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Akcaoglu Z, Vaessen T, Velthorst E, Lafit G, Achterhof R, Nelson B, McGorry P, Schirmbeck F, Morgan C, Hartmann J, van der Gaag M, de Haan L, Valmaggia L, McGuire P, Kempton M, Steinhart H, Klippel A, Viechtbauer W, Batink T, van Winkel R, van Amelsvoort T, Marcelis M, van Aubel E, Reininghaus U, Myin-Germeys I. The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis. Psychol Med 2024; 54:1684-1692. [PMID: 38179659 DOI: 10.1017/s0033291723003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. METHODS We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. RESULTS SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. CONCLUSIONS Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.
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Affiliation(s)
- Zeynep Akcaoglu
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands
| | - Eva Velthorst
- Department of Research, Community Mental Health Service GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands
| | - Ginette Lafit
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Robin Achterhof
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, North Holland, Netherlands
- Arkin, Institute for Mental Health, Amsterdam, North Holland, The Netherlands
| | - Craig Morgan
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, North Holland, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Location AMC, Amsterdam, North Holland, The Netherlands
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Kempton
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Henrietta Steinhart
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Annelie Klippel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Lifespan Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tim Batink
- Department of Lifespan Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Ruud van Winkel
- Department of Neurosciences, Psychiatry Research Group, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands, https://www.ggze.nl/
| | - Evelyne van Aubel
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK
- Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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Cowan HR, Williams TF, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshevan M, Perkins DO, Mathalon DH, Stone W, Woods SW, Walker EF. The Complex Latent Structure of Attenuated Psychotic Symptoms: Hierarchical and Bifactor Models of SIPS Symptoms Replicated in Two Large Samples at Clinical High Risk for Psychosis. Schizophr Bull 2024:sbae042. [PMID: 38728417 DOI: 10.1093/schbul/sbae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms. STUDY DESIGN Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders. STUDY RESULTS Most variance in SIPS items (75%-77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable. CONCLUSIONS Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.
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Affiliation(s)
- Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Departments of Psychiatry and Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Matcheri Keshevan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Benrimoh D, Dlugunovych V, Wright AC, Phalen P, Funaro MC, Ferrara M, Powers AR, Woods SW, Guloksuz S, Yung AR, Srihari V, Shah J. On the proportion of patients who experience a prodrome prior to psychosis onset: A systematic review and meta-analysis. Mol Psychiatry 2024; 29:1361-1381. [PMID: 38302562 DOI: 10.1038/s41380-024-02415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Preventing or delaying the onset of psychosis requires identification of those at risk for developing psychosis. For predictive purposes, the prodrome - a constellation of symptoms which may occur before the onset of psychosis - has been increasingly recognized as having utility. However, it is unclear what proportion of patients experience a prodrome or how this varies based on the multiple definitions used. METHODS We conducted a systematic review and meta-analysis of studies of patients with psychosis with the objective of determining the proportion of patients who experienced a prodrome prior to psychosis onset. Inclusion criteria included a consistent prodrome definition and reporting the proportion of patients who experienced a prodrome. We excluded studies of only patients with a prodrome or solely substance-induced psychosis, qualitative studies without prevalence data, conference abstracts, and case reports/case series. We searched Ovid MEDLINE, Embase (Ovid), APA PsycInfo (Ovid), Web of Science Core Collection (Clarivate), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, APA PsycBooks (Ovid), ProQuest Dissertation & Thesis, on March 3, 2021. Studies were assessed for quality using the Critical Appraisal Checklist for Prevalence Studies. Narrative synthesis and proportion meta-analysis were used to estimate prodrome prevalence. I2 and predictive interval were used to assess heterogeneity. Subgroup analyses were used to probe sources of heterogeneity. (PROSPERO ID: CRD42021239797). RESULTS Seventy-one articles were included, representing 13,774 patients. Studies varied significantly in terms of methodology and prodrome definition used. The random effects proportion meta-analysis estimate for prodrome prevalence was 78.3% (95% CI = 72.8-83.2); heterogeneity was high (I2 97.98% [95% CI = 97.71-98.22]); and the prediction interval was wide (95% PI = 0.411-0.936). There were no meaningful differences in prevalence between grouped prodrome definitions, and subgroup analyses failed to reveal a consistent source of heterogeneity. CONCLUSIONS This is the first meta-analysis on the prevalence of a prodrome prior to the onset of first episode psychosis. The majority of patients (78.3%) were found to have experienced a prodrome prior to psychosis onset. However, findings are highly heterogenous across study and no definitive source of heterogeneity was found despite extensive subgroup analyses. As most studies were retrospective in nature, recall bias likely affects these results. While the large majority of patients with psychosis experience a prodrome in some form, it is unclear if the remainder of patients experience no prodrome, or if ascertainment methods employed in the studies were not sensitive to their experiences. Given widespread investment in indicated prevention of psychosis through prospective identification and intervention during the prodrome, a resolution of this question as well as a consensus definition of the prodrome is much needed in order to effectively direct and organize services, and may be accomplished through novel, densely sampled and phenotyped prospective cohort studies that aim for representative sampling across multiple settings.
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Affiliation(s)
- David Benrimoh
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada.
- Department of Psychiatry, Stanford University, Stanford, CA, USA.
| | | | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Phalen
- Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Sinan Guloksuz
- Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology Maastricht University Medical Center, Maastricht, Netherlands
| | - Alison R Yung
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Australia
| | - Vinod Srihari
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Jai Shah
- PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada
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Hinzen W, Palaniyappan L. The 'L-factor': Language as a transdiagnostic dimension in psychopathology. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110952. [PMID: 38280712 DOI: 10.1016/j.pnpbp.2024.110952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Thoughts and moods constituting our mental life incessantly change. When the steady flow of this dynamics diverges in clinical directions, the possible pathways involved are captured through discrete diagnostic labels. Yet a single vulnerable neurocognitive system may be causally involved in psychopathological deviations transdiagnostically. We argue that language viewed as integrating cortical functions is the best current candidate, whose forms of breakdown along its different dimensions are then manifest as symptoms - from prosodic abnormalities and rumination in depression to distortions of speech perception in verbal hallucinations, distortions of meaning and content in delusions, or disorganized speech in formal thought disorder. Spontaneous connected speech provides continuous objective readouts generating a highly accessible bio-behavioral marker with the potential of revolutionizing neuropsychological measurement. This argument turns language into a transdiagnostic 'L-factor' providing an analytical and mechanistic substrate for previously proposed latent general factors of psychopathology ('p-factor') and cognitive functioning ('c-factor'). Together with immense practical opportunities afforded by rapidly advancing natural language processing (NLP) technologies and abundantly available data, this suggests a new era of translational clinical psychiatry, in which both psychopathology and language may be rethought together.
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Affiliation(s)
- Wolfram Hinzen
- Department of Translation & Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Institut Català de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal H4H1R3, Quebec, Canada; Robarts Research Institute & Lawson Health Research Institute, London, ON, Canada
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Naughton S, Brady A, Geary E, Counihan E, Clarke M. An exploratory study of psychosis risk factors in individuals who are referred but do not meet criteria for an early intervention in psychosis service. BJPsych Open 2024; 10:e21. [PMID: 38179675 PMCID: PMC10790220 DOI: 10.1192/bjo.2023.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The 'at-risk mental state' (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk. AIMS To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria. METHOD A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period. RESULTS From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort. CONCLUSIONS This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.
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Affiliation(s)
- Sean Naughton
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland; and School of Medicine, University College Dublin, Ireland
| | - Aoife Brady
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Eoin Geary
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Eimear Counihan
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Early Intervention in Psychosis Service, Dublin, Ireland; and School of Medicine, University College Dublin, Ireland
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Rimvall MK, Vassard D, Christensen R, Nielsen SM, Pagsberg AK, Correll CU, Jeppesen P. Do psychotic experiences act as effect modifiers in youths with common mental health problems allocated to transdiagnostic cognitive behavioural therapy versus management as usual? Secondary analyses of the Mind-My-Mind randomized trial. Early Interv Psychiatry 2024; 18:26-33. [PMID: 37078563 DOI: 10.1111/eip.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Psychotic experiences (PEs) are common in help-seeking youths with non-psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems. METHODS We present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6-16-year-old youths to either 9-13 sessions of transdiagnostic modular community-based CBT (MMM) or community-based management as usual (MAU). MMM was superior to MAU in reducing parent-reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi-structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent-reported SDQ-impact (primary outcome, rated 0[low]-10[high]) and other SDQ-related outcomes. RESULTS Baseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ-impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] -0.89 [95%CI -1.77;-0.01] vs. PEs[no] -1.10 [95%CI -1.52;-0.68], p-value for interaction .68). For secondary outcomes similar patterns were observed. Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta-analytic evidence are needed. CONCLUSIONS The beneficial effects of MMM transdiagnostic CBT did not differ by PE-status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co-occurring PEs.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Vassard
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Paquin V, Philippe FL, Shannon H, Guimond S, Ouellet-Morin I, Geoffroy MC. Associations between digital media use and psychotic experiences in young adults of Quebec, Canada: a longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:65-75. [PMID: 37516683 DOI: 10.1007/s00127-023-02537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Digital media use has been associated with psychotic experiences in youth from the community, but the direction of association remains unclear. We aimed to examine between- and within-person associations of digital media use and psychotic experiences in youth. METHODS The sample included 425 participants aged 18-25 years (82.5% female) from the community, followed between May 2021 and January 2022 over 3 time points-of which 263 participants (61.9%) completed at least 2. Digital media use was self-reported as time spent daily on TV and streaming platforms, social media, and video games over the past 3 months. Psychotic experiences in the past 3 months were measured with the 15-item Community Assessment of Psychic Experiences. Associations between digital media use and psychotic experiences were estimated using a random-intercept cross-lagged panel model. RESULTS On average, individuals who reported greater digital media use also reported higher levels of psychotic experiences (r = 0.34, 95% CI 0.15, 0.53). However, a person's variation in digital media use, relative to their personal average, was not significantly associated with subsequent variations in their levels of psychotic experiences, or vice-versa. Results were similar across TV/streaming, social media and video game use, and after adjusting for age, sex, education, sleep, physical activity, and cannabis use. CONCLUSION Individuals with a tendency for higher levels of digital media use also had a tendency for higher levels of psychotic experiences. Understanding this association may help personalize mental health interventions for people with psychotic experiences, which may be offered digitally to promote their accessibility.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Ludmer Research and Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada.
| | - Frederick L Philippe
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | - Holly Shannon
- The Royal's Institute of Mental Health Research and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Synthia Guimond
- The Royal's Institute of Mental Health Research and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
| | - Isabelle Ouellet-Morin
- School of Criminology, University of Montreal, and Research Center of the Montreal Mental Health University Institute, Montreal, QC, Canada
| | - Marie-Claude Geoffroy
- Department of Psychiatry, McGill University, Ludmer Research and Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, QC, Canada
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van Os J, Scheepers F, Milo M, Ockeloen G, Guloksuz S, Delespaul P. "It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands. Clin Pract Epidemiol Ment Health 2023; 19:e17450179271206. [PMID: 38680529 PMCID: PMC11046893 DOI: 10.2174/0117450179271206231114064736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 05/01/2024]
Abstract
Background The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. Methods A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. Results A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. Conclusion By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Floortje Scheepers
- Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Michael Milo
- Milo Health Care Connector and Change Management Consultant, Berlagehof 14, 1067 NB Amsterdam, The Netherlands
| | - Gijs Ockeloen
- Reframing Studio Design Introspector, Bilderdijkkade 50 A11053 VN Amsterdam, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
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9
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Birkenæs V, Refsum Bakken N, Frei E, Jaholkowski P, Smeland OB, Tesfaye M, Agartz I, Susser E, Bresnahan M, Røysamb E, Nordbø Jørgensen K, Nesvåg R, Havdahl A, Andreassen OA, Elken Sønderby I. Psychometric Properties and Diagnostic Associations of the Short-Form Community Assessment of Psychic Experiences in a Population-Based Sample of 29 021 Adult Men. Schizophr Bull 2023; 49:1229-1238. [PMID: 37262330 PMCID: PMC10483447 DOI: 10.1093/schbul/sbad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND HYPOTHESIS Around 5%-7% of the adult population are estimated to have lifetime psychotic experiences (PEs), which are associated with psychosis risk. PEs assessed with Community Assessment of Psychic Experiences (CAPE) are associated with psychosis but also non-psychotic disorders, which could be partly explained by CAPE indirectly capturing emotional symptoms. We investigated the psychometric properties of a shorter version, CAPE-9, and whether CAPE-9 scores are associated with lifetime psychotic or non-psychotic mental disorders after controlling for current anxiety and depressive symptoms. DESIGN CAPE-9 questionnaire data were obtained from 29 021 men (42.4 ± 5.6 yrs.) from the Norwegian Mother, Father, and Child Cohort Study. We investigated CAPE-9 reliability and factor structure. Logistic regression was used to test effects of current anxiety and depressive symptoms (SCL-12) on associations between CAPE-9 scores and psychiatric diagnoses. RESULTS CAPE-9 fit a previously reported 3-factor structure and showed good reliability. Twenty-six percent reported at least one lifetime PE. CAPE-9 scores were significantly associated with most psychiatric disorders (schizophrenia, depression, bipolar disorder, substance abuse, anxiety, trauma-related disorders, and ADHD). After controlling for concurrent emotional symptoms, only associations with schizophrenia (OR = 1.29; 95% CI = 1.18-1.38) and trauma-related disorders (OR = 1.09; CI = 1.02-1.15) remained significant. CONCLUSIONS CAPE-9 showed good psychometric properties in this large population-based adult male sample, and PEs were more clearly associated with psychotic disorders after controlling for current emotional symptoms. These results support the use of the short CAPE-9 as a cost-effective tool for informing public health initiatives and advancing our understanding of the dimensionality of psychosis.
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Affiliation(s)
- Viktoria Birkenæs
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nora Refsum Bakken
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Evgeniia Frei
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Piotr Jaholkowski
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav B Smeland
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markos Tesfaye
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakohjemmet Hospital, Oslo, Norway
| | - Ezra Susser
- Mailman School of Public Health, Department of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michaeline Bresnahan
- Mailman School of Public Health, Department of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Espen Røysamb
- Faculty of Social Sciences, Department of Psychology, Oslo University Hospital, Oslo, Norway
| | - Kjetil Nordbø Jørgensen
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnar Nesvåg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Alexandra Havdahl
- Center for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Ida Elken Sønderby
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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10
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Radhakrishnan R, Pries LK, Erzin G, ten Have M, de Graaf R, van Dorsselaer S, Gunther N, Bak M, Rutten BPF, van Os J, Guloksuz S. Bidirectional relationships between cannabis use, anxiety and depressive symptoms in the mediation of the association with psychotic experience: further support for an affective pathway to psychosis. Psychol Med 2023; 53:5551-5557. [PMID: 36093677 PMCID: PMC10482707 DOI: 10.1017/s0033291722002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Empirical evidence suggests that people use cannabis to ameliorate anxiety and depressive symptoms, yet cannabis also acutely worsens psychosis and affective symptoms. However, the temporal relationship between cannabis use, anxiety and depressive symptoms and psychotic experiences (PE) in longitudinal studies is unclear. This may be informed by examination of mutually mediating roles of cannabis, anxiety and depressive symptoms in the emergence of PE. METHODS Data were derived from the second longitudinal Netherlands Mental Health Survey and Incidence Study. Mediation analysis was performed to examine the relationship between cannabis use, anxiety/depressive symptoms and PE, using KHB logit in STATA while adjusting for age, sex and education status. RESULTS Cannabis use was found to mediate the relationship between preceding anxiety, depressive symptoms and later PE incidence, but the indirect contribution of cannabis use was small (for anxiety: % of total effect attributable to cannabis use = 1.00%; for depression: % of total effect attributable to cannabis use = 1.4%). Interestingly, anxiety and depressive symptoms were found to mediate the relationship between preceding cannabis use and later PE incidence to a greater degree (% of total effect attributable to anxiety = 17%; % of total effect attributable to depression = 37%). CONCLUSION This first longitudinal cohort study examining the mediational relationship between cannabis use, anxiety/depressive symptoms and PE, shows that there is a bidirectional relationship between cannabis use, anxiety/depressive symptoms and PE. However, the contribution of anxiety/depressive symptoms as a mediator was greater than that of cannabis.
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Affiliation(s)
- Rajiv Radhakrishnan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gamze Erzin
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
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11
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Solmi M, Soardo L, Kaur S, Azis M, Cabras A, Censori M, Fausti L, Besana F, Salazar de Pablo G, Fusar-Poli P. Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment. Mol Psychiatry 2023; 28:2291-2300. [PMID: 37296309 PMCID: PMC10611568 DOI: 10.1038/s41380-023-02029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 06/12/2023]
Abstract
Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. We conducted a PRISMA/MOOSE-compliant systematic meta-analysis, searching PubMed/PsycInfo up to June 21st, 2021 for observational studies/randomized controlled trials reporting on comorbid DSM/ICD-mental disorders in CHR-P subjects ( protocol ). The primary and secondary outcomes were baseline and follow-up prevalence of comorbid mental disorders. We also explored the association of comorbid mental disorders compared with CHR-P versus psychotic/non-psychotic control groups, their impact on baseline functioning and transition to psychosis. We conducted random-effects meta-analyses, meta-regression, and assessed heterogeneity/publication bias/quality (Newcastle Ottawa Scale, NOS). We included 312 studies (largest meta-analyzed sample = 7834, any anxiety disorder, mean age = 19.98 (3.40), females = 43.88%, overall NOS > 6 in 77.6% of studies). The prevalence was 0.78 (95% CI = 0.73-0.82, k = 29) for any comorbid non-psychotic mental disorder, 0.60 (95% CI = 0.36-0.84, k = 3) for anxiety/mood disorders, 0.44 (95% CI = 0.39-0.49, k = 48) for any mood disorders, 0.38 (95% CI = 0.33-0.42, k = 50) for any depressive disorder/episode, 0.34 (95% CI = 0.30-0.38, k = 69) for any anxiety disorder, 0.30 (95% CI 0.25-0.35, k = 35) for major depressive disorders, 0.29 (95% CI, 0.08-0.51, k = 3) for any trauma-related disorder, 0.23 (95% CI = 0.17-0.28, k = 24) for any personality disorder, and <0.23 in other mental disorders (I2 > 50% in 71.01% estimates). The prevalence of any comorbid mental disorder decreased over time (0.51, 95% CI = 0.25-0.77 over 96 months), except any substance use which increased (0.19, 95% CI = 0.00-0.39, k = 2, >96 months). Compared with controls, the CHR-P status was associated with a higher prevalence of anxiety, schizotypal personality, panic, and alcohol use disorders (OR from 2.90 to 1.54 versus without psychosis), a higher prevalence of anxiety/mood disorders (OR = 9.30 to 2.02) and lower prevalence of any substance use disorder (OR = 0.41, versus psychosis). Higher baseline prevalence of alcohol use disorder/schizotypal personality disorder was negatively associated with baseline functioning (beta from -0.40 to -0.15), while dysthymic disorder/generalized anxiety disorder with higher functioning (beta 0.59 to 1.49). Higher baseline prevalence of any mood disorder/generalized anxiety disorder/agoraphobia (beta from -2.39 to -0.27) was negatively associated with transition to psychosis. In conclusion, over three-quarters of CHR-P subjects have comorbid mental disorders, which modulate baseline functionig and transition to psychosis. Transdiagnostic mental health assessment should be warranted in subjects at CHR-P.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track, First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Matilda Azis
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Anna Cabras
- Sapienza University of Rome, Department of Neurology and Psychiatry, Roma, Italy
| | - Marco Censori
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Dipartimento di Salute Mentale, Azienda ULSS 3 Serenissima, Venezia, Italy
| | - Luigi Fausti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Sapienza University of Rome, Department of Neurology and Psychiatry, Roma, Italy
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London UK, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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12
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Hagler MA, Ferrara M, Yoviene Sykes LA, Li F, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, Powers AR, Allen AR, Srihari VH, Woods SW. Sampling from different populations: Sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high-risk individuals who progressed to psychosis. Schizophr Res 2023; 255:239-245. [PMID: 37028205 PMCID: PMC10207144 DOI: 10.1016/j.schres.2023.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Over the past two decades, research and clinical resources on clinical high risk (CHR) for psychosis have both expanded, with goals to better understanding risk and protective factors on the course of illness and inform early intervention efforts. However, some studies have highlighted potential sampling bias among CHR research studies, raising questions about generalizability of findings and inequitable access to early detection and intervention. The current study sought to explore these questions by comparing 94 participants in a CHR longitudinal monitoring study across North America (NAPLS-2) who converted to syndromal psychosis over the course of the study (CHR-CV) to 171 participants who presented for treatment at a localized first-episode psychosis service (FES) after converting. CHR-CV participants were significantly more likely to be White and have a college-educated parent, while FES participants were more likely to be Black and first- or second-generation immigrants. On average, CHR-CV participants were younger at onset of attenuated positive symptoms, had a longer period of attenuated symptoms prior to conversion, and were more likely to be treated with antipsychotics prior to conversion compared to those in FES programs. After controlling for time since conversion, CHR-CV participants had higher global functioning and were less likely to have experienced recent psychiatric hospitalization. Findings suggest that CHR research and FES clinics may be sampling from different populations, although conclusions are limited by inconsistent sampling frames and methods. Integrated early detection that targets defined geographic catchments may deliver more epidemiologically representative samples to both CHR research and FES.
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Affiliation(s)
- Matthew A Hagler
- Department of Psychiatry, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry, Yale University, New Haven, CT, United States of America; Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Fangyong Li
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Adrienne R Allen
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
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13
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Fusar-Poli L, Prachason T, Erzin G, Pries LK, Brondino N, Politi P, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran EŞ, Kaymak SU, Mihaljevic MM, Andric-Petrovic S, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Escarti MJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Üçok A, Alptekin K, Saka MC, Arango C, O'Donovan M, van Os J, Rutten BP, Guloksuz S. Examining the association between exposome score for schizophrenia and cognition in schizophrenia, siblings, and healthy controls: Results from the EUGEI study. Psychiatry Res 2023; 323:115184. [PMID: 37015164 DOI: 10.1016/j.psychres.2023.115184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND People with schizophrenia spectrum disorders (SSD) frequently present cognitive impairments. Here, we investigated whether the exposome score for schizophrenia (ES-SCZ) - a cumulative environmental exposure score - was associated with impairments of neurocognition, social cognition, and perception in patients with SSD, their unaffected siblings, and healthy controls. METHODS This cross-sectional sample consisted of 1200 patients, 1371 siblings, and 1564 healthy controls. Neurocognition, social cognition, and perception were assesed using a short version of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), the Degraded Facial Affect Recognition Task (DFAR), and the Benton Facial Recognition Test (BFR), respectively. Regression models were used to analyze the association between ES-SCZ and cognitive domains in each group. RESULTS There were no statistically significant associations between ES-SCZ and cognitive domains in SSD. ES-SCZ was negatively associated with T-score of cognition in siblings (B=-0.40, 95% CI -0.76 to -0.03) and healthy controls (B=-0.63, 95% CI -1.06 to -0.21). Additionally, ES-SCZ was positively associated with DFAR-total in siblings (B=0.83, 95% CI 0.26 to 1.40). Sensitivity analyses excluding cannabis use history from ES-SCZ largely confirmed the main findings. CONCLUSIONS Longitudinal cohorts may elucidate how environmental exposures influence the onset and course of cognitive impairments in trans-syndromic psychosis spectrum.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Thanavadee Prachason
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gamze Erzin
- Department of Psychiatry, Health Science University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Mondriaan Mental Health Centre, Maastricht/Heerlen, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bochao D Lin
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander L Richards
- Cardiff University Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey; Brain Research Center, Ankara University, Ankara, Turkey; Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Marina M Mihaljevic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Clinic for Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Andric-Petrovic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
| | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Maria Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Maria Jose Escarti
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - José Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica (SERGAS), IDIS, Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Üçok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Michael O'Donovan
- Cardiff University Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Bart Pf Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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14
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Karcher NR, Merchant J, Rappaport BI, Barch DM. Associations with youth psychotic-like experiences over time: Evidence for trans-symptom and specific cognitive and neural risk factors. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:514-526. [PMID: 37023280 PMCID: PMC10164137 DOI: 10.1037/abn0000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
The current study examined whether impairments in cognitive and neural factors at baseline (ages 9-10) predict initial levels or changes in psychotic-like experiences (PLEs) and whether such impairments generalize to other psychopathology symptoms (i.e., internalizing and externalizing symptoms). Using unique longitudinal Adolescent Brain Cognitive Development Study data, the study examined three time points from ages 9 to 13. Univariate latent growth models examined associations between baseline cognitive and neural metrics with symptom measures using discovery (n = 5,926) and replication (n = 5,952) data sets. For symptom measures (i.e., PLEs, internalizing, externalizing), we examined mean initial levels (i.e., intercepts) and changes over time (i.e., slopes). Predictors included neuropsychological test performance, global structural MRI, and several a priori within-network resting-state functional connectivity metrics. Results showed a pattern whereby baseline cognitive and brain metric impairments showed the strongest associations with PLEs over time. Lower cognitive, volume, surface area, and cingulo-opercular within-network connectivity metrics showed associations with increased PLEs and higher initial levels of externalizing and internalizing symptoms. Several metrics were uniquely associated with PLEs, including lower cortical thickness with higher initial PLEs and lower default mode network connectivity with increased PLEs slopes. Neural and cognitive impairments in middle childhood were broadly associated with increased PLEs over time, and showed stronger associations with PLEs compared with other psychopathology symptoms. The current study also identified markers potentially uniquely associated with PLEs (e.g., cortical thickness). Impairments in broad cognitive metrics, brain volume and surface area, and a network associated with information integration may represent risk factors for general psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Jaisal Merchant
- Department of Psychology, Washington University in St. Louis
| | | | - Deanna M. Barch
- Department of Psychiatry, Washington University School of Medicine
- Department of Psychology, Washington University in St. Louis
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15
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Paquin V, Cupo L, Malla AK, Iyer SN, Joober R, Shah JL. Dynamic association of the first identifiable symptom with rapidity of progression to first-episode psychosis. Psychol Med 2023; 53:2008-2016. [PMID: 34538292 DOI: 10.1017/s0033291721003755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rapid progression from the first identifiable symptom to the onset of first-episode psychosis (FEP) allows less time for early intervention. The aim of this study was to examine the association between the first identifiable symptom and the subsequent speed of illness progression. METHODS Data were available for 390 patients attending a catchment-based early intervention service for FEP. Exposure to non-psychotic and subthreshold psychotic symptoms was retrospectively recorded using semi-structured interviews. Outcomes following the onset of the first identifiable symptom were (1) time to onset of FEP and (2) symptom incidence rate (i.e. number of symptoms emerging per person-year until FEP onset). These outcomes were respectively analyzed with Cox proportional hazards and negative binomial regressions. RESULTS After Bonferroni correction, having a subthreshold psychotic (v. non-psychotic) symptom as the first symptom was not associated with time to FEP onset [hazard ratio (HR) = 1.39; 95% CI 0.94-2.04] but was associated with higher symptom incidence [incidence rate ratio (IRR) = 1.92; 95% CI 1.10-3.48]. A first symptom of suspiciousness was associated with shorter time to FEP onset (HR = 2.37; 95% CI 1.38-4.08) and higher symptom incidence rate (IRR = 3.20; 95% CI 1.55-7.28) compared to other first symptoms. In contrast, a first symptom of self-harm was associated with lower symptom incidence rate (IRR = 0.06; 95% CI 0.01-0.73) compared to other first symptoms. Several associations between symptoms and illness progression were moderated by the age at symptom onset. CONCLUSIONS Appreciating the content and timing of early symptoms can identify windows and treatment targets for early interventions in psychosis.
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Affiliation(s)
- Vincent Paquin
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Lani Cupo
- Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
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16
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Erzin G, Pries LK, Dimitrakopoulos S, Ralli I, Xenaki LA, Soldatos R–F, Vlachos I, Selakovic M, Foteli S, Kosteletos I, Nianiakas N, Mantonakis L, Rizos E, Kollias K, Van Os J, Guloksuz S, Stefanis N. Association between exposome score for schizophrenia and functioning in first-episode psychosis: results from the Athens first-episode psychosis research study. Psychol Med 2023; 53:2609-2618. [PMID: 34789350 PMCID: PMC10123830 DOI: 10.1017/s0033291721004542] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that environmental factors not only increase psychosis liability but also influence the prognosis and outcomes of psychotic disorders. We investigated temporal and cross-sectional associations of a weighted score of cumulative environmental liability for schizophrenia - the exposome score for schizophrenia (ES-SCZ) - with functioning in first-episode psychosis (FEP). METHODS Data were derived from the baseline and 1-month assessments of the Athens FEP Research Study that enrolled 225 individuals with FEP. The Global Assessment of Functioning (GAF) and the Personal and Social Performance Scale (PSP) were used to measure social, occupational, and psychological functioning. The ES-SCZ was calculated based on the previously validated method. RESULTS ES-SCZ was associated with the total scores of GAF and PSP at baseline and 1-month assessments. These findings remained significant when accounting for several associated alternative explanatory variables, including other environmental factors (obstetric complications, migration, ethnic minority), clinical characteristics (duration of untreated psychosis, symptom severity, previous antipsychotic use), and family history of psychosis, demonstrating that the association between ES-SCZ and functioning is over and above other risk factors and cannot be explained by symptom severity alone. Functioning improved from baseline to 1-month assessment, but no significant ES-SCZ-by-time interaction was found on functioning, indicating that functioning changes were not contingent on ES-SCZ. CONCLUSIONS Our findings suggest that rather than a predictor of functional improvement, ES-SCZ represents a stable severity indicator that captures poor functioning in early psychosis. Environmental risk loading for schizophrenia (ES-SCZ) can be beneficial for clinical characterization and incorporated into transdiagnostic staging models.
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Affiliation(s)
- Gamze Erzin
- Department of Psychiatry, University of Health Sciences Ankara Diskapi Training and Research Hospital, Ankara, Turkey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
- Psychiatric Clinic, 414 Military Hospital of Athens, Penteli, Greece
| | - Irene Ralli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Lida-Alkisti Xenaki
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Rigas – Filippos Soldatos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Ilias Vlachos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Stefania Foteli
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Ioannis Kosteletos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Nikos Nianiakas
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Leonidas Mantonakis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, National and Kapodistrian University of Athens Medical School, ‘ATTIKON’ University Hospital, Athens, Greece
| | - Konstantinos Kollias
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
| | - Jim Van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nikos Stefanis
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
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17
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van Os J, Pries LK, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Kenis G, Lin BD, Gunther N, Luykx JJ, Rutten BPF, Guloksuz S. Context v. algorithm: evidence that a transdiagnostic framework of contextual clinical characterization is of more clinical value than categorical diagnosis. Psychol Med 2023; 53:1825-1833. [PMID: 37310330 PMCID: PMC10106290 DOI: 10.1017/s0033291721003445] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A transdiagnostic and contextual framework of 'clinical characterization', combining clinical, psychopathological, sociodemographic, etiological, and other personal contextual data, may add clinical value over and above categorical algorithm-based diagnosis. METHODS Prediction of need for care and health care outcomes was examined prospectively as a function of the contextual clinical characterization diagnostic framework in a prospective general population cohort (n = 6646 at baseline), interviewed four times between 2007 and 2018 (NEMESIS-2). Measures of need, service use, and use of medication were predicted as a function of any of 13 DSM-IV diagnoses, both separately and in combination with clinical characterization across multiple domains: social circumstances/demographics, symptom dimensions, physical health, clinical/etiological factors, staging, and polygenic risk scores (PRS). Effect sizes were expressed as population attributable fractions. RESULTS Any prediction of DSM-diagnosis in relation to need and outcome in separate models was entirely reducible to components of contextual clinical characterization in joint models, particularly the component of transdiagnostic symptom dimensions (a simple score of the number of anxiety, depression, mania, and psychosis symptoms) and staging (subthreshold, incidence, persistence), and to a lesser degree clinical factors (early adversity, family history, suicidality, slowness at interview, neuroticism, and extraversion), and sociodemographic factors. Clinical characterization components in combination predicted more than any component in isolation. PRS did not meaningfully contribute to any clinical characterization model. CONCLUSION A transdiagnostic framework of contextual clinical characterization is of more value to patients than a categorical system of algorithmic ordering of psychopathology.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lotta-Katrin Pries
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bochao D. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicole Gunther
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Jurjen J. Luykx
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bart P. F. Rutten
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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18
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de Boer N, Vermeulen J, Lin B, van Os J, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Rutten B, Batalla A, Guloksuz S, Luykx JJ. Longitudinal associations between alcohol use, smoking, genetic risk scoring and symptoms of depression in the general population: a prospective 6-year cohort study. Psychol Med 2023; 53:1409-1417. [PMID: 35023464 PMCID: PMC10009403 DOI: 10.1017/s0033291721002968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol consumption, smoking and mood disorders are leading contributors to the global burden of disease and are highly comorbid. Yet, their interrelationships have remained elusive. The aim of this study was to examine the multi-cross-sectional and longitudinal associations between (change in) smoking and alcohol use and (change in) number of depressive symptoms. METHODS In this prospective, longitudinal study, 6646 adults from the general population were included with follow-up measurements after 3 and 6 years. Linear mixed-effects models were used to test multi-cross-sectional and longitudinal associations, with smoking behaviour, alcohol use and genetic risk scores for smoking and alcohol use as independent variables and depressive symptoms as dependent variables. RESULTS In the multi-cross-sectional analysis, smoking status and number of cigarettes per day were positively associated with depressive symptoms (p < 0.001). Moderate drinking was associated with less symptoms of depression compared to non-use (p = 0.011). Longitudinally, decreases in the numbers of cigarettes per day and alcoholic drinks per week as well as alcohol cessation were associated with a reduction of depressive symptoms (p = 0.001-0.028). Results of genetic risk score analyses aligned with these findings. CONCLUSIONS While cross-sectionally smoking and moderate alcohol use show opposing associations with depressive symptoms, decreases in smoking behaviour as well as alcohol consumption are associated with improvements in depressive symptoms over time. Although we cannot infer causality, these results open avenues to further investigate interventions targeting smoking and alcohol behaviours in people suffering from depressive symptoms.
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Affiliation(s)
- N. de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. Vermeulen
- Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B. Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - R. de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - S. van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M. Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - B. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A. Batalla
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S. Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J. J. Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
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19
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Lindgren M, Kuvaja H, Jokela M, Therman S. Predictive validity of psychosis risk models when applied to adolescent psychiatric patients. Psychol Med 2023; 53:547-558. [PMID: 34024309 DOI: 10.1017/s0033291721001938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several multivariate algorithms have been developed for predicting psychosis, as attempts to obtain better prognosis prediction than with current clinical high-risk (CHR) criteria. The models have typically been based on samples from specialized clinics. We evaluated the generalizability of 19 prediction models to clinical practice in an unselected adolescent psychiatric sample. METHODS In total, 153 adolescent psychiatric patients in the Helsinki Prodromal Study underwent an extensive baseline assessment including the SIPS interview and a neurocognitive battery, with 50 participants (33%) fulfilling CHR criteria. The adolescents were followed up for 7 years using comprehensive national registers. Assessed outcomes were (1) any psychotic disorder diagnosis (n = 18, 12%) and (2) first psychiatric hospitalization (n = 25, 16%) as an index of overall deterioration of functioning. RESULTS Most models improved the overall prediction accuracy over standard CHR criteria (area under the curve estimates ranging between 0.51 and 0.82), although the accuracy was worse than that in the samples used to develop the models, also when applied only to the CHR subsample. The best models for transition to psychosis included the severity of positive symptoms, especially delusions, and negative symptoms. Exploratory models revealed baseline negative symptoms, low functioning, delusions, and sleep problems in combination to be the best predictor of psychiatric hospitalization in the upcoming years. CONCLUSIONS Including the severity levels of both positive and negative symptomatology proved beneficial in predicting psychosis. Despite these advances, the applicability of extended psychosis-risk models to general psychiatric practice appears limited.
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Affiliation(s)
- Maija Lindgren
- Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heidi Kuvaja
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Sebastian Therman
- Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
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20
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Fusar-Poli L, Rutten BPF, van Os J, Aguglia E, Guloksuz S. Polygenic risk scores for predicting outcomes and treatment response in psychiatry: hope or hype? Int Rev Psychiatry 2022; 34:663-675. [PMID: 36786114 DOI: 10.1080/09540261.2022.2101352] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Over the last years, the decreased costs and enhanced accessibility to large genome-wide association studies datasets have laid the foundations for the development of polygenic risk scores (PRSs). A PRS is calculated on the weighted sum of single nucleotide polymorphisms and measures the individual genetic predisposition to develop a certain phenotype. An increasing number of studies have attempted to utilize the PRSs for risk stratification and prognostic evaluation. The present narrative review aims to discuss the potential clinical utility of PRSs in predicting outcomes and treatment response in psychiatry. After summarizing the evidence on major mental disorders, we have discussed the advantages and limitations of currently available PRSs. Although PRSs represent stable trait features with a normal distribution in the general population and can be relatively easily calculated in terms of time and costs, their real-world applicability is reduced by several limitations, such as low predictive power and lack of population diversity. Even with the rapid expansion of the psychiatric genetic knowledge base, pure genetic prediction in clinical psychiatry appears to be out of reach in the near future. Therefore, combining genomic and exposomic vulnerabilities for mental disorders with a detailed clinical characterization is needed to personalize care.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.,UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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21
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Lång U, Ramsay H, Yates K, Veijola J, Gyllenberg D, Clarke MC, Leacy FP, Gissler M, Kelleher I. Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987. World Psychiatry 2022; 21:436-443. [PMID: 36073707 PMCID: PMC9453911 DOI: 10.1002/wps.21009] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Current strategies to predict psychosis identify only a small proportion of individuals at risk. Additional strategies are needed to increase capacity for pre-diction and prevention of serious mental illness, ideally during childhood and adolescence. One possible approach would be to investigate systems in which psychosis risk factors are concentrated during childhood. One notable such system is represented by Child and Adolescent Mental Health Services (CAMHS). Although psychotic disorders are uncommon in CAMHS, many risk factors for psychosis are highly prevalent in young people who enter this system. We hypothesized, therefore, that youth attending CAMHS would be a high-risk group for psychosis if followed into adulthood and, furthermore, that CAMHS systems would capture a substantial proportion of future psychosis cases. We constructed a total population cohort study of all Finns born in 1987 (N=55,875), linking together extensive register data on health care contacts from birth through age 28 years. We identified all individuals diagnosed with a psychotic or bipolar disorder by age 28 (N=1,785). The risk of psychosis/bipolar disorder by age 28 years was 1.8% for individuals who had not attended CAMHS during childhood or adolescence, whereas it was 12.8% for those with a history of any outpatient CAMHS contact (odds ratio, OR=7.9, 95% CI: 7.2-8.7). Furthermore, the risk of psychosis/bipolar disorder by age 28 years was 2.3% for individuals without a history of inpatient CAMHS admission, whereas it was 24.0% for those with a history of inpatient CAMHS admission (OR=13.3, 95% CI: 11.9-14.9), and 36.5% for those with a history of inpatient CAMHS admission in adolescence (age 13-17 years) (OR=24.2, 95% CI: 21.2-27.6). Individuals who attended CAMHS but received no mental disorder diagnosis had an equally high risk of subsequently developing a psychosis/bipolar disorder as individuals who did receive a diagnosis (OR=0.9, 99.5% CI: 0.7-1.1). Compared to other CAMHS attendees, individuals who developed psychosis or bipolar disorder were more likely to have had an initial CAMHS diagnosis of depressive or other mood disorder (OR=2.3, 99.5% CI: 1.6-3.0) and disruptive behaviour disorder (OR=1.7, 99.5% CI: 1.2-2.5). Of all psychosis/bipolar diagnoses by age 28 years, 50.2% occurred in individuals who had, at some point in childhood or adolescence, attended CAMHS, indicating that CAMHS represent not only a high-risk but also a high-capacity system for prediction of psychosis/bipolar disorder. These findings suggest an enormous, untapped potential for large-scale psychosis/bipolar disorder prediction and prevention research within existing specialist CAMHS.
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Affiliation(s)
- Ulla Lång
- School of Medicine, University College Dublin, Health Science CentreDublinIreland,Department of PsychiatryRCSI University of Medicine and Health SciencesDublinIreland
| | - Hugh Ramsay
- School of Medicine, University College Dublin, Health Science CentreDublinIreland,St. Michael's HouseDublinIreland
| | - Kathryn Yates
- Department of PsychiatryRCSI University of Medicine and Health SciencesDublinIreland
| | - Juha Veijola
- Research Unit of Clinical Neuroscience, Department of PsychiatryUniversity of OuluOuluFinland,Department of PsychiatryUniversity Hospital of OuluOuluFinland
| | - David Gyllenberg
- Department of Child Psychiatry and INVEST Research Flagship CenterUniversity of TurkuTurkuFinland,Turku University HospitalTurkuFinland,Department of Adolescent PsychiatryUniversity of HelsinkiHelsinkiFinland,Helsinki University Central HospitalHelsinkiFinland,Welfare DepartmentNational Institute for Health and WelfareHelsinkiFinland
| | - Mary C. Clarke
- Department of PsychiatryRCSI University of Medicine and Health SciencesDublinIreland,Department of PsychologyRCSI University of Medicine and Health SciencesDublinIreland
| | - Finbarr P. Leacy
- Health Products Regulatory AuthorityEarlsfort CentreDublinIreland
| | - Mika Gissler
- Information Services DepartmentNational Institute of Health and WelfareHelsinkiFinland,Research Centre for Child PsychiatryUniversity of TurkuTurkuFinland,Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden,Academic Primary Health Care CentreRegion StockholmStockholmSweden
| | - Ian Kelleher
- School of Medicine, University College Dublin, Health Science CentreDublinIreland,Department of PsychiatryRCSI University of Medicine and Health SciencesDublinIreland,Lucena Clinic Child and Adolescent Mental Health ServiceSt. John of God Hospitaller ServicesDublinIreland,Division of Psychiatry, Centre for Clinical Brain Sciences, Royal Edinburgh HospitalUniversity of EdinburghEdinburghUK
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22
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Staines L, Healy C, Coughlan H, Clarke M, Kelleher I, Cotter D, Cannon M. Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions. Psychol Med 2022; 52:1-12. [PMID: 36004805 PMCID: PMC9772919 DOI: 10.1017/s0033291722002550] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/31/2022]
Abstract
Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College, Dublin 4, Ireland
- Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin 6, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
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23
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van Os J, Pries LK, Ten Have M, de Graaf R, van Dorsselaer S, Delespaul P, Bak M, Kenis G, Lin BD, Luykx JJ, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran EŞ, Kaymak SU, Mihaljevic MM, Petrovic SA, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Ucok A, Alptekin K, Saka MC, Arango C, O'Donovan M, Rutten BPF, Guloksuz S. Evidence, and replication thereof, that molecular-genetic and environmental risks for psychosis impact through an affective pathway. Psychol Med 2022; 52:1910-1922. [PMID: 33070791 DOI: 10.1017/s0033291720003748] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation. METHODS We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls. RESULTS The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: -0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465). CONCLUSIONS The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Alexander L Richards
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey
- Brain Research Center, Ankara University, Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey (Discharged by statutory decree No:701 at 8 July 2018 because of signing 'Peace Petition')
| | | | | | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Sanja Andric Petrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Tijana Mirjanic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - María Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - José Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica (SERGAS), IDIS, Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Michael O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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24
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Exposome and Trans-syndromal Developmental Trajectories Toward Psychosis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:197-205. [PMID: 36325037 PMCID: PMC9616341 DOI: 10.1016/j.bpsgos.2022.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
The prenatal period, early childhood, and adolescence are considered sensitive periods for brain and behavior development, when environmental exposures may have long-lasting effects on mental health. Psychosis spectrum disorder (PSD) is a developmental disorder that often manifests with nonspecific clinical presentations long before full-blown PSD is diagnosed. Genetic factors only partly explain PSD. Multiple early-life environmental exposures are associated with PSD. In this review, we describe the conceptual framework of the exposome and its relevance to PSD research in developmental cohorts and beyond and discuss key challenges for the field as it attempts to move beyond studying environment (in the sense of "searching under the lamppost because this is where the light is") to a more comprehensive assessment of environment and its contribution to PSD. We then suggest that the field should aspire to studying environmental origins of PSD through a developmental lens focusing on young cohorts and using multilevel phenotyping of environment, adopting an exposome framework that embraces the dynamic complex nature of environment and acknowledges the effect of additive and interactive environmental exposures alongside the genome. Furthermore, we highlight the need for a developmental perspective when studying exposome effects on psychopathology, accepting the nonspecificity of child/adolescent psychopathology and encouraging the study of trans-syndromal manifestations, shifting the research paradigm from categorical outcomes (e.g., schizophrenia) and going beyond clinical settings to investigate trajectories of risk and resilience.
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25
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Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry 2022; 9:413-422. [PMID: 35430004 DOI: 10.1016/s2215-0366(21)00467-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP)-Montreal, Montreal, QC, Canada; ACCESS Open Minds, Douglas Hospital Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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26
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van Hooijdonk CF, Drukker M, van de Giessen E, Booij J, Selten JP, van Amelsvoort TA. Dopaminergic alterations in populations at increased risk for psychosis: a systematic review of imaging findings. Prog Neurobiol 2022; 213:102265. [DOI: 10.1016/j.pneurobio.2022.102265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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27
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Estradé A, Salazar de Pablo G, Zanotti A, Wood S, Fisher HL, Fusar-Poli P. Public health primary prevention implemented by clinical high-risk services for psychosis. Transl Psychiatry 2022; 12:43. [PMID: 35091529 PMCID: PMC8799684 DOI: 10.1038/s41398-022-01805-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may implement other preventive approaches. PRISMA 2020-compliant systematic review of Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO, from inception until 14th June 2021, identifying original studies describing public health strategies: (a) service characteristics (configuration of mental health service, outreach, pathways to care); (b) universal interventions (general population); (c) selective interventions targeting CHR-P service-users or family/carers. Public health preventive initiatives were systematically stratified according to core social determinants of mental disorders associated with the 2030 Sustainable Development Goals promoted by the United Nations Member States (UN 2030 SDG) and good mental health outcomes. A total of 66 publications were included, providing data on 13 standalone, 40 integrated, three networks, and six regional or international surveys of CHR-P services across Europe, Asia, Oceania, Africa, North and South America, providing care to >28 M people. CHR-P services implement numerous public health initiatives targeting social and cultural (16 initiatives), economic (seven initiatives), demographic (six initiatives), environmental events (four initiatives) and neighbourhood (three initiatives) UN 2030 SGD determinants of mental disorders. There is additional evidence for CHR-P services promoting good mental health. The main barriers were the lack of resources for expanding public health prevention at a large scale. CHR-P services implement numerous public health prevention initiatives and promotion of good mental health beyond indicated prevention of psychosis.
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Affiliation(s)
- Andrés Estradé
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.410526.40000 0001 0277 7938Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain ,grid.37640.360000 0000 9439 0839Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alice Zanotti
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Scott Wood
- grid.47100.320000000419368710Yale School of Medicine, Yale University, New Heaven, CT USA
| | - Helen L. Fisher
- grid.13097.3c0000 0001 2322 6764King’s College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK ,grid.13097.3c0000 0001 2322 6764Economic & Social Research Council (ESRC) Centre for Society and Mental Health, King’s College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK. .,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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Poletti M, Preti A, Raballo A. Mind the (transition) gap: Youth mental health-oriented early intervention services to overcome the child-adolescent vs. adult hiatus. Front Psychiatry 2022; 13:965467. [PMID: 36061290 PMCID: PMC9428274 DOI: 10.3389/fpsyt.2022.965467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
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Fusar-Poli P, Salazar de Pablo G, Rajkumar RP, López-Díaz Á, Malhotra S, Heckers S, Lawrie SM, Pillmann F. Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda. Lancet Psychiatry 2022; 9:72-83. [PMID: 34856200 DOI: 10.1016/s2215-0366(21)00121-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 12/25/2022]
Abstract
Brief psychotic episodes represent an intriguing paradox in clinical psychiatry because they elude the standard knowledge that applies to the persisting psychotic disorders such as schizophrenia. This Review describes key diagnostic considerations such as conceptual foundations, current psychiatric classification versus research-based operationalisations, epidemiology, and sociocultural variations; prognostic aspects including the risk of psychosis recurrence, types of psychotic recurrences, other clinical outcomes, prognostic factors; and therapeutic issues such as treatment guidelines and unmet need of care. The advances and challenges associated with the scientific evidence are used to set a research agenda in this area. We conclude that brief psychotic episodes can be reconceptualised within a clinical staging model to promote innovative translational research and improve our understanding and treatment of psychotic disorders.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERSAM, Madrid, Spain
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Álvaro López-Díaz
- University Hospital Virgen Macarena, Seville, Spain; Institute of Biomedicine of Seville, Seville, Spain
| | | | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Frank Pillmann
- WO Center of Psychiatry, Halle, Germany; Martin Luther University, Halle-Wittenberg, Germany
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Arribas M, Solmi M, Thompson T, Oliver D, Fusar-Poli P. Timing of antipsychotics and benzodiazepine initiation during a first episode of psychosis impacts clinical outcomes: Electronic health record cohort study. Front Psychiatry 2022; 13:976035. [PMID: 36213895 PMCID: PMC9539549 DOI: 10.3389/fpsyt.2022.976035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
The impact of timing of antipsychotics and benzodiazepine treatment during a first episode of psychosis on clinical outcomes is unknown. We present a RECORD-compliant electronic health record cohort study including patients (n = 4,483, aged 14-35) with a primary diagnosis of any non-organic ICD-10 first episode of psychosis at SLAM-NHS between 2007 and 2017. The impact of antipsychotic timing (prescription > 1 week after a first episode of psychosis) was assessed on the primary outcome (risk of any psychiatric inpatient admission over 6 years), and secondary outcomes (cumulative duration of any psychiatric/medical/accident/emergency [A&E] admission over 6 years). The impact of prescribing benzodiazepine before antipsychotic at any point and of treatment patterns (antipsychotic alone, benzodiazepine alone, combination of antipsychotic with benzodiazepine) within the first week after a first episode of psychosis were also assessed. Survival analyses and zero-inflated negative binomial regressions, adjusted for core covariates, and complementary analyses were employed. Antipsychotic prescribed >1 week after a first episode of psychosis did not affect the risk of any psychiatric admission (HR = 1.04, 95% CI = 0.92-1.17, p = 0.557), but increased the duration of any psychiatric (22-28%), medical (78-35%) and A&E (30-34%) admission (months 12-72). Prescribing benzodiazepine before antipsychotic at any point did not affect the risk of any psychiatric admission (HR = 1.03, 95% CI = 0.94-1.13, p = 0.535), but reduced the duration of any psychiatric admission (17-24%, months 12-72), and increased the duration of medical (71-45%, months 12-72) and A&E (26-18%, months 12-36) admission. Prescribing antipsychotic combined with benzodiazepine within the first week after a first episode of psychosis showed better overall clinical outcomes than antipsychotic or benzodiazepine alone. Overall, delaying antipsychotic 1 week after a first episode of psychosis may worsen some clinical outcomes. Early benzodiazepine treatment can be considered with concomitant antipsychotic but not as standalone intervention.
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Affiliation(s)
- Maite Arribas
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research, Maudsley Biomedical Research Centre, London, United Kingdom
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Giordano GM, Giuliani L, Perrottelli A, Bucci P, Di Lorenzo G, Siracusano A, Brando F, Pezzella P, Fabrazzo M, Altamura M, Bellomo A, Cascino G, Comparelli A, Monteleone P, Pompili M, Galderisi S, Maj M. Mismatch Negativity and P3a Impairment through Different Phases of Schizophrenia and Their Association with Real-Life Functioning. J Clin Med 2021; 10:5838. [PMID: 34945138 PMCID: PMC8707866 DOI: 10.3390/jcm10245838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Impairment in functioning since the onset of psychosis and further deterioration over time is a key aspect of subjects with schizophrenia (SCZ). Mismatch negativity (MMN) and P3a, indices of early attention processing that are often impaired in schizophrenia, might represent optimal electrophysiological candidate biomarkers of illness progression and poor outcome. However, contrasting findings are reported about the relationships between MMN-P3a and functioning. The study aimed to investigate in SCZ the influence of illness duration on MMN-P3a and the relationship of MMN-P3a with functioning. Pitch (p) and duration (d) MMN-P3a were investigated in 117 SCZ and 61 healthy controls (HCs). SCZ were divided into four illness duration groups: ≤ 5, 6 to 13, 14 to 18, and 19 to 32 years. p-MMN and d-MMN amplitude was reduced in SCZ compared to HCs, independently from illness duration, psychopathology, and neurocognitive deficits. p-MMN reduction was associated with lower "Work skills". The p-P3a amplitude was reduced in the SCZ group with longest illness duration compared to HCs. No relationship between P3a and functioning was found. Our results suggested that MMN amplitude reduction might represent a biomarker of poor functioning in SCZ.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Paola Bucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.D.L.); (A.S.)
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.D.L.); (A.S.)
| | - Francesco Brando
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Mario Altamura
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Antonello Bellomo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, 84133 Salerno, Italy; (G.C.); (P.M.)
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (A.C.); (M.P.)
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, 84133 Salerno, Italy; (G.C.); (P.M.)
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (A.C.); (M.P.)
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.); (A.P.); (P.B.); (F.B.); (P.P.); (M.F.); (S.G.); (M.M.)
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Steenkamp LR, Tiemeier H, Blanken LME, Hillegers MHJ, Kushner SA, Bolhuis K. Predicting persistence of hallucinations from childhood to adolescence. Br J Psychiatry 2021; 219:670-677. [PMID: 35048879 PMCID: PMC8674728 DOI: 10.1192/bjp.2021.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Psychotic experiences predict adverse health outcomes, particularly if they are persistent. However, it is unclear what distinguishes persistent from transient psychotic experiences. AIMS In a large population-based cohort, we aimed to (a) describe the course of hallucinatory experiences from childhood to adolescence, (b) compare characteristics of youth with persistent and remittent hallucinatory experiences, and (c) examine prediction models for persistence. METHOD Youth were assessed longitudinally for hallucinatory experiences at mean ages of 10 and 14 years (n = 3473). Multi-informant-rated mental health problems, stressful life events, self-esteem, non-verbal IQ and parental psychopathology were examined in relation to absent, persistent, remittent and incident hallucinatory experiences. We evaluated two prediction models for persistence with logistic regression and assessed discrimination using the area under the curve (AUC). RESULTS The persistence rate of hallucinatory experiences was 20.5%. Adolescents with persistent hallucinatory experiences had higher baseline levels of hallucinatory experiences, emotional and behavioural problems, as well as lower self-esteem and non-verbal IQ scores than youth with remittent hallucinatory experiences. Although the prediction model for persistence versus absence of hallucinatory experiences demonstrated excellent discriminatory power (AUC-corrected = 0.80), the prediction model for persistence versus remittance demonstrated poor accuracy (AUC-corrected = 0.61). CONCLUSIONS This study provides support for the dynamic expression of childhood hallucinatory experiences and suggests increased neurodevelopmental vulnerability in youth with persistent hallucinatory experiences. Despite the inclusion of a wide array of psychosocial parameters, a prediction model discriminated poorly between youth with persistent versus remittent hallucinatory experiences, confirming that persistent hallucinatory experiences are a complex multifactorial trait.
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Affiliation(s)
- Lisa R. Steenkamp
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, the Netherlands and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
| | - Laura M. E. Blanken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, the Netherlands
| | - Manon H. J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, the Netherlands
| | - Steven A. Kushner
- Department of Psychiatry, Erasmus University Medical Centre, the Netherlands
| | - Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, the Netherlands,Correspondence: Koen Bolhuis.
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Moore D, Castagnini E, Mifsud N, Geros H, Sizer H, Addington J, van der Gaag M, Nelson B, McGorry P, O'Donoghue B. The associations between migrant status and ethnicity and the identification of individuals at ultra-high risk for psychosis and transition to psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1923-1941. [PMID: 33641006 DOI: 10.1007/s00127-021-02047-3] [Citation(s) in RCA: 7] [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] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Migrant and ethnic minority populations exhibit a higher incidence of psychotic disorders. The Ultra-High Risk for psychosis (UHR) paradigm provides an opportunity to explore the stage at which such factors influence the development of psychosis. In this systematic review, we collate and appraise the literature on the association between ethnicity and migrant status and the rate of identification of individuals at UHR, as well as their rate of transition to psychosis. METHODS We conducted a systematic review in the Ovid Medline, PsychINFO, Pubmed, CINAHL and EMBASE databases according to PRISMA guidelines. We included studies written in English that included an UHR cohort, provided a measure of ethnicity or migrant status, and examined the incidence, rate, or risk of UHR identification or transition to psychosis. RESULTS Of 2182 unique articles identified, seven fulfilled the criteria. One study found overrepresentation of UHR individuals from black ethnic groups, while another found underrepresentation. Two studies found increased rates of transition among certain ethnic groups and a further two found no association. Regarding migrant status, one study found that first-generation migrants were underrepresented in an UHR sample. Lastly, a lower transition rate in migrant populations was identified in one study, while two found no association. CONCLUSION Rates of UHR identification and transition according to ethnic and migrant status were inconsistent and insufficient to conclusively explain higher incidences of psychotic disorders among these groups. We discuss the clinical implications and avenues for future research, which is required to clarify the nature of the associations.
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Affiliation(s)
- Danielle Moore
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Hellen Geros
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Holly Sizer
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mark van der Gaag
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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ERZİN G, GÜLÖKSÜZ S. Early Interventions for Clinical High-Risk State for Psychosis. Noro Psikiyatr Ars 2021; 58:S7-S11. [PMID: 34658629 PMCID: PMC8498818 DOI: 10.29399/npa.27404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 07/09/2021] [Indexed: 11/07/2022] Open
Abstract
The aim of this review was to discuss early intervention options for clinical high-risk states of psychosis, the limitations of the high-risk concept, and the importance of population-based approaches in preventing psychosis. Interventions for individuals at high risk of psychosis can be classified into two main categories: pharmacological and non-pharmacological. When selecting any of these intervention options, it should be taken into account that only a small proportion of individuals in the high-risk group will have a transition to clinical psychosis. Therefore, it is necessary to avoid aggressive interventions. Pharmacotherapies, particularly antipsychotics, are generally not considered as a treatment of choice for individuals at high risk of psychosis due to their potential side-effect profiles, whereas cognitive behavioral therapies and family-oriented therapies are the leading alternatives with virtually no side effects. However, meta-analyses have shown that none of the interventions are specifically more effective than needs-based treatment (including placebo) in preventing transition to psychosis. These interventions might not be effective in preventing transition to psychosis; however, they may improve the outcomes of psychosis. Accumulating evidence suggests that the targeted prevention approaches focusing on the clinical high risk of psychosis concept have major limitations in terms of the impact on reducing psychosis incidence in the general population compared to the population-based approaches. Recently, psychosis-focused prevention approaches have been replaced by easily accessible youth mental health centers that provide services for transdiagnostic conditions. Future studies on the efficacy of these community-based youth mental health services may provide guidance on how to prevent psychosis.
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Affiliation(s)
- Gamze ERZİN
- Department of Psychiatry, Dışkapı Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sinan GÜLÖKSÜZ
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, Connecticut, USA
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What makes the psychosis 'clinical high risk' state risky: psychosis itself or the co-presence of a non-psychotic disorder? Epidemiol Psychiatr Sci 2021; 30:e53. [PMID: 34225831 PMCID: PMC8264801 DOI: 10.1017/s204579602100041x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Although attenuated psychotic symptoms in the psychosis clinical high-risk state (CHR-P) almost always occur in the context of a non-psychotic disorder (NPD), NPD is considered an undesired 'comorbidity' epiphenomenon rather than an integral part of CHR-P itself. Prospective work, however, indicates that much more of the clinical psychosis incidence is attributable to prior mood and drug use disorders than to psychosis clinical high-risk states per se. In order to examine this conundrum, we analysed to what degree the 'risk' in CHR-P is indexed by co-present NPD rather than attenuated psychosis per se. METHODS We examined the incidence of early psychotic experiences (PE) with and without NPD (mood disorders, anxiety disorders, alcohol/drug use disorders), in a prospective general population cohort (n = 6123 at risk of incident PE at baseline). Four interview waves were conducted between 2007 and 2018 (NEMESIS-2). The incidence of PE, alone (PE-only) or with NPD (PE + NPD) was calculated, as were differential associations with schizophrenia polygenic risk score (PRS-Sz), environmental, demographical, clinical and cognitive factors. RESULTS The incidence of PE + NPD (0.37%) was lower than the incidence of PE-only (1.04%), representing around a third of the total yearly incidence of PE. Incident PE + NPD was, in comparison with PE-only, differentially characterised by poor functioning, environmental risks, PRS-Sz, positive family history, prescription of antipsychotic medication and (mental) health service use. CONCLUSIONS The risk in 'clinical high risk' states is mediated not by attenuated psychosis per se but specifically the combination of attenuated psychosis and NPD. CHR-P/APS research should be reconceptualised from a focus on attenuated psychotic symptoms with exclusion of non-psychotic DSM-disorders, as the 'pure' representation of a supposedly homotypic psychosis risk state, towards a focus on poor-outcome NPDs, characterised by a degree of psychosis admixture, on the pathway to psychotic disorder outcomes.
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Scott J, Crouse JJ, Ho N, Iorfino F, Martin N, Parker R, McGrath J, Gillespie NA, Medland S, Hickie IB. Early expressions of psychopathology and risk associated with trans-diagnostic transition to mood and psychotic disorders in adolescents and young adults. PLoS One 2021; 16:e0252550. [PMID: 34086749 PMCID: PMC8177455 DOI: 10.1371/journal.pone.0252550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The heterogeneity and comorbidity of major mental disorders presenting in adolescents and young adults has fostered calls for trans-diagnostic research. This study examines early expressions of psychopathology and risk and trans-diagnostic caseness in a community cohort of twins and non-twin siblings. METHODS Using data from the Brisbane Longitudinal Twin Study, we estimated median number of self-rated psychiatric symptoms, prevalence of subthreshold syndromes, family history of mood and/or psychotic disorders, and likelihood of subsequent trans-diagnostic caseness (individuals meeting diagnostic criteria for mood and/or psychotic syndromes). Next, we used cross-validated Chi-Square Automatic Interaction Detector (CHAID) analyses to identify the nature and relative importance of individual self-rated symptoms that predicted trans-diagnostic caseness. We examined the positive and negative predictive values (PPV; NPV) and accuracy of all classifications (Area under the Curve and 95% confidence intervals: AUC; 95% CI). RESULTS Of 1815 participants (Female 1050, 58%; mean age 26.40), more than one in four met caseness criteria for a mood and/or psychotic disorder. Examination of individual factors indicated that the AUC was highest for subthreshold syndromes, followed by family history then self-rated psychiatric symptoms, and that NPV always exceeded PPV for caseness. In contrast, the CHAID analysis (adjusted for age, sex, twin status) generated a classification tree comprising six trans-diagnostic symptoms. Whilst the contribution of two symptoms (need for sleep; physical activity) to the model was more difficult to interpret, CHAID analysis indicated that four self-rated symptoms (sadness; feeling overwhelmed; impaired concentration; paranoia) offered the best discrimination between cases and non-cases. These four symptoms showed different associations with family history status. CONCLUSIONS The findings need replication in independent cohorts. However, the use of CHAID might provide a means of identifying specific subsets of trans-diagnostic symptoms representing clinical phenotypes that predict transition to caseness in individuals at risk of onset of major mental disorders.
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Affiliation(s)
- Jan Scott
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Jacob J. Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Nicholas Martin
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Richard Parker
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - John McGrath
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Sarah Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, and Child Studies Center at Yale, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Healthcare Behavioral Health Network, Hartford, CT, USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University School of Medicine, Washington, WA, USA
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Guloksuz S, van Os J. En attendant Godot: Waiting for the Funeral of "Schizophrenia" and the Baby Shower of the Psychosis Spectrum. Front Psychiatry 2021; 12:618842. [PMID: 34122159 PMCID: PMC8193729 DOI: 10.3389/fpsyt.2021.618842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/03/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, United Kingdom
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40
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Community Mental Health Services in Italy. CONSORTIUM PSYCHIATRICUM 2021. [DOI: 10.17816/cp76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In 1978, in Italy, approval of Basaglias reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options.
By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units.
Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model.
Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.
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Rimvall MK, van Os J, Jeppesen P. Promoting a patient-centered, transdiagnostic approach to prevention of severe mental illness. Eur Child Adolesc Psychiatry 2021; 30:823-824. [PMID: 32468436 DOI: 10.1007/s00787-020-01563-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Martin Køster Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Hellerup, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jim van Os
- Department of Psychiatry, University Medical Centre Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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42
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Erzin G, Pries LK, van Os J, Fusar-Poli L, Delespaul P, Kenis G, Luykx JJ, Lin BD, Richards AL, Akdede B, Binbay T, Altınyazar V, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Ulaş H, Cankurtaran EŞ, Kaymak SU, Mihaljevic MM, Andric-Petrovic S, Mirjanic T, Bernardo M, Mezquida G, Amoretti S, Bobes J, Saiz PA, García-Portilla MP, Sanjuan J, Aguilar EJ, Santos JL, Jiménez-López E, Arrojo M, Carracedo A, López G, González-Peñas J, Parellada M, Maric NP, Atbaşoğlu C, Ucok A, Alptekin K, Saka MC, Arango C, O'Donovan MC, Rutten BPF, Guloksuz S. Examining the association between exposome score for schizophrenia and functioning in schizophrenia, siblings, and healthy controls: Results from the EUGEI study. Eur Psychiatry 2021; 64:e25. [PMID: 33736735 PMCID: PMC8080213 DOI: 10.1192/j.eurpsy.2021.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls. Methods This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate. Results ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group. Conclusions Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
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Affiliation(s)
- Gamze Erzin
- Department of Psychiatry, University of Health Sciences Ankara Diskapi Training and Research Hospital, Ankara, Turkey.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Psychiatry, UUMC Utrecht Brain Centre, University Medical Centre Utrecht, trecht University, Utrecht, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Gunter Kenis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UUMC Utrecht Brain Centre, University Medical Centre Utrecht, trecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Berna Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Physiology, School of Medicine, Ankara University, Ankara, Turkey.,Brain Research Center, Ankara University, Ankara, Turkey.,Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
| | - Halis Ulaş
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Marina M Mihaljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Andric-Petrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Tijana Mirjanic
- Special Hospital for Psychiatric Disorders Kovin, Kovin, Serbia
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain
| | - Julio Bobes
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Pilar A Saiz
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Maria Paz García-Portilla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Mental Health Services of Principado de Asturias, Oviedo, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Clínico Universitario de Valencia, INCLIVA, School of Medicine, Universidad de Valencia, Valencia, Spain
| | - Jose Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Psychiatry, Hospital Virgen de la Luz, Cuenca, Spain
| | - Estela Jiménez-López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Instituto de Investigación Sanitaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Carracedo
- Grupo de Medicina Genómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Pública Galega de Medicina Xenómica (SERGAS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Gonzalo López
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Mental Health, Belgrade, Serbia
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.,Department of Neuroscience, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
| | | | - Celso Arango
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Barcelona, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Micheal C O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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van Os J, Pries LK, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Wittchen HU, Rutten BPF, Guloksuz S. Schizophrenia and the Environment: Within-Person Analyses May be Required to Yield Evidence of Unconfounded and Causal Association-The Example of Cannabis and Psychosis. Schizophr Bull 2021; 47:594-603. [PMID: 33693921 PMCID: PMC8084443 DOI: 10.1093/schbul/sbab019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypotheses about the link between cannabis use and psychosis apply to the within-person level but have been tested mostly at the between-person level. We used a within-person design, in which a person serves as his own control, thus removing the need to consider confounding by any fixed (genetic and nongenetic) characteristic to study the prospective association between cannabis use and the incidence of attenuated psychotic experiences, and vice versa, adjusted for time-varying confounders. We combined 2 general population cohorts (at baseline: Early Developmental Stages of Psychopathology Study, n = 1395; Netherlands Mental Health Survey and Incidence Study-2, n = 6603), which applied a similar methodology to study cannabis use and attenuated psychotic experiences with repeated interviews (T0, T1, T2, and T3) over a period of approximately 10 years. The Hausman test was significant for the adjusted models, indicating the validity of the fixed-effects model. In the adjusted fixed-effects model, prior cannabis use was associated with psychotic experiences (aOR = 7.03, 95% CI: 2.39, 20.69), whereas prior psychotic experiences were not associated with cannabis use (aOR = 0.59, 95% CI: 0.21, 1.71). Longitudinal studies applying random-effects models to study associations between risk factors and mental health outcomes, as well as reverse causality, may not yield precise estimates. Cannabis likely impacts causally on psychosis but not the other way round.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, PO BOX 85500, 3508 GA Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- To whom correspondence should be addressed; tel: +31 88 75 583 46, fax: +31 88 75 583 47, e-mail:
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- FACT, Mondriaan Mental Health, Maastricht, Netherlands
| | - Hans-Ulrich Wittchen
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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van Os J, Schaub A, Carpenter WT. Resurrection of the Follow-Back Method to Study the Transdiagnostic Origins of Psychosis. Schizophr Bull 2021; 47:583-585. [PMID: 33543754 PMCID: PMC8084420 DOI: 10.1093/schbul/sbab008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/12/2022]
Abstract
There has been a major drive in research trying to understand the onset of psychosis. Clinical-high risk (CHR) studies focus on opportunistic help-seeking samples with non-psychotic disorders and a degree of psychosis admixture of variable outcome, but it is unlikely that these represent the population incidence of psychotic disorders. Longitudinal cohort studies of representative samples in the general population have focused on development and outcome of attenuated psychotic symptoms, but typically have low power to detect transition to clinical psychotic disorder. In this issue of Schizophrenia Bulletin, Cupo and colleagues resurrect a time-honored method to examine psychosis onset: the epidemiological follow-back study, modernizing it to fit the research framework of the early intervention era. The authors set out to investigate the hypothesis that psychotic disorder represents the poorest outcome fraction of initially non-psychotic, common mental disorders and present compelling findings, unifying previous opportunistic CHR and representative cohort-based work.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; tel: +31 88 75 583 46, fax: +31 88 75 583 47, e-mail:
| | - Annette Schaub
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - William T Carpenter
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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Cupo L, McIlwaine SV, Daneault JG, Malla AK, Iyer SN, Joober R, Shah JL. Timing, Distribution, and Relationship Between Nonpsychotic and Subthreshold Psychotic Symptoms Prior to Emergence of a First Episode of Psychosis. Schizophr Bull 2021; 47:604-614. [PMID: 33410487 PMCID: PMC8759816 DOI: 10.1093/schbul/sbaa183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Prospective population studies suggest that psychotic syndromes may be an emergent phenomenon-a function of severity and complexity of more common mental health presentations and their nonpsychotic symptoms. Examining the relationship between nonpsychotic and subthreshold psychotic symptoms in individuals who later developed the ultimate outcome of interest, a first episode of psychosis (FEP), could provide valuable data to support or refute this conceptualization of how psychosis develops. We therefore conducted a detailed follow-back study consisting of semistructured interviews with 430 patients and families supplemented by chart reviews in a catchment-based sample of affective and nonaffective FEP. The onset and sequence of 27 pre-onset nonpsychotic (NPS) or subthreshold psychotic (STPS) symptoms was systematically characterized. Differences in proportions were analyzed with z-tests, and correlations were assessed with negative binomial regressions. Both the first psychiatric symptom (86.24% NPS) and the first prodromal symptom (66.51% NPS) were more likely to be NPS than STPS. Patients reporting pre-onset STPS had proportionally more of each NPS than did those without pre-onset STPS. Finally, there was a strong positive correlation between NPS counts (reflecting complexity) and STPS counts (β = 0.34, 95% CI [0.31, 0.38], P < 2 e-16). Prior to a FEP, NPS precede STPS, and greater complexity of NPS is associated with the presence and frequency of STPS. These findings complement recent arguments that the emergence of psychotic illness is better conceptualized as part of a continuum-with implications for understanding pluripotential developmental trajectories and strengthening early intervention paradigms.
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Affiliation(s)
- Lani Cupo
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Sarah V McIlwaine
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jean-Gabriel Daneault
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada,Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Montréal, QC, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jai L Shah
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada,To whom correspondence should be addressed; Department of Psychiatry, McGill University, Montréal, QC, Canada; tel: (514) 761-6131x2465, fax: (514) 888-4458, e-mail:
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Pries LK, Erzin G, Rutten BPF, van Os J, Guloksuz S. Estimating Aggregate Environmental Risk Score in Psychiatry: The Exposome Score for Schizophrenia. Front Psychiatry 2021; 12:671334. [PMID: 34122186 PMCID: PMC8193078 DOI: 10.3389/fpsyt.2021.671334] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
To understand the role of environment in the pathoetiology of psychosis spectrum disorders, research has thus far mainly investigated the effects of single exposures in isolation, such as the association between cannabis use and schizophrenia. However, this approach fails to acknowledge the complexity of the exposome, which represents the totality of the environment involving many exposures over an individual's lifetime. Therefore, contemporary research adopting the exposome paradigm has aimed at capturing the combined effect of different environmental exposures by utilizing an aggregate environmental vulnerability score for schizophrenia: the exposome score for schizophrenia. Here, we attempt to provide a comprehensive overview of studies applying the exposome score for schizophrenia. First, we describe several approaches estimating exposomic vulnerability for schizophrenia, which falls into three categories: simple environmental sum scores (sum of dichotomized exposures), meta-analysis-based environmental risk score (sum scores weighted by estimates from meta-analyses), and the exposome score (sum score weighted by estimates from an analysis in an independent training dataset). Studies show that the exposome score for schizophrenia that assumes interdependency of exposures performs better than scores that assume independence of exposures, such as the environmental sum score and the meta-analysis-based environmental risk score. Second, we discuss findings on the pluripotency of the exposome score for schizophrenia and summarize findings from gene-environment studies using the exposome score for schizophrenia. Finally, we discuss possible scientific, clinical, and population-based applications of exposome score for schizophrenia, as well as limitations and future directions for exposome research to understand the etiology of psychosis spectrum disorders.
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Affiliation(s)
- Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Gamze Erzin
- Department of Psychiatry, University of Health Sciences Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.,King's Health Partners, Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, United Kingdom
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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47
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Giuliani L, Giordano GM, Bucci P, Pezzella P, Brando F, Galderisi S. Improving Knowledge on Pathways to Functional Outcome in Schizophrenia: Main Results From the Italian Network for Research on Psychoses. Front Psychiatry 2021; 12:791117. [PMID: 34970172 PMCID: PMC8712575 DOI: 10.3389/fpsyt.2021.791117] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
The identification of factors associated with functional outcome of subjects with schizophrenia is a great challenge in current research oriented to the personalization of care. The Italian Network for Research on Psychoses (NIRP) is a network of 26 university psychiatric clinics and/or mental health departments aimed to carry out multicenter research projects to improve the standards of prevention, diagnosis, and treatments of schizophrenia. The network has promoted 2 main studies, a cross-sectional one and a longitudinal one and seven "add-on" studies. The cross-sectional study of the network included 921 subjects with schizophrenia, 379 unaffected first-degree relatives of these patients, and 780 healthy controls. Results from this study documented that social and non-social cognition, functional capacity, negative symptoms, resilience, and family or social incentives strongly influence a measure of global functioning. The follow-up study included 618 patients from the original sample and has produced evidence of the key role of cognition, functional capacity, the experiential domain of negative symptoms, and everyday life skills in predicting functional outcome. The longitudinal study demonstrated that social cognition and the experiential domain of negative symptoms had an impact on interpersonal functioning, while non-social cognition had an impact on everyday life skills. Both non-social cognition and social cognition predicted work skills. The research question concerning the relationships of cognitive impairment and negative symptoms has been investigated with an innovative approach, using a structural equation model (SEM) and a network analysis. Both analyses demonstrated that only the experiential domain of negative symptoms had a distinct direct effect on functioning. The network analysis showed that expressive deficit was connected to functional capacity, as were social and non-social cognitive variables, and to disorganization. These findings were confirmed by the follow-up study. The add-on studies showed distinct electrophysiological correlates of the two negative symptom domains and the partial overlap between disorganization and neurocognitive impairment. Moreover, they identified and characterized a specific subgroup of patients suffering from schizophrenia with autism spectrum symptoms. The NIRP studies have implications for personalized management of patients with schizophrenia and highlight the need for a careful assessment of several domains rarely evaluated in clinical settings.
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Affiliation(s)
- Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Lim K, Lam M, Huang H, Liu J, Lee J. Genetic liability in individuals at ultra-high risk of psychosis: A comparison study of 9 psychiatric traits. PLoS One 2020; 15:e0243104. [PMID: 33264322 PMCID: PMC7710117 DOI: 10.1371/journal.pone.0243104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
Individuals at ultra-high risk (UHR) of psychosis are characterised by the emergence of attenuated psychotic symptoms and deterioration in functioning. In view of the high non-psychotic comorbidity and low rates of transition to psychosis, the specificity of the UHR status has been called into question. This study aims to (i) investigate if the UHR construct is associated with the genetic liability of schizophrenia or other psychiatric conditions; (ii) examine the ability of polygenic risk scores (PRS) to discriminate healthy controls from UHR, remission and conversion status. PRS was calculated for 210 youths (nUHR = 102, nControl = 108) recruited as part of the Longitudinal Youth at Risk Study (LYRIKS) using nine psychiatric traits derived from twelve large-scale psychiatric genome-wide association studies as discovery datasets. PRS was also examined to discriminate UHR-Healthy control status, and healthy controls from UHR remission and conversion status. Result indicated that schizophrenia PRS appears to best index the genetic liability of UHR, while trend level associations were observed for depression and cross-disorder PRS. Schizophrenia PRS discriminated healthy controls from UHR (R2 = 7.9%, p = 2.59 x 10-3, OR = 1.82), healthy controls from non-remitters (R2 = 8.1%, p = 4.90 x 10-4, OR = 1.90), and converters (R2 = 7.6%, p = 1.61 x 10-3, OR = 1.82), with modest predictive ability. A trend gradient increase in schizophrenia PRS was observed across categories. The association between schizophrenia PRS and UHR status supports the hypothesis that the schizophrenia polygenic liability indexes the risk for developing psychosis.
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Affiliation(s)
- Keane Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Max Lam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Feinstein Institute of Medical Research, The Zucker Hillside Hospital, New York, New York, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Genome Institute of Singapore, Singapore, Singapore
| | - Hailiang Huang
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jianjun Liu
- Genome Institute of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
- Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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Pries LK, Erzin G, van Os J, ten Have M, de Graaf R, van Dorsselaer S, Bak M, Rutten BPF, Guloksuz S. Predictive Performance of Exposome Score for Schizophrenia in the General Population. Schizophr Bull 2020; 47:277-283. [PMID: 33215211 PMCID: PMC7965069 DOI: 10.1093/schbul/sbaa170] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Previously, we established an estimated exposome score for schizophrenia (ES-SCZ) as a cumulative measure of environmental liability for schizophrenia to use in gene-environment interaction studies and for risk stratification in population cohorts. Hereby, we examined the discriminative function of ES-SCZ for identifying individuals diagnosed with schizophrenia spectrum disorder in the general population by measuring the area under the receiver operating characteristic curve (AUC). Furthermore, we compared this ES-SCZ method to an environmental sum score (Esum-SCZ) and an aggregate environmental score weighted by the meta-analytical estimates (Emet-SCZ). We also estimated ORs and Nagelkerke's R2 for ES-SCZ in association with psychiatric diagnoses and other medical outcomes. ES-SCZ showed a good discriminative function (AUC = 0.84) and statistically significantly performed better than both Esum-SCZ (AUC = 0.80) and Emet-SCZ (AUC = 0.80). At optimal cut point, ES-SCZ showed similar performance in ruling out (LR- = 0.20) and ruling in (LR+ = 3.86) schizophrenia. ES-SCZ at optimal cut point showed also a progressively greater magnitude of association with increasing psychosis risk strata. Among all clinical outcomes, ES-SCZ was associated with schizophrenia diagnosis with the highest OR (2.76, P < .001) and greatest explained variance (R2 = 14.03%), followed by bipolar disorder (OR = 2.61, P < .001, R2 = 13.01%) and suicide plan (OR = 2.44, P < .001, R2 = 12.44%). Our findings from an epidemiologically representative general population cohort demonstrate that an aggregate environmental exposure score for schizophrenia constructed using a predictive modeling approach-ES-SCZ-has the potential to improve risk prediction and stratification for research purposes and may help gain insight into the multicausal etiology of psychopathology.
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Affiliation(s)
- Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gamze Erzin
- Department of Psychiatry, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands,Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands,FACT, Mondriaan Mental Health, Maastricht, The Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands,Department of Psychiatry, Yale University School of Medicine, New Haven, CT,To whom correspondence should be addressed; tel: 31-433-88-4071, fax: 31433-88-4122, e-mail:
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Examining the independent and joint effects of genomic and exposomic liabilities for schizophrenia across the psychosis spectrum. Epidemiol Psychiatr Sci 2020; 29:e182. [PMID: 33200977 PMCID: PMC7681168 DOI: 10.1017/s2045796020000943] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene-environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum. METHODS The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components). RESULTS Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene-environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions. CONCLUSIONS The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.
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