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Kindler J, Schultze-Lutter F, Hauf M, Dierks T, Federspiel A, Walther S, Schimmelmann BG, Hubl D. Increased Striatal and Reduced Prefrontal Cerebral Blood Flow in Clinical High Risk for Psychosis. Schizophr Bull 2018; 44:182-192. [PMID: 28575528 PMCID: PMC5768043 DOI: 10.1093/schbul/sbx070] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Increased striatal dopaminergic activity and decreased prefrontal functioning have been reported in individuals at clinical high risk (CHR) for psychosis. Abnormal metabolic rate might affect resting-state cerebral blood flow (rCBF) in the respective regions. Here, we examined if striatal and prefrontal rCBF differ between patients with CHR, first-episode psychosis (FEP), chronic schizophrenia-spectrum disorder (SZ) and controls. Two cohorts with a total of 122 participants were included and analyzed separately: 32 patients with SZ and 31 healthy controls (HC) from the University Hospital of Psychiatry, and 59 patients from the Bern Early Recognition and Intervention Center (29 with CHR, 12 with FEP, and 18 clinical controls [CC]). Ultra-high risk criteria were assessed with the Structured Interview for Psychosis-Risk Syndromes, basic symptom criteria with the Schizophrenia Proneness Instrument. rCBF was measured with pseudo-continuous arterial spin labeling 3T-Magnetic Resonance Imaging. Striatal rCBF was significantly increased and prefrontal rCBF significantly decreased in the SZ group compared to HC group and in the CHR and FEP groups compared to CC group. Striatal rCBF correlated significantly with positive symptom scores in SZ and CHR. An inverse correlation between striatal and frontal rCBF was found in controls (HC, CC), but not in patient groups (SZ, FEP, CHR). This is the first study to demonstrate increased neuronal activity within the striatum, but reduced prefrontal activity in patients with CHR, FEP, and SZ compared to the respective controls. Our results indicate that alterations in striatal and prefrontal rCBF are reflecting metabolic abnormalities preceding the onset of frank psychosis.
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Affiliation(s)
- Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,To whom correspondence should be addressed; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; tel: +41319328554, fax: +41319328569, e-mail:
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martinus Hauf
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Thomas Dierks
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - 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
| | - Daniela Hubl
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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202
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Strauss GP, Ruiz I, Visser KH, Crespo LP, Dickinson EK. Diminished Hedonic response in neuroleptic-free youth at ultra high-risk for psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2017; 12:1-7. [PMID: 29928593 PMCID: PMC6006907 DOI: 10.1016/j.scog.2017.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Abstract
Hedonic response is preserved in schizophrenia. However, it is unclear whether this is also true in individuals meeting criteria for “prodromal” psychosis, who are considered to be at symptomatic high risk for developing the disorder. In this study, we examined neurophysiological and self-reported response to emotional stimuli in UHR (n = 23) and healthy control (CN: n = 30) participants who passively viewed pleasant, unpleasant, and neutral images for 500 ms while the electroencephalogram was recorded and then provided self-reports of valence and arousal to the stimuli. The Late Positive Potential (LPP) event related potential (ERP) component was used as a neurophysiological marker of emotional reactivity. Results indicated that CN participants had higher LPP amplitude for pleasant and unpleasant compared to neutral stimuli; however, UHR youth displayed no differences in LPP amplitude among pleasant, unpleasant, and neutral stimuli. Self-report data mirrored neurophysiological data, as UHR youth had lower reports of positive emotion to pleasant stimuli and negative emotion to unpleasant stimuli compared to CN participants. Furthermore, the presence of a mood disorder diagnosis predicted reduced neurophysiological emotional reactivity in UHR youth. Findings suggest that youth at UHR for psychosis display diminished subjective and neurophysiological reactivity to emotional stimuli, and that symptoms of depression may result in diminished emotional reactivity.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
| | - Ivan Ruiz
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
| | | | - Laura P Crespo
- Department of Psychology, University of Georgia, Athens, GA 30602, USA
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203
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Jolley S, Browning S, Corrigall R, Laurens KR, Hirsch C, Bracegirdle K, Gin K, Muccio F, Stewart C, Banerjea P, Kuipers E, Garety P, Byrne M, Onwumere J, Achilla E, McCrone P, Emsley R. Coping with Unusual ExperienceS for 12-18 year olds (CUES+): a transdiagnostic randomised controlled trial of the effectiveness of cognitive therapy in reducing distress associated with unusual experiences in adolescent mental health services: study protocol for a randomised controlled trial. Trials 2017; 18:586. [PMID: 29202862 PMCID: PMC5716372 DOI: 10.1186/s13063-017-2326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Childhood 'unusual experiences' (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. Recommendations for psychological intervention are based on evidence from adult studies, with some support from small, pilot, child-specific evaluations. Research is needed to ensure that the recommendations suit children as well as adults. The CUES+ study (Coping with Unusual ExperienceS for 12-18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12-18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs. METHODS The CUES+ study is a randomised controlled trial comparing CBT-UED plus routine care to routine care alone. CBT-UED comprises up to 16 sessions, including up to 12 individual and up to four family support meetings, each lasting around 45-60 min, delivered weekly. The primary outcome is emotional distress. Secondary outcomes are change in UEDs, risk events (self-harm, attendance at emergency services, other adverse events) and health economic outcomes. Participants will be randomised in a 1:1 ratio after baseline assessment. Randomisation will be stratified by borough and by severity of mental health presentation: 'severe' (an identified psychotic or bipolar disorder) or any 'other' condition. Outcomes will be assessed by a trained assessor blind to treatment condition at 0, 16 and 24 weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017. DISCUSSION The CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation. TRIAL REGISTRATION International Standard Randomised Controlled Trials, ID: ISRCTN21802136 . Prospectively registered on 12 January 2015. Protocol V3 31 August 2015 with screening amended.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | | | - Kristin R. Laurens
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014 Australia
- Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
- Neuroscience Research Australia, Randwick, NSW 2031 Australia
| | - Colette Hirsch
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | | | - Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Francesca Muccio
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Catherine Stewart
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Elizabeth Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Philippa Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Majella Byrne
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Juliana Onwumere
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Evanthia Achilla
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul McCrone
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre Clinical Trials Unit, Manchester, M13 9PL UK
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204
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Abstract
BACKGROUND Schizophrenia is a chronic psychiatric disorder that generally begins in late adolescence or early adulthood. This early onset is often linked with a devastating lifelong impact on both the social network and work capacities of the affected subjects. Beginning in the mid-1990s, several sets of diagnostic criteria aiming to identify "high-risk" patients were developed and applied in clinical studies. Short-term rates of onset of psychosis in this subgroup of subjects ranged from 20% to 40%. However, 20 years later, the proposal to introduce "psychosis risk syndrome" as a coded diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders remained controversial and was finally rejected. Instead, "attenuated psychosis syndrome" was included in section III of the newly published manual as a condition for further studies. OBJECTIVE The goal of this article is to review the extant literature concerning the advantages and risks of early assessment of psychotic symptoms ("prodrome" and "psychosis-risk syndrome") and concerning available therapeutic options, both psychosocial and pharmacological. CONCLUSIONS "Attenuated psychosis syndrome" is a clinically useful concept. It identifies help-seeking individuals with mental health problems who need an intervention and who, if no treatment strategy is proposed, present a higher likelihood of developing a psychosis spectrum disorder in the years following their first contact with a mental health facility. In parallel with the clinical utility of this concept, additional research focused on this group of patients is warranted to further understand the emerging phase of psychotic disorders and to develop effective and efficient evidence-based prevention strategies.
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205
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Schultze-Lutter F, Hubl D, Schimmelmann BG, Michel C. Age effect on prevalence of ultra-high risk for psychosis symptoms: replication in a clinical sample of an early detection of psychosis service. Eur Child Adolesc Psychiatry 2017; 26:1401-1405. [PMID: 28456857 DOI: 10.1007/s00787-017-0994-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/26/2017] [Indexed: 01/01/2023]
Abstract
Higher frequencies of perceptual and lesser clinical significance of non-perceptual attenuated psychotic symptoms (APS) have been reported by 8- to 15-year-old of the general population compared to 16- to 40-year-old. We examined if such an age-effect can also be detected in a clinical never-psychotic sample (N = 133) referred to a specialized service for clinical suspicion of developing psychosis. APS and brief intermittent psychotic symptoms (BIPS) were assessed using items P1-P3 and P5 (non-perceptual), and P4 (perceptual) of the Structured Interview for Psychosis-Risk Syndromes, current axis-I disorders with the Mini-International Neuropsychiatric Interview, and psychosocial functioning with the Social and Occupational Functioning Assessment Scale. In the sample, 64% reported APS (61%) or BIPS (7%); any perceptual APS/BIPS was reported by 43% and any non-perceptual APS/BIPS by 44%. In correspondence to the results in the general population sample, perceptual but not non-perceptual APS/BIPS were significantly more frequent in younger age groups below the age of 16 (8-12 years: odds ratio (OR) = 4.7 (1.1-19.5); 13-15 years: OR = 2.7 (0.9-7.7); 20-24-year-old as reference group). An age-effect of APS/BIPS on the presence of any current axis-I disorder (59%) or functional difficulties (67%) was not detected. However, when onset requirements of APS criteria (onset/worsening in past year) were met, the likelihood of a psychiatric diagnosis increased significantly with advancing age. Overall, the replicated age-effect on perceptual APS/BIPS in this clinical sample highlights the need to examine ways to distinguish clinically relevant perceptual APS/BIPS from perceptual aberrations likely remitting over the course of adolescence.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland. .,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany.
| | - Daniela Hubl
- University Hospital Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000, Bern, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20149, Hamburg, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland.,Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Bd Du Pont-d'Arve 40, 1205, Geneva, Switzerland
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206
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The Italian version of the 92-item Prodromal Questionnaire: Concurrent validity with the SIPS and factor analysis in a sample of 258 outpatients aged 11-36years. Schizophr Res 2017; 189:50-56. [PMID: 28254200 DOI: 10.1016/j.schres.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current early screeners for psychosis-risk states have still to prove ability in identifying at-risk individuals. Among screeners, the 92-item Prodromal Questionnaire (PQ-92) is often used. We aimed to assess the validity of its Italian translation in a large Italian adolescent and young adult help-seeking sample. METHODS We included all individuals aged 12-36years seeking help at psychiatric mental health services in a large semirural Roman area (534,600 population) who accepted to participate. Participants completed the Italian version of the PQ-92 and were subsequently assessed with the Structured Interview of Prodromal/Psychosis-Risk Syndromes (SIPS). We examined diagnostic accuracy (sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) and content, concurrent, and convergent validity between PQ-92 and SIPS using Cronbach's alpha, Cohen's kappa, and Spearman's rho, respectively. We tested the validity of adopted cut-offs through Receiver Operating Characteristic (ROC) curves plotted against SIPS diagnoses and the instrument's factor-structure through Principal Component Analysis. RESULTS PQ-92 showed high internal consistency, acceptable diagnostic accuracy and concurrent validity, and excellent convergent validity. ROC analyses pointed to scores of 18 on the Positive subscale and 36 on the total PQ-92 as best cut-offs. The Scree-test identified a four-factor solution as fitting best. CONCLUSIONS Psychometric properties of Italian PQ-92 were satisfactory. Optimal cut-offs were confirmed at ≥18 on the positive subscale, but at ≥36 on the total scale was able to identify more SIPS-positive cases.
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207
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Malla A, Shah J, Lal S. Advances and challenges in early intervention in psychosis. World Psychiatry 2017; 16:274-275. [PMID: 28941088 PMCID: PMC5608857 DOI: 10.1002/wps.20453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ashok Malla
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Jai Shah
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Douglas Mental Health University InstituteMontrealQCCanada
| | - Shalini Lal
- School of RehabilitationUniversity of Montreal and University of Montreal's Hospital Research CenterMontrealQCCanada
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208
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Abstract
Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK
| | - Patrick D. McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of MelbourneMelbourneAustralia
| | - John M. Kane
- Zucker Hillside Hospital, Glen Oaks, NY, USA; Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA
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209
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Abstract
There is a debate concerning risks and benefits of early intervention in psychosis, especially concerning diagnosis disclosure. The present study reports preliminary findings on self-reported locus of control and psychological distress after the disclosure of diagnosis in an early recognition center. We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health. Persons with ARMS seem to particularly benefit from disclosure of diagnosis as part of early intervention.
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210
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Eisenacher S, Zink M. Holding on to false beliefs: The bias against disconfirmatory evidence over the course of psychosis. J Behav Ther Exp Psychiatry 2017; 56:79-89. [PMID: 27608522 DOI: 10.1016/j.jbtep.2016.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The ability to integrate evidence into a reasoning process is crucial in order to react to changing information, e.g. to adapt one's beliefs according to new evidence or to generate new beliefs when facing better alternatives. Evidence integration ability is thus associated with belief flexibility. A specific bias of evidence integration, a bias against disconfirmatory evidence (BADE), can be found in patients with schizophrenia and has been linked to delusion development and maintenance. Knowledge about whether the BADE occurs already in risk constellations of psychosis can clarify its role in the pathogenesis of psychosis. METHODS This article reviews the current literature on BADE. Many studies demonstrate BADE over the course of illness, ranging from healthy controls with subclinical properties of schizotypy, over patients with at-risk mental states (ARMS) and patients with a first episode of psychosis to patients with chronic schizophrenia. These data allow a comparison of competences and deficits over the course of illness. Underlying mechanisms of BADE are discussed, including interrelations with neurocognitive performance and dopaminergic processes. RESULTS The BADE could be found in different phases of psychosis development and can be regarded as a cognitive marker of the beginning psychotic state. LIMITATIONS The presented findings are derived from independent cross-sectional studies. So far, no comprehensive longitudinal assessment has been published. CONCLUSIONS Treatments of metacognitive deficits in general and as early as in the ARMS might interfere with the cognitive pathogenesis of psychosis, and thereby ameliorate, postpone or even prevent the transition to psychosis.
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Affiliation(s)
- Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
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211
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Demjaha A, Weinstein S, Stahl D, Day F, Valmaggia L, Rutigliano G, De Micheli A, Fusar-Poli P, McGuire P. Formal thought disorder in people at ultra-high risk of psychosis. BJPsych Open 2017; 3:165-170. [PMID: 28713586 PMCID: PMC5509964 DOI: 10.1192/bjpo.bp.116.004408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Formal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear. AIMS Examine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis. METHOD The Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis. RESULTS TLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04). CONCLUSIONS TLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group. DECLARATION OF INTERESTS None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Arsime Demjaha
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sara Weinstein
- , PhD, Boeing Vancouver Labs, Vancuver, British Columbia, Canada
| | - Daniel Stahl
- , PhD, Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fern Day
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucia Valmaggia
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Grazia Rutigliano
- , MD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea De Micheli
- , MD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Philip McGuire
- , PhD, Department of Psychosis Studies, Biomedical Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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212
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Abstract
The transdiagnostic expression of psychotic experiences in common mental disorder (anxiety/depression/substance use disorder) is associated with a poorer prognosis, and a small minority of people may indeed develop a clinical picture that meets criteria for schizophrenia. However, it appears neither useful nor valid to observe early states of multidimensional psychopathology in young people through the "schizo"-prism, and apply misleadingly simple, unnecessary and inefficient binary concepts of "risk" and "transition". A review of the "ultra-high risk" (UHR) or "clinical high risk" (CHR) literature indicates that UHR/CHR samples are highly heterogeneous and represent individuals diagnosed with common mental disorder (anxiety/depression/substance use disorder) and a degree of psychotic experiences. Epidemiological research has shown that psychotic experiences are a (possibly non-causal) marker of the severity of multidimensional psychopathology, driving poor outcome, yet notions of "risk" and "transition" in UHR/CHR research are restrictively defined on the basis of positive psychotic phenomena alone, ignoring how baseline differences in multidimensional psychopathology may differentially impact course and outcome. The concepts of "risk" and "transition" in UHR/CHR research are measured on the same dimensional scale, yet are used to produce artificial diagnostic shifts. In fact, "transition" in UHR/CHR research occurs mainly as a function of variable sample enrichment strategies rather than the UHR/CHR "criteria" themselves. Furthermore, transition rates in UHR/CHR research are inflated as they do not exclude false positives associated with the natural fluctuation of dimensional expression of psychosis. Biological associations with "transition" thus likely represent false positive findings, as was the initial claim of strong effects of omega-3 polyunsatured fatty acids in UHR samples. A large body of UHR/CHR intervention research has focused on the questionable outcome of "transition", which shows lack of correlation with functional outcome. It may be more productive to consider the full range of person-specific psychopathology in all young individuals who seek help for mental health problems, instead of "policing" youngsters for the transdiagnostic dimension of psychosis. Instead of the relatively inefficient medical high-risk approach, a public health perspective, focusing on improved access to a low-stigma, high-hope, small scale and youth-specific environment with acceptable language and interventions may represent a more useful and efficient strategy.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and PsychologyMaastricht University Medical CentreMaastrichtthe Netherlands,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of PsychiatryLondonUK
| | - Sinan Guloksuz
- Department of Psychiatry and PsychologyMaastricht University Medical CentreMaastrichtthe Netherlands,Department of Psychiatry, Yale University School of MedicineNew HavenCTUSA
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Entwicklungsspezifische Aspekte in der Früherkennung und Frühbehandlung eines erhöhten Psychoserisikos. Prax Kinderpsychol Kinderpsychiatr 2017; 66:324-344. [DOI: 10.13109/prkk.2017.66.5.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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214
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Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, McGuire P. Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis. JAMA Psychiatry 2017; 74:493-500. [PMID: 28355424 PMCID: PMC5470394 DOI: 10.1001/jamapsychiatry.2017.0284] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Importance The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniel Stahl
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
| | - Thomas Reilly
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
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215
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Studerus E, Ramyead A, Riecher-Rössler A. Prediction of transition to psychosis in patients with a clinical high risk for psychosis: a systematic review of methodology and reporting. Psychol Med 2017; 47:1163-1178. [PMID: 28091343 DOI: 10.1017/s0033291716003494] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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 To enhance indicated prevention in patients with a clinical high risk (CHR) for psychosis, recent research efforts have been increasingly directed towards estimating the risk of developing psychosis on an individual level using multivariable clinical prediction models. The aim of this study was to systematically review the methodological quality and reporting of studies developing or validating such models. METHOD A systematic literature search was carried out (up to 14 March 2016) to find all studies that developed or validated a clinical prediction model predicting the transition to psychosis in CHR patients. Data were extracted using a comprehensive item list which was based on current methodological recommendations. RESULTS A total of 91 studies met the inclusion criteria. None of the retrieved studies performed a true external validation of an existing model. Only three studies (3.5%) had an event per variable ratio of at least 10, which is the recommended minimum to avoid overfitting. Internal validation was performed in only 14 studies (15%) and seven of these used biased internal validation strategies. Other frequently observed modeling approaches not recommended by methodologists included univariable screening of candidate predictors, stepwise variable selection, categorization of continuous variables, and poor handling and reporting of missing data. CONCLUSIONS Our systematic review revealed that poor methods and reporting are widespread in prediction of psychosis research. Since most studies relied on small sample sizes, did not perform internal or external cross-validation, and used poor model development strategies, most published models are probably overfitted and their reported predictive accuracy is likely to be overoptimistic.
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Affiliation(s)
- E Studerus
- University of Basel Psychiatric Hospital,Center for Gender Research and Early Detection,Basel,Switzerland
| | - A Ramyead
- Department of Psychiatry,Weill Institute for Neurosciences,University of California (UCSF),San Francisco,CA,USA
| | - A Riecher-Rössler
- University of Basel Psychiatric Hospital,Center for Gender Research and Early Detection,Basel,Switzerland
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216
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Prediction of conversion to psychosis in individuals with an at-risk mental state: a brief update on recent developments. Curr Opin Psychiatry 2017; 30:209-219. [PMID: 28212173 DOI: 10.1097/yco.0000000000000320] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW So far, only little more than one-third of individuals classified as being at-risk for psychosis have been shown to actually convert to frank psychosis during follow-up. There have therefore been enormous efforts to improve the accuracy of predicting this transition. We reviewed the most recent studies in the field with the aim to clarify whether accuracy of prediction has been improved by the different research endeavors and what could be done to further improve it, and/or what alternative goals research should pursue. RECENT FINDINGS A total of 56 studies published between May 2015 and December 2016 were included, of which eight were meta-analyses. New meta-analytical evidence confirms that established instruments for checking clinical risk criteria have an excellent clinical utility in individuals referred to high-risk services. Within a such identified group of ultra-high-risk (UHR) individuals, especially Brief Limited Intermittent Psychotic Symptoms and Attenuated Psychotic Symptoms seem to predict transition. Further assessments should be performed within the UHR individuals, as risk of transition seems particularly high in those with an even higher severity of certain symptoms such as suspiciousness or anhedonia, in those with lower global or social functioning, poor neurocognitive performance or cannabis abuse. Also, electroencephalography, neuroimaging and blood biomarkers might contribute to improving individual prediction. The most promising approach certainly is a staged multidomain assessment. Risk calculators to integrate all data for an individualized prediction are being developed. SUMMARY Prediction of psychosis is already possible with an excellent prognostic performance based on clinical assessments. Recent studies show that this accuracy can be further improved by using multidomain approaches and modern statistics for individualized prediction. The challenge now is the translation into the clinic with a broad clinical implementation.
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217
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Abstract
PURPOSE OF REVIEW Schizophrenia occurs in ∼25% of individuals with 22q11.2 deletion syndrome (22q11.2DS), the strongest known molecular genetic risk factor for schizophrenia. This review highlights recent literature in 22q11.2DS as it pertains to psychosis and schizophrenia. RECENT FINDINGS Advances in noninvasive prenatal testing allow for early detection of 22q11.2DS in utero, whereas premature birth has been shown to be a significant risk factor for development of psychotic illness in 22q11.2DS. Impairments in various domains of cognitive and social functioning, as well as neuroanatomical alterations, are comparable with those in other high-risk groups and may serve as early signs of psychosis in 22q11.2DS. Novel research on the pathogenesis of schizophrenia in 22q11.2DS using cellular and mouse models indicates changes in expression of genes within the 22q11.2 deletion region and elsewhere in the genome, implicating molecular pathways involved in schizophrenia and associated neurocognitive deficits. Increased risks of obesity and of Parkinson's disease in 22q11.2DS warrant consideration in antipsychotic management. SUMMARY Progress in characterizing and predicting psychotic illness in 22q11.2DS supports this identifiable subpopulation as a molecular model with important implications for understanding the pathogenesis of schizophrenia in the general population and for development of potential novel therapies.
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218
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Armando M, Schneider M, Pontillo M, Vicari S, Debbané M, Schultze-Lutter F, Eliez S. No age effect in the prevalence and clinical significance of ultra-high risk symptoms and criteria for psychosis in 22q11 deletion syndrome: Confirmation of the genetically driven risk for psychosis? PLoS One 2017; 12:e0174797. [PMID: 28406913 PMCID: PMC5390987 DOI: 10.1371/journal.pone.0174797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/15/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is one of the highest known risk factors for schizophrenia. Thus, the detection of 22q11DS patients at particularly high risk of psychosis is important, yet studies on the clinical significance of the widely used ultra-high risk (UHR) criteria in 22q11DS are inconclusive. Since age was reported to moderate clinical significance of UHR symptoms in community samples, we explored whether age at presentation of UHR symptoms and criteria may explain part of this heterogeneity. METHODS 111 patients with 22q11DS (8-30 years; 15.7±4.7) were assessed for UHR symptoms/criteria. Information on diagnoses, psychosocial functioning, and IQ were collected. RESULTS Any UHR symptom was reported by 38.7%, any UHR criterion by 27%. No significant influence of age on the prevalence of UHR symptoms or criteria was detected. Moreover, age did not significantly modulate the association between UHR symptoms and functioning. However, significant interaction terms suggested that younger age groups were more likely to meet UHR criteria in the presence of UHR symptoms compared to the adult group. DISCUSSION Compared to the general population, prevalence of UHR symptoms and criteria was 3.8-fold and 20.8-fold in our 22q11DS sample. Contrary to the general population, age only modulated the prevalence of UHR criteria among those with UHR symptoms, but not their prevalence per se or their clinical significance. This suggests that UHR symptoms might develop as a trait factor in terms of a genetically driven schizotypal disposition in 22q11DS, thus necessitating future studies on psychosis-risk indicators in this genetic high-risk group.
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Affiliation(s)
- Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Maude Schneider
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - 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
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
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Ramyead A, Kometer M, Studerus E, Baumeler D, von Rotz R, Riecher-Rössler A. Alpha oscillations underlie working memory abnormalities in the psychosis high-risk state. Biol Psychol 2017; 126:12-18. [PMID: 28385625 DOI: 10.1016/j.biopsycho.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 03/17/2017] [Accepted: 04/02/2017] [Indexed: 11/17/2022]
Abstract
Working memory (WM) functioning, known to be modulated by neural oscillations, is impaired in schizophrenic psychoses. It remains unclear whether in the psychosis high-risk state, WM encoding is altered or whether patients are impaired at shielding their WM against distractors. We employed single-trial analyses of neurophysiological and behavioral data recorded during a WM paradigm, designed to include predictable distractors, on 18 patients with an at-risk mental state for psychosis (ARMS, 26.1±5.45 years) and 21 healthy controls (HCs, 25.5±3.95 years). Strong distractors were associated with reduced WM accuracy (p=0.036), but only ARMS patients required more processing time for strong distractors (p=0.002). Increased parieto-occipital alpha amplitude preceding distractor presentations was associated with enhanced accuracy only in HCs (p=0.009). During encoding, increased intertrial alpha phase locking values were associated with increased performance. Reduced shielding mechanisms against distractors in ARMS patients could lead to defective WM maintenance, which may result in significant confusion that may contribute to the formation of psychotic symptoms.
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Affiliation(s)
- Avinash Ramyead
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Michael Kometer
- Neuropsychopharmacology and Brain Imaging Research Unit, Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Denise Baumeler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Robin von Rotz
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Clinics, Center for Gender Research and Early Detection, Basel, Switzerland.
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Michel C, Toffel E, Schmidt SJ, Eliez S, Armando M, Solida-Tozzi A, Schultze-Lutter F, Debbané M. [Detection and early treatment of subjects at high risk of clinical psychosis: Definitions and recommendations]. Encephale 2017; 43:292-297. [PMID: 28347521 DOI: 10.1016/j.encep.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 02/04/2023]
Abstract
In children and adolescents, psychotic disorders already represent one of the leading causes of disability-adjusted life years. During the past two decades, early detection of risk for psychosis has been intensively investigated, and in particular, predictive power for early signs of risk has been initiated and translated into clinical practice. In particular, the attenuated and transient positive symptoms of the ultra-high risk criteria, and the basic symptom criterion "cognitive disturbances", open promising routes to an indicated prevention and have recently been considered by the European Psychiatric Association (EPA) as diagnostic criteria of a psychosis-risk syndrome. The EPA recently provided evidence-based recommendations on the early detection of clinical high risk (CHR) for psychosis in patients with mental distress. In 2015, experts in the field of early detection conducted a meta-analysis reporting on studies examining conversion rates to psychosis in non-overlapping samples meeting at least one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria, examining the effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates. In the 42 identified samples, comprising more than 4000 CHR patients who had been mainly identified by means of UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS), conversion rates showed considerable heterogeneity. While UHR and COGDIS criteria were related to comparable conversion rates until a 2-year follow-up, rates for COGDIS were significantly higher for follow-up periods beyond 2 years. Differences in onset and frequency requirements of symptomatic UHR criteria, or in their different consideration of functional decline, substance use and co-morbidity, did not seem to have an impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for the early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. The EPA guidance on early intervention aimed to provide evidence-based recommendations on early intervention in CHR states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were also made by experts in the field of early intervention in psychoses and derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. In addition to analyses of treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status. Overall, age-related specificities and developmental transitions in the early detection and intervention in psychoses should be better accounted for in future research.
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Affiliation(s)
- C Michel
- Département de recherche, hôpital universitaire de psychiatrie et psychothérapie de l'enfant et de l'adolescent, Bolligenstrasse 111, Haus A, 3000 Berne 60, Suisse; Unité de psychologie clinique développementale, faculte de psychologie et des sciences de l'éducation, université de Genève, 40, boulevard du Pont-d'Arve, 1211 Genève 4, Suisse.
| | - E Toffel
- Unité de psychologie clinique développementale, faculte de psychologie et des sciences de l'éducation, université de Genève, 40, boulevard du Pont-d'Arve, 1211 Genève 4, Suisse
| | - S J Schmidt
- Département de recherche, hôpital universitaire de psychiatrie et psychothérapie de l'enfant et de l'adolescent, Bolligenstrasse 111, Haus A, 3000 Berne 60, Suisse
| | - S Eliez
- Laboratoire de neuroimagerie et de psychopathologie développementales, office médico-pédagogique, faculté de médecine, université de Genève, 1, rue David-Dufour, 1211 Genève 8, Suisse
| | - M Armando
- Laboratoire de neuroimagerie et de psychopathologie développementales, office médico-pédagogique, faculté de médecine, université de Genève, 1, rue David-Dufour, 1211 Genève 8, Suisse
| | - A Solida-Tozzi
- Département de psychiatrie, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon 46, 1011 Lausanne, Suisse
| | - F Schultze-Lutter
- Département de recherche, hôpital universitaire de psychiatrie et psychothérapie de l'enfant et de l'adolescent, Bolligenstrasse 111, Haus A, 3000 Berne 60, Suisse
| | - M Debbané
- Unité de psychologie clinique développementale, faculte de psychologie et des sciences de l'éducation, université de Genève, 40, boulevard du Pont-d'Arve, 1211 Genève 4, Suisse; Département de recherche en psychologique clinique, éducative, et de la santé, University College London, Gower St, Kings Cross, WC1EBT London, Royaume-Uni
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221
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Schultze-Lutter F, Theodoridou A. The concept of basic symptoms: its scientific and clinical relevance. World Psychiatry 2017; 16:104-105. [PMID: 28127912 PMCID: PMC5269478 DOI: 10.1002/wps.20404] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland
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222
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Abstract
The Clinical High-Risk state for psychosis (CHR-P) paradigm was introduced about 2 decades ago. Over this period of time accumulating knowledge has been gained. Conceptual advancements involve new knowledge into risk enrichment and the impact of recruitment strategies, specificity for prediction of psychotic and nonpsychotic mental disorders and heterogeneity of psychosis risk among the different CHR-P subgroups. The current special issue advances current knowledge on deconstructing the CHR-P paradigm across its 3 subgroups: genetic risk, attenuated psychotic symptoms, and short-lived and remitting psychotic episodes. A conceptual revision of the paradigm (Version II) is suggested and supported by 3 original studies published in this special issue.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry , Psychology and Neuroscience, King's College London, London, UK;
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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223
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Conrad AM, Lewin TJ, Sly KA, Schall U, Halpin SA, Hunter M, Carr VJ. Utility of risk-status for predicting psychosis and related outcomes: evaluation of a 10-year cohort of presenters to a specialised early psychosis community mental health service. Psychiatry Res 2017; 247:336-344. [PMID: 27984822 DOI: 10.1016/j.psychres.2016.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/21/2016] [Accepted: 12/03/2016] [Indexed: 01/13/2023]
Abstract
Psychosis transition rates by those at clinical high risk have been highly variable and few studies have compared service presenters across the full psychosis risk spectrum with respect to medium-term outcomes. A 10-year service cohort was examined (N=1997), comprising all presentations to an early psychosis service for young people experiencing a recent psychotic episode or at increased risk ('Psychological Assistance Service', Newcastle, Australia). Baseline and longitudinal service data (median follow-up =7.3 years) were used in a series of logistic regressions to examine relationships between psychosis risk-status and subsequent illness episodes, hospital admissions, and community contacts. Six baseline groups were identified: existing (14.5%) and recent psychosis (19.8%); ultra-high risk (UHR, 9.6%); non-psychotic disorders without (35.4%, the reference group) and with psychiatric admissions (8.3%); and incomplete assessments (12.5%). High comorbidity levels were reported by the cohort (psychosocial problems, 61.1%; depression, 54.1%; substance misuse, 40.7%). UHR clients experienced similar psychosis transition rates to the reference group (17.3% vs. 14.6%; 8.9% vs. 9.1% within 2-years) and comparable rates of subsequent non-psychosis outcomes. A 25.9% conversion rate from early psychosis to schizophrenia was detected. However, among transitioning individuals, UHR clients faired relatively better, particularly with respect to changes in comorbidity and mental health contacts. Interventions tailored to current problems, recovery and psychological strengthening may be more appropriate than those based on estimated psychosis risk, which currently lacks clinical utility.
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Affiliation(s)
- Agatha M Conrad
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia.
| | - Terry J Lewin
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia.
| | - Ketrina A Sly
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Ulrich Schall
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia; Child and Adolescent Mental Health Services, Hunter New England Mental Health, Newcastle, NSW, Australia
| | - Sean A Halpin
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; Child and Adolescent Mental Health Services, Hunter New England Mental Health, Newcastle, NSW, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mick Hunter
- Centre for Brain and Mental Health Research (CBMHR), Hunter New England Mental Health, the University of Newcastle, and Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Vaughan J Carr
- Schizophrenia Research Institute, Neuroscience Research Australia, Randwick, NSW, Australia; School of Psychiatry, University of New South Wales, Kensington, NSW, Australia; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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Schmidt SJ, Schultze-Lutter F, Bendall S, Groth N, Michel C, Inderbitzin N, Schimmelmann BG, Hubl D, Nelson B. Mediators Linking Childhood Adversities and Trauma to Suicidality in Individuals at Risk for Psychosis. Front Psychiatry 2017; 8:242. [PMID: 29249990 PMCID: PMC5715383 DOI: 10.3389/fpsyt.2017.00242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022] Open
Abstract
Suicidality is highly prevalent in patients at clinical high risk (CHR) for psychosis. Childhood adversities and trauma are generally predictive of suicidality. However, the differential effects of adversity/trauma-domains and CHR-criteria, i.e., ultra-high risk and basic symptom criteria, on suicidality remain unclear. Furthermore, the underlying mechanisms and, thus, worthwhile targets for suicide-prevention are still poorly understood. Therefore, structural equation modeling was used to test theory-driven models in 73 CHR-patients. Mediators were psychological variables, i.e., beliefs about one's own competencies as well as the controllability of events and coping styles. In addition, symptomatic variables (depressiveness, basic symptoms, attenuated psychotic symptoms) were hypothesized to mediate the effect of psychological mediators on suicidality as the final outcome variable. Results showed two independent pathways. In the first pathway, emotional and sexual but not physical adversity/trauma was associated with suicidality, which was mediated by dysfunctional competence/control beliefs, a lack of positive coping-strategies and depressiveness. In the second pathway, cognitive basic symptoms but not attenuated psychotic symptoms mediated the relationship between trauma/adversity and suicidality. CHR-patients are, thus, particularly prone to suicidality if adversity/trauma is followed by the development of depressiveness. Regarding the second pathway, this is the first study showing that adversity/trauma led to suicidality through an increased risk for psychosis as indicated by cognitive basic symptoms. As insight is generally associated with suicidality, this may explain why self-experienced basic symptoms increase the risk for it. Consequently, these mediators should be monitored regularly and targeted by integrated interventions as early as possible to enhance resilience against suicidality.
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Affiliation(s)
- Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - 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
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Groth
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - 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
| | - Nadja Inderbitzin
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - 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
| | - Daniela Hubl
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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225
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Jagannath V, Theodoridou A, Gerstenberg M, Franscini M, Heekeren K, Correll CU, Rössler W, Grünblatt E, Walitza S. Prediction Analysis for Transition to Schizophrenia in Individuals at Clinical High Risk for Psychosis: The Relationship of DAO, DAOA, and NRG1 Variants with Negative Symptoms and Cognitive Deficits. Front Psychiatry 2017; 8:292. [PMID: 29326614 PMCID: PMC5742321 DOI: 10.3389/fpsyt.2017.00292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/06/2017] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is characterized by positive and negative symptoms and cognitive dysfunction. The glutamate hypothesis of schizophrenia has been hypothesized to explain the negative symptoms and cognitive deficits better than the dopamine hypothesis alone. Therefore, we aimed to evaluate whether glutamatergic variants such as d-amino acid oxidase (DAO), DAO activator (DAOA)/G72, and neuregulin 1 (NRG1) single-nucleotide polymorphisms (SNPs) and their mRNA levels predicted (i) transition to schizophrenia spectrum disorders and (ii) research domain criteria (RDoC) domains, mainly negative valence and cognitive systems. In a 3-year prospective study cohort of 185 individuals (age: 13-35 years) at high risk and ultra-high risk (UHR) for psychosis, we assessed DAO (rs3918347, rs4623951), DAOA (rs778293, rs3916971, rs746187), and NRG1 (rs10503929) SNPs and their mRNA expression. Furthermore, we investigated their association with RDoC domains, mainly negative valence (e.g., anxiety, hopelessness) and cognitive (e.g., perception disturbances, disorganized symptoms) systems. NRG1 rs10503929 CC + CT versus TT genotype carriers experienced significantly more disorganized symptoms. DAOA rs746187 CC versus CT + TT genotype, DAOA rs3916971 TT versus TC + CC genotype, and DAO rs3918347 GA + AA versus GG genotype carriers experienced nominally more hopelessness, visual perception disturbances, and auditory perception disturbances, respectively. The schizophrenia risk G-allele of DAO rs3918347 nominally increased risk for those UHR individuals with attenuated positive symptoms syndrome. No association between DAO, DAOA, NRG1 SNPs, and conversion to schizophrenia spectrum disorders was observed. Our findings suggest that DAO, DAOA, and NRG1 polymorphisms might influence both RDoC negative valence and cognitive systems, but not transition to schizophrenia spectrum disorders.
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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
| | - 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
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, 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
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, United States.,Hofstra Northwell School of Medicine, Hempstead, NY, United States.,The Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry 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
| | - Susanne Walitza
- 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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226
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Metzler S, Dvorsky D, Wyss C, Nordt C, Walitza S, Heekeren K, Rössler W, Theodoridou A. Neurocognition in help-seeking individuals at risk for psychosis: Prediction of outcome after 24 months. Psychiatry Res 2016; 246:188-194. [PMID: 27718468 DOI: 10.1016/j.psychres.2016.08.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 12/31/2022]
Abstract
An important aim in schizophrenia research is to optimize the prediction of psychosis and to improve strategies for early intervention. The objectives of this study were to explore neurocognitive performance in individuals at risk for psychosis and to optimize predictions through a combination of neurocognitive and psychopathological variables. Information on clinical outcomes after 24 months was available from 118 subjects who had completed an extensive assessment at baseline. Subjects who had converted to psychosis were compared with subjects who had not. Multivariate Cox regression analyses were used to determine which baseline measure best predicted a conversion to psychosis. The premorbid IQ and the neurocognitive domains of processing speed, learning/memory, working memory and verbal fluency significantly discriminated between converters and non-converters. When entered into multivariate regression analyses, the combination of PANSS positive/negative symptom severity and IQ best predicted the clinical outcomes. Our results confirm previous evidence suggesting moderate premorbid cognitive deficits in individuals developing full-blown psychosis. Overall, clinical symptoms appeared to be a more sensitive predictor than cognitive performance. Nevertheless, the two might serve as complementary predictors when assessing the risk for psychosis.
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Affiliation(s)
- Sibylle Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland.
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland; Collegium Helveticum, a joint Research Institute between the University of Zurich and the Swiss Federal Institute of Technology Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
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227
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Schneider M, Armando M, Pontillo M, Vicari S, Debbané M, Schultze‐Lutter F, Eliez S. Ultra high risk status and transition to psychosis in 22q11.2 deletion syndrome. World Psychiatry 2016; 15:259-265. [PMID: 27717277 PMCID: PMC5032509 DOI: 10.1002/wps.20347] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The 22q11.2 deletion syndrome (22q11DS) is characterized by high rates of psychotic symptoms and schizophrenia, making this condition a promising human model for studying risk factors for psychosis. We explored the predictive value of ultra high risk (UHR) criteria in a sample of patients with 22q11DS. We also examined the additional contribution of socio-demographic, clinical and cognitive variables to predict transition to psychosis within a mean interval of 32.5 ± 17.6 months after initial assessment. Eighty-nine participants with 22q11DS (age range: 8-30 years; mean 16.1 ± 4.7) were assessed using the Structured Interview for Psychosis-Risk Syndromes. Information on Axis I diagnoses, internalizing and externalizing symptoms, level of functioning and IQ was also collected. At baseline, 22 (24.7%) participants met UHR criteria. Compared to those without a UHR condition, they had a significantly lower functioning, more frequent anxiety disorders, and more severe psychopathology. Transition rate to psychosis was 27.3% in UHR and 4.5% in non-UHR participants. Cox regression analyses revealed that UHR status significantly predicted conversion to psychosis. Baseline level of functioning was the only other additional predictor. This is the first study investigating the predictive value of UHR criteria in 22q11DS. It indicates that the clinical path leading to psychosis is broadly comparable to that observed in other clinical high-risk samples. Nevertheless, the relatively high transition rate in non-UHR individuals suggests that other risk markers should be explored in this population. The role of low functioning as a predictor of transition to psychosis should also be investigated more in depth.
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Affiliation(s)
- Maude Schneider
- Developmental Imaging and Psychopathology LabGenevaSwitzerland,Center for Contextual Psychiatry, Department of NeuroscienceKU LeuvenLeuvenBelgium
| | - Marco Armando
- Developmental Imaging and Psychopathology LabGenevaSwitzerland,Child and Adolescence Neuropsychiatry Unit, Department of NeuroscienceBambino Gesù Children HospitalRomeItaly
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of NeuroscienceBambino Gesù Children HospitalRomeItaly
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of NeuroscienceBambino Gesù Children HospitalRomeItaly
| | - Martin Debbané
- Developmental Imaging and Psychopathology LabGenevaSwitzerland,Developmental Clinical Psychology Unit, Faculty of Psychology, University of GenevaGenevaSwitzerland,Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Frauke Schultze‐Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBernSwitzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology LabGenevaSwitzerland,Department of Genetic Medicine and Development, School of MedicineUniversity of GenevaGenevaSwitzerland
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228
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Lo Cascio N, Saba R, Hauser M, Vernal DL, Al-Jadiri A, Borenstein Y, Sheridan EM, Kishimoto T, Armando M, Vicari S, Fiori Nastro P, Girardi P, Gebhardt E, Kane JM, Auther A, Carrión RE, Cornblatt BA, Schimmelmann BG, Schultze-Lutter F, Correll CU. Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis. Eur Child Adolesc Psychiatry 2016; 25:1091-102. [PMID: 26921232 DOI: 10.1007/s00787-016-0832-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
While attenuated psychotic symptoms (APS) and basic symptoms (BS) are the main current predictors of psychosis in adults, studies in adolescents are scarce. Thus, we (1) described the prevalence and severity of positive, negative, disorganization, general, and basic symptoms in adolescent patients at ultra-high risk for psychosis (UHR), with other non-psychotic psychiatric disorders (PC) and with early-onset psychosis (EOP); and (2) investigated BS criteria in relation to UHR criteria. Sixty-nine 12-18-year-old adolescents (15.3 ± 1.7 years, female = 58.0 %, UHR = 22, PC = 27, EOP = 20) were assessed with the structured interview for prodromal syndromes (SIPS) and the schizophrenia proneness instrument-child and youth version (SPI-CY). Despite similar current and past 12-month global functioning, both UHR and EOP had significantly higher SIPS total and subscale scores compared to PC, with moderate-large effect sizes. Expectedly, UHR had significantly lower SIPS positive symptom scores than EOP, but similar SIPS negative, disorganized, and general symptom scores. Compared to PC, both EOP and UHR had more severe basic thought and perception disturbances, and significantly more often met cognitive disturbances criteria (EOP = 50.0 %, UHR = 40.9 %, PC = 14.8 %). Compared to UHR, both EOP and PC significantly less often met cognitive-perceptive BS criteria (EOP = 35.0 %, UHR = 68.2 %, PC = 25.9 %). BS were significantly more prevalent in both EOP and UHR than PC, and UHR were similar to EOP in symptom domains. Given the uncertain outcome of adolescents at clinical high-risk of psychosis, future research is needed to determine whether the combined assessment of early subjective disturbances with observable APS can improve the accuracy of psychosis prediction.
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Affiliation(s)
- Nella Lo Cascio
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marta Hauser
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, North Denmark Region, Denmark
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Yehonatan Borenstein
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Eva M Sheridan
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,School of Medicine, Keio University, Tokyo, Japan
| | - Marco Armando
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Eva Gebhardt
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - John M Kane
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Andrea Auther
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Ricardo E Carrión
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA.,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph U Correll
- The Zucker Hillside Hospital Department of Psychiatry, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY, 11004, USA. .,Hofstra North Shore-LIJ School of Medicine, Hofstra University, Hempstead, NY, USA. .,The Feinstein Institute for Medical Research, Manhasset, NY, USA. .,Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
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229
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Mamah D, Musau A, Mutiso VN, Owoso A, Abdallah AB, Cottler LB, Striley CW, Walker EF, Ndetei DM. Characterizing psychosis risk traits in Africa: A longitudinal study of Kenyan adolescents. Schizophr Res 2016; 176:340-348. [PMID: 27522263 DOI: 10.1016/j.schres.2016.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/31/2016] [Accepted: 08/05/2016] [Indexed: 12/27/2022]
Abstract
The schizophrenia prodrome has not been extensively studied in Africa. Identification of prodromal behavioral symptoms holds promise for early intervention and prevention of disorder onset. Our goal was to investigate schizophrenia risk traits in Kenyan adolescents and identify predictors of psychosis progression. 135 high-risk (HR) and 142 low-risk (LR) adolescents were identified from among secondary school students in Machakos, Kenya, using the structured interview of psychosis-risk syndromes (SIPS) and the Washington early recognition center affectivity and psychosis (WERCAP) screen. Clinical characteristics were compared across groups, and participants followed longitudinally over 0-, 4-, 7-, 14- and 20-months. Potential predictors of psychosis conversion and severity change were studied using multiple regression analyses. More psychiatric comorbidities and increased psychosocial stress were observed in HR compared to LR participants. HR participants also had worse attention and better abstraction. The psychosis conversion rate was 3.8%, with only disorganized communication severity at baseline predicting conversion (p=0.007). Decreasing psychotic symptom severity over the study period was observed in both HR and LR participants. ADHD, bipolar disorder, and major depression diagnoses, as well as poor occupational functioning and avolition were factors relating to lesser improvement in psychosis severity. Our results indicate that psychopathology and disability occur at relatively high rates in Kenyan HR adolescents. Few psychosis conversions may reflect an inadequate time to conversion, warranting longer follow-up studies to clarify risk predictors. Identifying disorganized communication and other risk factors could be useful for developing preventive strategies for HR youth in Kenya.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States.
| | | | | | - Akinkunle Owoso
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States
| | - Arbi Ben Abdallah
- Department of Anesthesiology, Washington University Medical School, St. Louis, MO, United States
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, United States
| | - Catherine W Striley
- Department of Epidemiology, University of Florida, Gainesville, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, United States
| | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
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230
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Laprevote V, Heitz U, Di Patrizio P, Studerus E, Ligier F, Schwitzer T, Schwan R, Riecher-Rössler A. [Why and how to treat psychosis earlier?]. Presse Med 2016; 45:992-1000. [PMID: 27554461 DOI: 10.1016/j.lpm.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 12/22/2022] Open
Abstract
Chronic psychosis, as for instance schizophrenia, usually begins in young adulthood and may cause severe disability. It causes a mean loss of life expectancy of 22 years. Actual models of psychosis do not trace the beginning of psychosis to the first franc psychotic episode only, but to earlier symptoms. In a classical health system only considering the first psychotic episode, the mean duration of untreated illness (DUI) can last several years. Yet this DUI has a direct impact on the prognosis of the disease. Actual international recommendations prescribe to early detect and treat at risk mental states of psychosis, thus reducing DUI. Such an attitude also helps the patient to integrate care in a moment where she/he is fully in condition to consent and to adhere. Generalist practitioners are crucial actors of early detection. We describe here simple and standardized tools helping early detection of high-risk mental states of psychosis in primary care and the appropriate attitude to do it properly. Numerous countries have developed early detection and treatment centers for psychosis. It has been established that such interventions clearly decrease the risk of transition towards chronic psychosis and improve the prognosis. These recent data about early detection and intervention in psychosis are a major step forward in psychiatry practice. It is now necessary to largely develop such actions in France.
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Affiliation(s)
- Vincent Laprevote
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Laxou, France; Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken Basel, Kornhausgasse 7, 4051 Basel, Suisse; EA 7298, INGRES, université de Lorraine, 54000 Vandœuvre-lès-Nancy, France.
| | - Ulrike Heitz
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken Basel, Kornhausgasse 7, 4051 Basel, Suisse
| | | | - Erich Studerus
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken Basel, Kornhausgasse 7, 4051 Basel, Suisse
| | - Fabienne Ligier
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Laxou, France; Université de Lorraine, EA 4360, APEMAC, 54000 Nancy, France
| | - Thomas Schwitzer
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Laxou, France; EA 7298, INGRES, université de Lorraine, 54000 Vandœuvre-lès-Nancy, France
| | - Raymund Schwan
- Centre psychothérapique de Nancy, 1, rue du Dr-Archambault, 54520 Laxou, France; EA 7298, INGRES, université de Lorraine, 54000 Vandœuvre-lès-Nancy, France; Université de Lorraine, faculté de médecine, 54000 Nancy, France
| | - Anita Riecher-Rössler
- Zentrum für Gender Research und Früherkennung, Universitäre Psychiatrische Kliniken Basel, Kornhausgasse 7, 4051 Basel, Suisse
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231
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Kindler J, Schultze-Lutter F, Michel C, Martz-Irngartinger A, Linder C, Schmidt SJ, Stegmayer K, Schimmelmann BG, Walther S. Abnormal involuntary movements are linked to psychosis-risk in children and adolescents: Results of a population-based study. Schizophr Res 2016; 174:58-64. [PMID: 27160790 DOI: 10.1016/j.schres.2016.04.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Altered motor behavior has consistently been reported in medication-naive adult patients with schizophrenia and first episode psychosis and adults at clinical high risk for psychosis (CHR). This study is the first to evaluate the prevalence of abnormal involuntary movements in a community sample of children and adolescents with and without CHR. METHODS We examined CHR in 102 children and adolescents aged 8-17years from the general population of the Canton Bern. Attenuated and brief intermittent psychotic symptoms, as well as basic symptoms, were assessed using the Structured Interview for Psychosis Risk Syndromes and the Schizophrenia Proneness Instrument, Child & Youth Version. Motor symptoms were assessed using the Abnormal Involuntary Movement Scale (AIMS). Additionally, psychosocial functioning, a neurocognitive test battery, and DSM-IV Axis I disorders were examined. RESULTS Eleven (10.8%) participants met CHR criteria, 13 (12.7%, 5 with and 8 without CHR) met criteria for increased abnormal involuntary movements (AIMS≥2). Both AIMS total scores and the percentage of children with AIMS≥2 were significantly higher in the CHR group. Psychosocial functioning was reduced in subjects with abnormal involuntary movements, and movement abnormalities were linked to deficits in attention and perception but not to the presence of non-psychotic mental disorders. CONCLUSIONS Our findings suggest that abnormal involuntary movements are linked to psychosis risk in children and adolescents from the general population. Thus, abnormal involuntary movements might represent an additional useful and easily accessible predictor of psychosis.
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Affiliation(s)
- Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Alexandra Martz-Irngartinger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Caroline Linder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
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Debbané M, Benmiloud J, Salaminios G, Solida-Tozzi A, Armando M, Fonagy P, Bateman A. Mentalization-Based Treatment in Clinical High-Risk for Psychosis: A Rationale and Clinical Illustration. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9337-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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233
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Affiliation(s)
- Anita Riecher‐Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric ClinicsBaselSwitzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric ClinicsBaselSwitzerland
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Fusar-Poli P, Schultze-Lutter F, Cappucciati M, Rutigliano G, Bonoldi I, Stahl D, Borgwardt S, Riecher-Rössler A, Addington J, Perkins DO, Woods SW, McGlashan T, Lee J, Klosterkötter J, Yung AR, McGuire P. The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis. Schizophr Bull 2016; 42:732-43. [PMID: 26591006 PMCID: PMC4838090 DOI: 10.1093/schbul/sbv162] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. METHODS Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR-). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. RESULTS 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR-: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%-24%, I (2) = 96, P < .001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = -.166, Q = 9.441, P = .002) outreach campaigns primarily targeting the general public (n = 11, β = -1.15, Q = 21.35, P < .001) along with higher proportions of self-referrals (n = 10, β = -.029, Q = 4.262, P = .039), which diluted pretest risk for psychosis in patients undergoing CHR assessment. CONCLUSIONS There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38 monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38 monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.
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Affiliation(s)
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Department of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Marco Cappucciati
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry Psychology and Neuroscience, King's College London, London UK
| | - Stephan Borgwardt
- Department of Psychiatry (UPK), University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Anita Riecher-Rössler
- Department of Psychiatry (UPK), University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT
| | | | - Jimmy Lee
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | | | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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235
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Gerstenberg M, Theodoridou A, Traber-Walker N, Franscini M, Wotruba D, Metzler S, Müller M, Dvorsky D, Correll CU, Walitza S, Rössler W, Heekeren K. Adolescents and adults at clinical high-risk for psychosis: age-related differences in attenuated positive symptoms syndrome prevalence and entanglement with basic symptoms. Psychol Med 2016; 46:1069-1078. [PMID: 26671170 DOI: 10.1017/s0033291715002627] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The attenuated positive symptoms syndrome (APSS) is considered an at-risk indicator for psychosis. However, the characteristics and developmental aspects of the combined or enriched risk criteria of APSS and basic symptom (BS) criteria, including self-experienced cognitive disturbances (COGDIS) remain under-researched. METHOD Based on the Structured Interview of Prodromal Syndromes (SIPS), the prevalence of APSS in 13- to 35-year-old individuals seeking help in an early recognition program for schizophrenia and bipolar-spectrum disorders was examined. BS criteria and COGDIS were rated using the Schizophrenia Proneness Instrument for Adults/Children and Youth. Participants meeting APSS criteria were compared with participants meeting only BS criteria across multiple characteristics. Co-occurrence (APSS+/BS+, APSS+/COGDIS+) was compared across 13-17, 18-22 and 23-35 years age groups. RESULTS Of 175 individuals (age = 20.6 ± 5.8, female = 38.3%), 94 (53.7%) met APSS criteria. Compared to BS, APSS status was associated with suicidality, higher illness severity, lower functioning, higher SIPS positive, negative, disorganized and general symptoms scores, depression scores and younger age (18.3 ± 5.0 v. 23.2 ± 5.6 years, p < 0.0001) with age-related differences in the prevalence of APSS (ranging from 80.3% in 13- to 17-year-olds to 33.3% in 23- to 35-year-olds (odds ratio 0.21, 95% confidence interval 0.11-0.37). Within APSS+ individuals, fewer adolescents fulfilled combined risk criteria of APSS+/BS+ or APSS+/COGDIS+ compared to the older age groups. CONCLUSIONS APSS status was associated with greater suicidality and illness/psychophathology severity in this help-seeking cohort, emphasizing the need for clinical care. The age-related differences in the prevalence of APSS and the increasing proportion of APSS+/COGDIS+ may point to a higher proportion of non-specific/transient, rather than risk-specific attenuated positive symptoms in adolescents.
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Affiliation(s)
- M Gerstenberg
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - A Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - N Traber-Walker
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - M Franscini
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - D Wotruba
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - S Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - M Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - D Dvorsky
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - C U Correll
- The Zucker Hillside Hospital,Psychiatry Research,North Shore - Long Island Jewish Health System (LIJ),Glen Oaks,NY,USA
| | - S Walitza
- University Clinics for Child and Adolescent Psychiatry Zurich,Zurich,Switzerland
| | - W Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
| | - K Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Zurich,Switzerland
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Abstract
Despite a lack of recent progress in the treatment of schizophrenia, our understanding of its genetic and environmental causes has considerably improved, and their relationship to aberrant patterns of neurodevelopment has become clearer. This raises the possibility that 'disease-modifying' strategies could alter the course to - and of - this debilitating disorder, rather than simply alleviating symptoms. A promising window for course-altering intervention is around the time of the first episode of psychosis, especially in young people at risk of transition to schizophrenia. Indeed, studies performed in both individuals at risk of developing schizophrenia and rodent models for schizophrenia suggest that pre-diagnostic pharmacotherapy and psychosocial or cognitive-behavioural interventions can delay or moderate the emergence of psychosis. Of particular interest are 'hybrid' strategies that both relieve presenting symptoms and reduce the risk of transition to schizophrenia or another psychiatric disorder. This Review aims to provide a broad-based consideration of the challenges and opportunities inherent in efforts to alter the course of schizophrenia.
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237
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Woodberry KA, Shapiro DI, Bryant C, Seidman LJ. Progress and Future Directions in Research on the Psychosis Prodrome: A Review for Clinicians. Harv Rev Psychiatry 2016; 24:87-103. [PMID: 26954594 PMCID: PMC4870599 DOI: 10.1097/hrp.0000000000000109] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to: ABSTRACT The psychosis prodrome, or period of clinical and functional decline leading up to acute psychosis, offers a unique opportunity for identifying mechanisms of psychosis onset and for testing early-intervention strategies. We summarize major findings and emerging directions in prodromal research and provide recommendations for clinicians working with individuals suspected to be at high risk for psychosis. The past two decades of research have led to three major advances. First, tools and criteria have been developed that can reliably identify imminent risk for a psychotic disorder. Second, longitudinal clinical and psychobiological data from large multisite studies are strengthening individual risk assessment and offering insights into potential mechanisms of illness onset. Third, psychosocial and pharmacological interventions are demonstrating promise for delaying or preventing the onset of psychosis in help-seeking, high-risk individuals. The dynamic psychobiological processes implicated in both risk and onset of psychosis, including altered gene expression, cognitive dysfunction, inflammation, gray and white matter brain changes, and vulnerability-stress interactions suggest a wide range of potential treatment targets and strategies. The expansion of resources devoted to early intervention and prodromal research worldwide raises hope for investigating them. Future directions include identifying psychosis-specific risk and resilience factors in children, adolescents, and non-help-seeking community samples, improving study designs to test hypothesized mechanisms of change, and intervening with strategies that, in order to improve functional outcomes, better engage youth, address their environmental contexts, and focus on evidence-based neurodevelopmental targets. Prospective research on putatively prodromal samples has the potential to substantially reshape our understanding of mental illness and our efforts to combat it.
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Affiliation(s)
- Kristen A Woodberry
- From Harvard Medical School (Drs. Woodberry, Shapiro, and Seidman) and Beth Israel Deaconess Medical Center (Drs. Woodberry, Shapiro, and Seidman, and Ms. Bryant)
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Fusar-Poli P, Schultze-Lutter F. Predicting the onset of psychosis in patients at clinical high risk: practical guide to probabilistic prognostic reasoning. EVIDENCE-BASED MENTAL HEALTH 2016; 19:10-5. [PMID: 26792832 PMCID: PMC10699348 DOI: 10.1136/eb-2015-102295] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 11/03/2022]
Abstract
Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychosis in, person-time rate of psychosis, Kaplan-Meier estimates of psychosis risk, measures of prognostic accuracy, sensitivity and specificity in receiver operator characteristic curves, positive and negative predictive values, Bayes' theorem, likelihood ratios, potentials and limits of real-life applications of prognostic probabilistic reasoning in the CHR state. Understanding basic measures used for prognostic probabilistic reasoning is a prerequisite for successfully implementing the early detection and prevention of psychosis in clinical practice. Future refinement of these measures for CHR patients may actually influence risk management, especially as regards initiating or withholding treatment.
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Affiliation(s)
- P Fusar-Poli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- OASIS service, South London and the Maudsley NHS Foundation Trust, London, UK
| | - F Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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239
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N100 Repetition Suppression Indexes Neuroplastic Defects in Clinical High Risk and Psychotic Youth. Neural Plast 2016; 2016:4209831. [PMID: 26881109 PMCID: PMC4737454 DOI: 10.1155/2016/4209831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Highly penetrant mutations leading to schizophrenia are enriched for genes coding for N-methyl-D-aspartate receptor signaling complex (NMDAR-SC), implicating plasticity defects in the disease's pathogenesis. The importance of plasticity in neurodevelopment implies a role for therapies that target these mechanisms in early life to prevent schizophrenia. Testing such therapies requires noninvasive methods that can assess engagement of target mechanisms. The auditory N100 is an obligatory cortical response whose amplitude decreases with tone repetition. This adaptation may index the health of plasticity mechanisms required for normal development. We exposed participants aged 5 to 17 years with psychosis (n = 22), at clinical high risk (CHR) for psychosis (n = 29), and healthy controls (n = 17) to an auditory tone repeated 450 times and measured N100 adaptation (mean amplitude during first 150 tones − mean amplitude during last 150 tones). N100 adaptation was reduced in CHR and psychosis, particularly among participants <13 years old. Initial N100 blunting partially accounted for differences. Decreased change in the N100 amplitude with tone repetition may be a useful marker of defects in neuroplastic mechanisms measurable early in life.
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240
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Fusar-Poli P, Cappucciati M, Rutigliano G, Lee TY, Beverly Q, Bonoldi I, Lelli J, Kaar SJ, Gago E, Rocchetti M, Patel R, Bhavsar V, Tognin S, Badger S, Calem M, Lim K, Kwon JS, Perez J, McGuire P. Towards a Standard Psychometric Diagnostic Interview for Subjects at Ultra High Risk of Psychosis: CAARMS versus SIPS. PSYCHIATRY JOURNAL 2016; 2016:7146341. [PMID: 27314005 PMCID: PMC4904115 DOI: 10.1155/2016/7146341] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 02/05/2023]
Abstract
Background. Several psychometric instruments are available for the diagnostic interview of subjects at ultra high risk (UHR) of psychosis. Their diagnostic comparability is unknown. Methods. All referrals to the OASIS (London) or CAMEO (Cambridgeshire) UHR services from May 13 to Dec 14 were interviewed for a UHR state using both the CAARMS 12/2006 and the SIPS 5.0. Percent overall agreement, kappa, the McNemar-Bowker χ (2) test, equipercentile methods, and residual analyses were used to investigate diagnostic outcomes and symptoms severity or frequency. A conversion algorithm (CONVERT) was validated in an independent UHR sample from the Seoul Youth Clinic (Seoul). Results. There was overall substantial CAARMS-versus-SIPS agreement in the identification of UHR subjects (n = 212, percent overall agreement = 86%; kappa = 0.781, 95% CI from 0.684 to 0.878; McNemar-Bowker test = 0.069), with the exception of the brief limited intermittent psychotic symptoms (BLIPS) subgroup. Equipercentile-linking table linked symptoms severity and frequency across the CAARMS and SIPS. The conversion algorithm was validated in 93 UHR subjects, showing excellent diagnostic accuracy (CAARMS to SIPS: ROC area 0.929; SIPS to CAARMS: ROC area 0.903). Conclusions. This study provides initial comparability data between CAARMS and SIPS and will inform ongoing multicentre studies and clinical guidelines for the UHR psychometric diagnostic interview.
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Affiliation(s)
- P. Fusar-Poli
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
- *P. Fusar-Poli:
| | - M. Cappucciati
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
| | - G. Rutigliano
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
| | - T. Y. Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 08826, Republic of Korea
| | - Q. Beverly
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5HH, UK
| | - I. Bonoldi
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - J. Lelli
- Real-Time Systems Laboratory, Scuola Superiore Sant'Anna, 56124 Pisa, Italy
| | - S. J. Kaar
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - E. Gago
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - M. Rocchetti
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
| | - R. Patel
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - V. Bhavsar
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - S. Tognin
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - S. Badger
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - M. Calem
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
| | - K. Lim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 08826, Republic of Korea
| | - J. S. Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 08826, Republic of Korea
| | - J. Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5HH, UK
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - P. McGuire
- Institute of Psychiatry Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11, UK
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241
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Nordgaard J, Henriksen MG. Self-disorders: A promising Candidate for Early Detection. Scand J Child Adolesc Psychiatr Psychol 2016. [DOI: 10.21307/sjcapp-2016-003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Schultze-Lutter F, Debbané M, Theodoridou A, Wood SJ, Raballo A, Michel C, Schmidt SJ, Kindler J, Ruhrmann S, Uhlhaas PJ. Revisiting the Basic Symptom Concept: Toward Translating Risk Symptoms for Psychosis into Neurobiological Targets. Front Psychiatry 2016; 7:9. [PMID: 26858660 PMCID: PMC4729935 DOI: 10.3389/fpsyt.2016.00009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022] Open
Abstract
In its initial formulation, the concept of basic symptoms (BSs) integrated findings on the early symptomatic course of schizophrenia and first in vivo evidence of accompanying brain aberrations. It argued that the subtle subclinical disturbances in mental processes described as BSs were the most direct self-experienced expression of the underlying neurobiological aberrations of the disease. Other characteristic symptoms of psychosis (e.g., delusions and hallucinations) were conceptualized as secondary phenomena, resulting from dysfunctional beliefs and suboptimal coping styles with emerging BSs and/or concomitant stressors. While BSs can occur in many mental disorders, in particular affective disorders, a subset of perceptive and cognitive BSs appear to be specific to psychosis and are currently employed in two alternative risk criteria. However, despite their clinical recognition in the early detection of psychosis, neurobiological research on the aetiopathology of psychosis with neuroimaging methods has only just begun to consider the neural correlate of BSs. This perspective paper reviews the emerging evidence of an association between BSs and aberrant brain activation, connectivity patterns, and metabolism, and outlines promising routes for the use of BSs in aetiopathological research on psychosis.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
| | - Stephen J Wood
- School of Psychology, University of Birmingham , Birmingham , UK
| | - Andrea Raballo
- Norwegian Centre for Mental Disorders Research (NORMENT), Faculty of Medicine, University of Oslo , Oslo , Norway
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern , Bern , Switzerland
| | - Stefanie J Schmidt
- 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
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow , Glasgow , UK
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Identifying children and adolescents at ultra high risk of psychosis in Italian neuropsychiatry services: a feasibility study. Eur Child Adolesc Psychiatry 2016; 25:91-106. [PMID: 25925786 DOI: 10.1007/s00787-015-0710-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 04/07/2015] [Indexed: 12/20/2022]
Abstract
The past 20 years have seen the evolution of the construct of a clinical high-risk (hereafter, HR) state for psychosis. This construct is designed to capture the pre-psychotic phase. Some aspects of this approach, such as its feasibility in children and adolescents, are still under investigation. In the present study, we address the feasibility of implementing prodrome clinics for HR individuals within the framework of Italy's national child and adolescent neuropsychiatry services and the clinical relevance of a HR diagnosis in this population. Using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify help-seeking patients meeting at least one HR criterion at baseline (HR+), we recruited 50 subjects for a feasibility study. The results obtained show that the Italian version of the CAARMS is easily administrable, causing patients no substantial discomfort. The prevalence of HR+ in our cohort was 44 %, which increased by an additional 18 % when negative symptoms were considered as an experimental inclusion criterion (HRNeg). The HR+ subjects were significantly more impaired in their social and occupational functioning than their HR- peers (subjects not at HR). The cumulative 1-year transition risk of psychosis of the HR+ group was 26.7 %. When the HRNeg group was added, the 1-year transition risk was 17.3 %. We suggest that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.
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Gonzalez-Heydrich J, Enlow MB, D’Angelo E, Seidman B LJ, Gumlak S, Kim A, Woodberry KA, Rober A, Tembulkar S, Graber K, O’Donnell K, Hamoda HM, Kimball K, Rotenberg A, Oberman LM, Pascual-Leone A, Keshavan MS, Duffy FH. Early auditory processing evoked potentials (N100) show a continuum of blunting from clinical high risk to psychosis in a pediatric sample. Schizophr Res 2015; 169:340-345. [PMID: 26549629 PMCID: PMC4821005 DOI: 10.1016/j.schres.2015.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The N100 is a negative deflection in the surface EEG approximately 100 ms after an auditory signal. It has been shown to be reduced in individuals with schizophrenia and those at clinical high risk (CHR). N100 blunting may index neural network dysfunction underlying psychotic symptoms. This phenomenon has received little attention in pediatric populations. METHOD This cross-sectional study compared the N100 response measured via the average EEG response at the left medial frontal position FC1 to 150 sinusoidal tones in participants ages 5 to 17 years with a CHR syndrome (n=29), a psychotic disorder (n=22), or healthy controls (n=17). RESULTS Linear regression analyses that considered potential covariates (age, gender, handedness, family mental health history, medication usage) revealed decreasing N100 amplitude with increasing severity of psychotic symptomatology from healthy to CHR to psychotic level. CONCLUSIONS Longitudinal assessment of the N100 in CHR children who do and do not develop psychosis will inform whether it predicts transition to psychosis and if its response to treatment predicts symptom change.
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Affiliation(s)
- Joseph Gonzalez-Heydrich
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA.
| | - Michelle Bosquet Enlow
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Eugene D’Angelo
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Larry J. Seidman B
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA,Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah Gumlak
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - April Kim
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kristen A. Woodberry
- Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA,Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA
| | - Ashley Rober
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sahil Tembulkar
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kelsey Graber
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kyle O’Donnell
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Hesham M. Hamoda
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA
| | - Kara Kimball
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alexander Rotenberg
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lindsay M. Oberman
- E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Alvaro Pascual-Leone
- Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA,Beth Israel Deaconess Medical Center, Division of Cognitive Neurology and Berenson-Allen Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Matcheri S. Keshavan
- Harvard Medical School, Department of Psychiatry, 401 Park Drive, Boston, MA 02215, USA,Beth Israel Deaconess Medical Center, Department of Psychiatry, Commonwealth Research Center, 75 Fenwood Road, Boston, MA 02115, USA
| | - Frank H. Duffy
- Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA,Harvard Medical School, Department of Neurology, 25 Shattuck Street, Boston, MA 02115, USA
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245
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Armando M, Pontillo M, De Crescenzo F, Mazzone L, Monducci E, Lo Cascio N, Santonastaso O, Pucciarini ML, Vicari S, Schimmelmann BG, Schultze-Lutter F. Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophr Res 2015; 169:186-192. [PMID: 26526751 DOI: 10.1016/j.schres.2015.10.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. METHOD Thirty-five children and adolescents (age 9-17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). RESULTS At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. CONCLUSIONS Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted.
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Affiliation(s)
- Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Franco De Crescenzo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Luigi Mazzone
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Elena Monducci
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Nella Lo Cascio
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ornella Santonastaso
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Maria Laura Pucciarini
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
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246
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Schultze-Lutter F, Rahman J, Ruhrmann S, Michel C, Schimmelmann BG, Maier W, Klosterkötter J. Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1831-41. [PMID: 26155901 DOI: 10.1007/s00127-015-1093-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/29/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Prevention of psychosis requires both presence of clinical high risk (CHR) criteria and early help-seeking. Previous retrospective studies of the duration of untreated illness (i.e. prodrome plus psychosis) did not distinguish between prodromal states with and without CHR symptoms. Therefore, we examined the occurrence of CHR symptoms and first help-seeking, thereby considering effects of age at illness-onset. METHODS Adult patients first admitted for psychosis (n = 126) were retrospectively assessed for early course of illness and characteristics of first help-seeking. RESULTS One-hundred and nine patients reported a prodrome, 58 with CHR symptoms. In patients with an early illness-onset before age 18 (n = 45), duration of both illness and psychosis were elongated, and CHR symptoms more frequent (68.9 vs. 33.3 %) compared to those with adult illness-onset. Only 29 patients reported help-seeking in the prodrome; this was mainly self-initiated, especially in patients with an early illness-onset. After the onset of first psychotic symptoms, help-seeking was mainly initiated by others. State- and age-independently, mental health professionals were the main first point-of-call (54.0 %). CONCLUSIONS Adult first-admission psychosis patients with an early, insidious onset of symptoms before age 18 were more likely to recall CHR symptoms as part of their prodrome. According to current psychosis-risk criteria, these CHR symptoms, in principle, would have allowed the early detection of psychosis. Furthermore, compared to patients with an adult illness-onset, patients with an early illness-onset were also more likely to seek help on their own account. Thus, future awareness strategies to improve CHR detection might be primarily related to young persons and self-perceived subtle symptoms.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland.
| | - Jonas Rahman
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern 60, Switzerland
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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247
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Fusar-Poli P, Cappucciati M, Rutigliano G, Schultze-Lutter F, Bonoldi I, Borgwardt S, Riecher-Rössler A, Addington J, Perkins D, Woods SW, McGlashan TH, Lee J, Klosterkötter J, Yung AR, McGuire P. At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry 2015; 14:322-32. [PMID: 26407788 PMCID: PMC4592655 DOI: 10.1002/wps.20250] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR-). The reference index was psychosis onset over time in both CHR+ and CHR- subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR-: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide.
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Affiliation(s)
- Paolo Fusar-Poli
- King's College London, Institute of Psychiatry, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ilaria Bonoldi
- King's College London, Institute of Psychiatry, London, UK
| | | | | | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | - Jimmy Lee
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | | | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- King's College London, Institute of Psychiatry, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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248
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Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F. Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies. World Psychiatry 2015; 14:189-97. [PMID: 26043337 PMCID: PMC4471976 DOI: 10.1002/wps.20216] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.
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Affiliation(s)
- Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Alexandra Martz-Irngartinger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Caroline Linder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBolligenstrasse 111, 3000 Bern 60, Switzerland
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Ruhrmann S, Schultze-Lutter F, Schmidt SJ, Kaiser N, Klosterkötter J. Prediction and prevention of psychosis: current progress and future tasks. Eur Arch Psychiatry Clin Neurosci 2014; 264 Suppl 1:S9-16. [PMID: 25256263 DOI: 10.1007/s00406-014-0541-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/06/2014] [Indexed: 12/28/2022]
Abstract
Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required.
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Affiliation(s)
- Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany,
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