not clinically significant as the mean values were within normal range for both groups. No significant differences were found for lipid profile. A BMI value within the range of normal weight was found for both groups, with no significant differences. CONCLUSION We suggested that HPRL, increase in HOMA-IR, and psychotic symptoms may be considered different manifestations of the acute onset of schizophrenia spectrum psychosis, with a common neurobiological vulnerability emerging since adolescence. The influence of age and gender on clinical manifestations of psychotic onset should be considered for early prevention and treatment of both schizophrenia spectrum psychosis and neuroendocrine-metabolic dysfunctions.
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Affiliation(s)
- Maria Giuseppina Petruzzelli
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Mariella Margari
- 0000 0001 0120 3326grid.7644.1Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonia Peschechera
- 0000 0001 0120 3326grid.7644.1Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Concetta de Giambattista
- 0000 0001 0120 3326grid.7644.1Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea De Giacomo
- 0000 0001 0120 3326grid.7644.1Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Emilia Matera
- 0000 0001 0120 3326grid.7644.1Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Margari
- 0000 0001 0120 3326grid.7644.1Psychiatry Unit , Department of Basic Medical Sciences, Neuroscience and Sense Organ, University of Bari “Aldo Moro”, Azienda Ospedaliero-Universitaria Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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186
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Jagannath V, Gerstenberg M, Walitza S, Franscini M, Heekeren K, Rössler W, Theodoridou A, Grünblatt E. Neuregulin 1 (NRG1) gene expression predicts functional outcomes in individuals at clinical high-risk for psychosis. Psychiatry Res 2018; 266:143-146. [PMID: 29864613 DOI: 10.1016/j.psychres.2018.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/07/2018] [Accepted: 05/10/2018] [Indexed: 01/09/2023]
Abstract
Little is known about valid predictive markers for functional outcomes in an at-risk for psychosis population. In a cohort of 185 individuals (age: 13-35 years) at high risk (HR) and ultra-high risk (UHR), we assessed pan-NRG1 mRNA levels across good functional status (GFS) and poor functional status (PFS) at baseline, and good functional outcome (GFO) and poor functional outcome (PFO) at 12-month follow-up. NRG1 mRNA levels were significantly higher in individuals with PFO than individuals with GFO at 12-month follow-up. Our findings suggest that NRG1 might emerge as a predictive marker for functional outcomes in at-risk for psychosis population.
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Affiliation(s)
- Vinita Jagannath
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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187
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Mohr P, Galderisi S, Boyer P, Wasserman D, Arteel P, Ieven A, Karkkainen H, Pereira E, Guldemond N, Winkler P, Gaebel W. Value of schizophrenia treatment I: The patient journey. Eur Psychiatry 2018; 53:107-115. [PMID: 30036773 DOI: 10.1016/j.eurpsy.2018.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of the European Brain Council project "The Value of Treatment" was to provide evidence-based, cost-effective policy recommendations for a patient-centered and sustainable coordinated care model for brain disorders. The first part of schizophrenia study examined the needs and gaps in the patients' care pathway. METHODS Descriptive analysis was based on an inventory of needs and treatment opportunities, using focus group sessions, expert interviews, users' input, and literature review. Three patient pathways were selected: indicated prevention, duration of untreated psychosis, and relapse prevention. RESULTS The analysis identified several critical barriers to optimal treatment. Available health care services often miss or delay detection of symptoms and diagnosis in at-risk individuals. There is a lack of illness awareness among patients, families, and the public; scarcity of information, training and education among primary care providers; stigmatizing beliefs. Early symptom recognition and timely intervention result in better outcome and prognosis; effective management leads to a functional recovery. In the current model of care, there is insufficient cooperation between health and social care providers, patients and families, inadequate utilization of pharmacological and psychosocial interventions, lacking patient monitoring, and low implementation of integrated community care. CONCLUSIONS Early detection and early intervention programs, timely intervention, and relapse prevention are essential for effective management of schizophrenia. It requires a paradigm shift from symptom control, achieving and maintaining remission, to the emphasis on recovery. Since the current services are not able to accomplish this goal, changes in mental health policies are needed.
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Affiliation(s)
- Pavel Mohr
- National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University Prague, Czech Republic.
| | | | | | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), The Karolinska Institute, Stockholm, Sweden
| | - Paul Arteel
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN Europe), Belgium
| | - Aagje Ieven
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Belgium
| | - Hilkka Karkkainen
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN Europe), Belgium
| | - Eulalia Pereira
- European Federation of Associations of Families of People with Mental Illness (EUFAMI), Belgium
| | - Nick Guldemond
- Institute of Health Policy & Management, Erasmus University Rotterdam, Netherlands
| | - Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Wolfgang Gaebel
- LVR-Klinikum, Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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188
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Functioning mediates help-seeking for mental problems in the general population. Eur Psychiatry 2018; 54:1-9. [DOI: 10.1016/j.eurpsy.2018.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 01/15/2023] Open
Abstract
AbstractAims:Absent or delayed help-seeking is considered to aggravate the immense personal and societal burden caused by mental disorders. Therefore, we cross-sectionally examined rates and clinical and sociodemographic moderators of early help-seeking for current clinician-assessed non-psychotic mental problems/disorders in the community.Methods:Altogether, 2683 individuals of the Swiss Canton Bern (16–40 years old, response rate 63.4%) were interviewed by telephone for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for psychosocial functioning using the Social and Occupational Functioning Assessment Scale, and for help-seeking for mental problems.Results:In total, 1122 (41.8%) reported mental problems. Of these, 769 (68.5%) affirmed any one screening question and 353 (31.5%) fulfilled criteria for any current axis-I disorder, and 396 (35.3%) reported any lifetime help-seeking (28.3% sought help in the past and 7.0% were in current treatment). In path analyses, current help-seeking was associated mainly by type and number of mental problems/disorders mediated by functional impairment, in addition to older age, no current partner, and past treatment.Conclusion:Our cross-sectional data indicate a gap in help-seeking for mental problems/disorders. The relationship between number of mental problems/disorders and help-seeking mediated by functional impairment confirm that individuals commonly do not seek help until problems are severe enough to cause problems in occupational and psychosocial functioning, driving the already immense costs of mental disorders. Thus, campaigns promoting early help-seeking, including early diagnostic clarification of and support for subthreshold mental problems in terms of an indicated prevention, should focus on psychosocial functioning, aside from signs of mental illness.
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189
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Preti A, Raballo A, Kotzalidis GD, Scanu R, Muratore T, Gabbrielli M, Tronci D, Masala C, Petretto DR, Carta MG. Quick Identification of the Risk of Psychosis: The Italian Version of the Prodromal Questionnaire-Brief. Clin Pract Epidemiol Ment Health 2018; 14:120-131. [PMID: 29997679 PMCID: PMC5971201 DOI: 10.2174/1745017901814010154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/14/2022]
Abstract
Background: Diagnosing people during the prodromal phase of an incipient psychosis can improve the chance of better outcome. In busy clinical settings, the ideal tool is a brief, easy-to-complete self-report questionnaire. Objective: To test the psychometric properties of the Italian version of one of the most used screening tools for the identification of the risk of psychosis, the Prodromal Questionnaire-Brief (PQ-B). Methods: Cross-sectional design. A convenience sample of college students was enrolled via snowball procedure (n=243; men: 45%). After understanding and signing the consent form, the participants received a booklet containing the following questionnaires: the 21-item Prodromal Questionnaire-Brief (PQ-B); the 12-item General Health Questionnaire (GHQ-12), and the 74-item Schizotypal Personality Questionnaire (SPQ). Receiver operating characteristic (ROC) analysis was used to assess the capacity of the PQ-B to identify individuals at risk of psychosis as independently defined based on the combination of GHQ-12 and SPQ thresholds. Results: The Italian version of the PQ-B revealed good internal consistency, test-retest reliability, and adequate convergent and divergent validity. The Youden method retrieved a cut-off = 7 for the PQ-B frequency score and a cut-off = 22 for the PQ-B distress score. Both PQ-B scores had a perfect (99%) negative predictive value. Conclusion: The PQ-B is a promising screening tool in two-stage protocols. The major advantage of the PQ-B is to exclude cases that are unlikely to be at risk of psychosis.
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Affiliation(s)
- Antonio Preti
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy.,Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy.,Genneruxi Medical Center, Cagliari, Italy
| | - Andrea Raballo
- Department of Psychology, Psychopathology and Development Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Georgios D Kotzalidis
- NESMOS Department, Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Rosanna Scanu
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Tamara Muratore
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Mersia Gabbrielli
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Debora Tronci
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Carmelo Masala
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Donatella Rita Petretto
- Section on Clinical Psychology, Department of Education, Psychology, Philosophy, University of Cagliari, Cagliari, Italy
| | - Mauro G Carta
- Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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190
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Polari A, Lavoie S, Yuen HP, Amminger P, Berger G, Chen E, deHaan L, Hartmann J, Markulev C, Melville F, Nieman D, Nordentoft M, Riecher-Rössler A, Smesny S, Stratford J, Verma S, Yung A, McGorry P, Nelson B. Clinical trajectories in the ultra-high risk for psychosis population. Schizophr Res 2018; 197:550-556. [PMID: 29463457 DOI: 10.1016/j.schres.2018.01.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/19/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Traditionally, research in the ultra-high risk (UHR) for psychosis population has focused on the treatment of existing symptomatology and prevention of transition to psychosis. Recently, there has been an increase in focus on outcomes in individuals who do not transition to psychosis. However, there is a lack of standardised definitions of remission, recovery, recurrence and relapse in UHR, resulting in the inability to generalise and replicate outcomes. METHOD The aims of the current study were to develop definitions for remission, recovery, recurrence and relapse, and apply them to a UHR cohort allowing the identification of longitudinal clinical trajectories. Further stratification in broader categories of favourable and unfavourable outcomes was applied. The predictive value of various baseline factors on specific clinical trajectories was also assessed. RESULTS 17 different trajectories were identified in a cohort of 202 individuals within a 12-month period and classified according to the suggested definitions for recovery (35.7%), remission (7.5%), any recurrence (20%), no remission (17.3%), relapse (4.0%) and transition to psychosis (15.8%). Favourable and unfavourable trajectories represented 43.2% and 57.1% respectively. Long duration of untreated symptoms and high depression scores were associated with unfavourable outcomes. DISCUSSION It is possible to apply clear definitions of remission, recovery, recurrence, relapse and transition to psychosis to a UHR cohort to evaluate longitudinal clinical trajectories. Acceptance and use of these definitions will help to facilitate comparisons between trials and to improve clinical clarity across the range of available therapeutic options in UHR individuals.
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Affiliation(s)
- Andrea Polari
- Orygen Youth Health, Melbourne, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Hok-Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of 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, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Dorien Nieman
- Academic Medical Centre, Department of Psychiatry, Amsterdam, The Netherlands
| | | | - Anita Riecher-Rössler
- University of Basel, Psychiatric University Clinics, Centre for Gender Research and Early Detection, Basel, Switzerland
| | - Stefan Smesny
- Universitätsklinikum Jena, Department of Psychiatry, Jena, Germany
| | | | - Swapna Verma
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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191
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Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:683-700. [PMID: 28914382 DOI: 10.1007/s00787-017-1046-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.
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192
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Uttinger M, Studerus E, Ittig S, Heitz U, Schultze-Lutter F, Riecher-Rössler A. The Frankfurt Complaint Questionnaire for self-assessment of basic symptoms in the early detection of psychosis-Factor structure, reliability, and predictive validity. Int J Methods Psychiatr Res 2018; 27:e1600. [PMID: 29266529 PMCID: PMC6877158 DOI: 10.1002/mpr.1600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Patients with schizophrenia often experience subtle disturbances in several domains of information processing-so-called basic symptoms (BS). BS are already present before onset of frank psychosis and can be assessed by interviews but also by the self-administered Frankfurt Complaint Questionnaire (FCQ). We investigated the factor structure, reliability, and predictive validity for transition to psychosis of the FCQ, comparing previously proposed factor solutions containing 1, 2, 4, and 10 factors. METHODS Confirmatory factor analysis was used in a sample of 117 at-risk mental state and 92 first-episode psychosis participants of the Basel FePsy (early detection of psychosis) study. RESULTS Although all factor models fitted to the data, the 2- or 4-factor solutions performed best among the models that used at least half of the FCQ items, suggesting the covariance between FCQ items is best explained by 2 to 4 underlying factors. No FCQ-scale predicted transition to psychosis. CONCLUSION We could confirm a 2- to 4-factor structure of the FCQ in a sample of at-risk mental state and first-episode psychosis patients using confirmatory factor analysis. Contrary to interview-assessed cognitive-perceptive BS, self-assessed BS do not seem to improve prediction of psychosis. This result reinforces reports of poor correspondence between interview- and questionnaire-assessed BS.
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Affiliation(s)
- Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Psychiatric Services Solothurn, Olten, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, 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, Germany
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
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193
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Kotlicka-Antczak M, Pawełczyk T, Podgórski M, Żurner N, Karbownik MS, Pawełczyk A. Polish individuals with an at-risk mental state: demographic and clinical characteristics. Early Interv Psychiatry 2018; 12:391-399. [PMID: 27111136 DOI: 10.1111/eip.12333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/11/2015] [Accepted: 02/18/2016] [Indexed: 12/21/2022]
Abstract
AIM The aim of this study is to present sociodemographic and clinical characteristics of Polish individuals with an at-risk mental state (ARMS). METHODS A group of 99 individuals meeting the ARMS criteria were assessed in terms of sociodemographic data, psychopathological symptoms, psychosocial functioning and comorbidity. RESULTS The sample (mean age 19 years) was 54.55% women. At baseline, nearly 73% of the sample was educated, and 20.20% were employed. Approximately 87.88% of the participants lived with their families. Nearly 77% of the sample presented attenuated psychotic symptoms (APS), 17.17% demonstrated APS with accompanying vulnerability traits and 19.19% showed vulnerability features only. The mean Social and Occupational Functioning Assessment Scale score was 49.55 (±7.70). No effect of age, gender or level of functioning on psychopathological symptoms was observed. The most common comorbid diagnoses were depressive (44.44%) and anxiety disorders (19.19%), which coexisted in 5.05% of the individuals. Approximately 28.28% of the diagnoses met the criteria for personality disorders. The dropout rate from the study was 19.09%, with stigma as the most common reason. CONCLUSIONS Polish ARMS individuals are help-seeking young people most commonly presenting APS or vulnerability features. Despite a high level of psychosocial dysfunction, these individuals remain educationally active. Most individuals showed comorbid diagnoses (commonly depressive or anxiety disorders). Despite some differences resulting from the socioeconomic situation of the country or the specificity of the mental health services, the characteristics of the sample remain consistent with descriptions of ARMS populations worldwide. This study reaffirms the need for organizing early intervention services in non-stigmatizing settings.
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Affiliation(s)
| | - Tomasz Pawełczyk
- Medical University of Lodz, Department of Affective and Psychotic Disorders, Lodz, Poland
| | - Michał Podgórski
- Medical University of Lodz, Department of Angiology, Lodz, Poland
| | - Natalia Żurner
- Child and Adolescent Psychiatry Unit, Central Clinical Hospital of Lodz, Lodz, Poland
| | - Michał S Karbownik
- Department of Toxicology and Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Pawełczyk
- Medical University of Lodz, Department of Affective and Psychotic Disorders, Lodz, Poland
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194
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Lincoln TM, Sundag J, Schlier B, Karow A. The Relevance of Emotion Regulation in Explaining Why Social Exclusion Triggers Paranoia in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2018; 44:757-767. [PMID: 29878274 PMCID: PMC6007363 DOI: 10.1093/schbul/sbx135] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerability-stress models postulate that social stress triggers psychotic episodes in vulnerable individuals. However, experimental evidence for the proposed causal pathway is scarce and the translating mechanisms are insufficiently understood. The study assessed the impact of social exclusion on paranoid beliefs in a quasi-experimental design and investigated the role of emotion regulation (ER) as a vulnerability indicator and emotional responses as a putative translating mechanism. METHODS Participants fulfilling criteria for clinical high risk of psychosis (CHR, n = 25), controls with anxiety disorders (AC, n = 40), and healthy controls (HC, n = 40) were assessed for dysfunctional (eg, rumination, catastrophizing, blaming) and functional ER-strategies (eg, reappraising, accepting, refocusing). They were then exposed to social exclusion during a virtual ball game (Cyberball) and assessed for changes in self-reported emotions and paranoid beliefs. RESULTS The CHR sample showed a significantly stronger increase in paranoid beliefs from before to after the social exclusion than both control groups. This was accounted for by lower levels of functional and higher levels of dysfunctional ER (compared to HC) and by a stronger increase in self-reported negative emotion in the CHR group (compared to AC and HC). CONCLUSIONS The results confirm the role of negative emotion on the pathway from social stressors to psychotic symptoms and indicate that both the use of dysfunctional ER strategies and difficulties in employing functional strategies add to explaining why people at risk of psychosis respond to a social stressor with increased paranoia.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
- To whom correspondence should be addressed; tel: 0049-40-428385360, fax: 0049-40-428386170, e-mail:
| | - Johanna Sundag
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne Karow
- Department for Psychiatry and Psychotherapy, Psychosis Centre, Centre for Psychosocial Medicine, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
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195
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Tsujino N, Tagata H, Baba Y, Kojima A, Yamaguchi T, Katagiri N, Nemoto T, Mizuno M. Survey of recognition and treatment of at-risk mental state by Japanese psychiatrists. Psychiatry Clin Neurosci 2018; 72:391-398. [PMID: 29485233 DOI: 10.1111/pcn.12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Abstract
AIM The importance of early intervention in psychiatry is widely recognized among psychiatrists. However, it is unknown whether precise knowledge of at-risk mental state has been disseminated. With this survey, we aimed to reveal how Japanese psychiatrists diagnose patients with at-risk mental state and prescribe treatment strategies for them. METHODS Using fictional case vignettes, we conducted a questionnaire survey of psychiatrists (n = 1399) who worked in Tokyo. We mailed study documents to all eligible participants in November 2015 with a requested return date in December. RESULTS Two hundred and sixty (19.3%) psychiatrists responded to the survey. Their correct diagnosis rates for the patients in the at-risk mental state vignettes were low (14.6% for the vignette describing at-risk mental state with attenuated positive symptom syndrome; 13.1% for the vignette describing at-risk mental state with brief intermittent psychotic syndrome). Many psychiatrists selected pharmacotherapy and antipsychotics to treat patients in the at-risk mental state vignettes. The psychiatrists who correctly diagnosed patients in the at-risk mental state vignettes had significantly fewer years of clinical psychiatric experience than did those who diagnosed them as having a non-at-risk mental state (12.5 years vs 22.7 years for the vignette describing at-risk mental state with attenuated positive symptom syndrome, P < 0.01; 14.3 years vs 22.2 years for the vignette describing at-risk mental state with brief intermittent psychotic syndrome, P < 0.01). CONCLUSION This study suggests that precise knowledge of at-risk mental state has not been disseminated among Japanese psychiatrists.
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Affiliation(s)
- Naohisa Tsujino
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Yoko Baba
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Akiko Kojima
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Taiju Yamaguchi
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
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196
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Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG. Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community. Psychol Med 2018; 48:1167-1178. [PMID: 28889802 PMCID: PMC6088777 DOI: 10.1017/s0033291717002586] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND An efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic. METHODS Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16-40 years; response rate: 63.4%). RESULTS The point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse. CONCLUSIONS Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.
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Affiliation(s)
- 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, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, 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
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197
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McHugh MJ, McGorry PD, Yuen HP, Hickie IB, Thompson A, de Haan L, Mossaheb N, Smesny S, Lin A, Markulev C, Schloegelhofer M, Wood SJ, Nieman D, Hartmann JA, Nordentoft M, Schäfer M, Amminger GP, Yung A, Nelson B. The Ultra-High-Risk for psychosis groups: Evidence to maintain the status quo. Schizophr Res 2018; 195:543-548. [PMID: 29055567 DOI: 10.1016/j.schres.2017.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 01/12/2023]
Abstract
Individuals are considered Ultra-High-Risk (UHR) for psychosis if they meet a set of standardised criteria including presumed genetic vulnerability (Trait), or a recent history of Attenuated Psychotic Symptoms (APS) or Brief Limited Intermittent Psychotic Symptoms (BLIPS). Recent calls to revise these criteria have arisen from evidence that Trait, APS and BLIPS groups may transition to psychosis at different rates. Concurrently, it has become clear that the UHR status confers clinical risk beyond transition to psychosis. Specifically, most UHR individuals will not develop psychosis, but will experience high rates of non-psychotic disorders, persistent APS and poor long-term functional outcomes. Rather than focus on transition, the present study investigated whether UHR groups differ in their broader clinical risk profile by examining baseline clinical characteristics and long-term outcomes other than transition to psychosis. Four UHR groups were defined: Trait-only, APS-only, Trait+APS, and any BLIPS. Participants (N=702) were recruited upon entry to early intervention services and followed-up over a period of up to 13years (mean=4.53, SD=3.84). The groups evidenced similar symptom severity (SANS for negative symptoms, BPRS for positive and depression/anxiety symptoms) and psychosocial functioning (SOFAS, GAF, QLS) at baseline and follow-up as well as similar prevalence of non-psychotic disorders at follow-up. Our findings demonstrate that UHR groups evidence a similar clinical risk profile when we expand this beyond transition to psychosis, and consequently support maintaining the existing UHR criteria.
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Affiliation(s)
- M J McHugh
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia.
| | - P D McGorry
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - H P Yuen
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - A Thompson
- Division of Mental Health and Wellbeing, The University of Warwick, Coventry, UK
| | - L de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - C Markulev
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - M Schloegelhofer
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - S J Wood
- School of Psychology, University of Birmingham, Birmingham, UK; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, Australia
| | - D Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J A Hartmann
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - M Nordentoft
- Mental Health Centre Copenhagen, Mental health Services Capital Region of Denmark, Denmark; Psychiatric Centre Copenhagen, University of Copenhagen, Denmark
| | - M Schäfer
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - G P Amminger
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
| | - A Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - B Nelson
- Orygen, The National Centre for Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, VIC, Australia
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198
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Clark V, Conrad AM, Lewin TJ, Baker AL, Halpin SA, Sly KA, Todd J. Addiction Vulnerability: Exploring Relationships Among Cigarette Smoking, Substance Misuse, and Early Psychosis. J Dual Diagn 2018; 14:78-88. [PMID: 29261427 DOI: 10.1080/15504263.2017.1416436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Smoking rates in adolescents at risk for psychosis are significantly greater than in those who are not at risk. Recent research suggests that cigarette smoking in adolescence may be a potential marker of transition to psychosis, although the exact relationship between the two remains unclear. Our aim was to examine whether tobacco smoking is a potential marker of transition to psychosis or subsequent episodes of psychosis, independently of other substance use, or alternatively whether smoking is essentially a general marker of later mental illness episodes. METHODS This substudy was conducted as part of an audit of a specialized early psychosis community mental health service, the Psychological Assistance Service (PAS). A multilayered audit over 10 years (January 1997 to December 2007) of PAS presentations was conducted (N = 1997), which documented baseline sociodemographic and clinical characteristics and subsequent illness episodes and service usage. Among clients with baseline smoking status information (n = 421, mean age = 18.3 years), this study examined predictors of transition to or subsequent episodes of psychosis, substance misuse, and affective disorder. RESULTS A recent psychosis episode at baseline and receiving ongoing treatment from PAS predicted transition to or subsequent psychosis episodes; however, baseline ultra-high-risk status was not predictive. In addition, baseline smoking/substance misuse status was a significant predictor, with smokers being twice as likely to experience a subsequent episode of psychosis, even after controlling for other baseline comorbidity. Baseline smoking status also independently predicted subsequent substance misuse episodes, but not subsequent affective disorder. Among clients experiencing post-PAS comorbid substance misuse and psychosis, the majority (80.3%) reported smoking at baseline. CONCLUSIONS Smoking status at service presentation appeared to function as a general proxy for addiction vulnerability among young help seekers and thereby as a potential marker for the development of severe mental illness (including psychosis) and associated health problems. Routine evaluations of presenting problems need to incorporate comprehensive assessments of early substance misuse and tobacco smoking. Adjunctive lifestyle interventions promoting smoking cessation, physical health, and well-being need to be offered in conjunction with conventional mental health interventions tailored to key presenting problems, recovery, and psychological strengthening.
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Affiliation(s)
- Vanessa Clark
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Agatha M Conrad
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Terry J Lewin
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Amanda L Baker
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Sean A Halpin
- c School of Psychology, University of Newcastle , Callaghan , New South Wales , Australia
| | - Ketrina A Sly
- a School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia.,b Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Juanita Todd
- c School of Psychology, University of Newcastle , Callaghan , New South Wales , Australia
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199
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Dimitrakopoulos S, Vitoratou S, Mougiakos T, Bogeas N, Giotakos O, van Os J, Stefanis NC. Steinberg and Durell (1968) revisited: increased rates of First Episode Psychosis following military induction in Greek Army Recruits. Psychol Med 2018; 48:728-736. [PMID: 28826418 DOI: 10.1017/s0033291717002276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.
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Affiliation(s)
- S Dimitrakopoulos
- Psychiatric Clinic,414 Military Hospital of Athens,P. Penteli,Greece
| | - S Vitoratou
- Department of Biostatistics,Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - T Mougiakos
- Psychiatric Clinic,414 Military Hospital of Athens,P. Penteli,Greece
| | - N Bogeas
- Psychiatric Clinic,414 Military Hospital of Athens,P. Penteli,Greece
| | - O Giotakos
- Psychiatric Clinic,414 Military Hospital of Athens,P. Penteli,Greece
| | - J van Os
- Department Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - N C Stefanis
- 1st Department of Psychiatry,National and Kapodistrian University of Athens Medical School,Eginition Hospital,Athens,Greece
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200
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Jolley S, Kuipers E, Stewart C, Browning S, Bracegirdle K, Basit N, Gin K, Hirsch C, Corrigall R, Banerjea P, Turley G, Stahl D, Laurens KR. The Coping with Unusual Experiences for Children Study (CUES): A pilot randomized controlled evaluation of the acceptability and potential clinical utility of a cognitive behavioural intervention package for young people aged 8-14 years with unusual experiences and emotional symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018. [PMID: 29527754 DOI: 10.1111/bjc.12176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED). DESIGN Pilot randomized controlled trial. METHODS Participants aged 8-14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs. RESULTS Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty-nine (96%) consented to randomization to either CBT-UED (9-12 weekly sessions of 40-50 min, adjunctive to usual care, n = 24) or treatment-as-usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling 'nervous'/'scared'/'tearful'/'worried'/'sick'; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (<12 sessions) at 12 weeks, at end-of-treatment (EOT). Twenty-two CBT-UED participants (92%) attended ≥5 sessions. Forty-four participants (90%) completed 12-week assessments (CBT-UED, n = 21/24, 88%; TAU/WL, n = 23/25, 92%). Preliminary findings were encouraging for emotional symptoms and UEDs, but otherwise mixed. CONCLUSIONS Retention, screening, and consent rates were as anticipated; recruitment took longer than planned. Trial procedures were acceptable to young people, their families, and clinicians. Therapy exceeded 12 weeks, but was well-received, with no serious adverse events attributed to participation. Further evaluation is needed. PRACTITIONER POINTS Around half of 8- to 14-year-olds in Child and Adolescent Mental Health Services reported distressing unusual experiences. An age-adapted cognitive behavioural intervention appears feasible, and safe to deliver, with the potential to augment standard care. This is a pilot study, and further evaluation is needed. Longer term outcomes should be a focus of future evaluation.
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Affiliation(s)
- Suzanne Jolley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Catherine Stewart
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Nedah Basit
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - Colette Hirsch
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.,National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | | | - Grainne Turley
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Daniel Stahl
- National Institute for Health Research Mental Health Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kristin R Laurens
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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