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González-Medina GA, Corral SA, Castillo-Passi RI, Irarrazaval M, Maturana-Hurtado AJ, Gaspar PA. Lifetime prevalence of psychotic-like experiences and associated factors in Chile. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02741-y. [PMID: 39066802 DOI: 10.1007/s00127-024-02741-y] [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] [Received: 03/07/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Psychotic-like experiences (PLEs), which include hallucinations and delusional experiences, are usually present in healthy populations, and their persistence, quality, and severity are associated with the development of psychiatric diseases, including schizophrenia and other poor psychosocial outcomes. Urbanicity, depression, and other psychosocial stressors have been associated with PLEs. However, evidence of PLEs in Latin American (LATAM) countries is still scarce, and there are no studies about PLEs in Chile. The main aim of this study is to describe the prevalence of PLEs in a nationally representative sample according to other social determinants of health. METHODS The last results of the Chilean National Health Survey (ENS 2016-2017) were analyzed. PLEs were obtained from the Composite International Diagnostic Interview (CIDI) 3.0 and included in this survey. Other psychosocial variables (age, sex, educational level, financial stress, depressive symptoms, and urbanicity) were also included for further analysis. Exclusion criteria were (1) > = 65 and < 18 years old, and (2) previous diagnosis or treatment for schizophrenia or bipolar disorder. Descriptive statistics were used to describe data, and Poisson regression models were performed to weight variables and find psychosocial correlations with PLEs. RESULTS 2095 subjects were considered for this study (women 62.9% and mean age = 42.5, SD = 13.5). The lifetime prevalence of the PLEs (> = 1 PLE) in Chile was 12.9%. Visual hallucinations were the most common PLE (9.6%), and ideas of reference were the least common (0.4%). The Poisson regression model showed a higher prevalence of PLEs in the Gran Concepción conurbation (OR = 2.56) and Gran Valparaíso conurbation (OR = 1.69) compared with non-big cities. On the other hand, the 18-24 year group had higher PLEs prevalence compared to other age groups. No correlations were found with educational status, financial stress, or depressive symptoms. CONCLUSIONS A relatively high prevalence of PLEs was found in the Chilean general population, particularly in youth living in large urban areas (Gran Valparaíso and Gran Concepción), which is compatible with previous research. Considering that there were no correlations between low educational level and financial or depressive symptoms, it is necessary to have more studies that correlate other urban relevant variables, such as natural disasters, drug consumption, and domestic or neighborhood violence.
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Affiliation(s)
- Gabriel A González-Medina
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Psicología, Universidad Alberto Hurtado, Santiago, Chile
| | - Sebastián A Corral
- Departamento de Psicología, Universidad de La Serena, La Serena, Chile
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Chile, Clínica Psiquiátrica Universitaria, Santiago, RM, Chile
| | - Rolando I Castillo-Passi
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Imhay, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana Universidad del Desarrollo, Santiago, RM, Chile
| | - Matías Irarrazaval
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Chile, Clínica Psiquiátrica Universitaria, Santiago, RM, Chile
- Instituto Milenio para la Investigación de la Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Alejandro J Maturana-Hurtado
- Clínica Psiquiátrica Universitaria, Hospital Clínico de la Universidad de Chile, Santiago, Chile
- Departamento de Psiquiatría de Niños y Adolescentes, Universidad de Chile. Santiago, Santiago, Chile
| | - Pablo A Gaspar
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Chile, Clínica Psiquiátrica Universitaria, Santiago, RM, Chile.
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, Imhay, Chile.
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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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de Medeiros MW, Andrade JC, Haddad NM, Mendonça M, de Jesus LP, Fekih-Romdhane F, van de Bilt MT, Gattaz WF, Loch AA. Cannabis use influences disorganized symptoms severity but not transition in a cohort of non-help-seeking individuals at-risk for psychosis from São Paulo, Brazil. Psychiatry Res 2024; 331:115665. [PMID: 38113810 DOI: 10.1016/j.psychres.2023.115665] [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: 07/21/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Cannabis use is associated with an increased risk of developing a psychotic disorder. However, in individuals with at-risk mental states for psychosis (ARMS) this association is not clear, as well as the impact of cannabis use on symptom severity. The objective of this study was to evaluate the association of cannabis use patterns and ARMS risk status, transition to psychotic and psychiatric disorders, and psychopathology. METHOD A sample of 109 ARMS and 197 control individuals was drawn from the general population. Lifetime, maximum and current amount of cannabis use were assessed with the South Westminster modified questionnaire. Participants were followed-up for a mean of 2.5 years and reassessed for transition to any psychiatric disorder. RESULTS There were no differences between ARMS and controls regarding lifetime use, current amount of use, or maximum amount of cannabis use. There were also no differences between those who transitioned to a psychiatric disorder and those who did not regarding cannabis use variables. In ARMS individuals, cannabis use was significantly related to disorganization symptoms. CONCLUSION The results of this study suggest that cannabis plays a role in the psychopathology of ARMS individuals, leading to more severe symptomatology.
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Affiliation(s)
- Matheus Wanderley de Medeiros
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Julio Cesar Andrade
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Mansur Haddad
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Melina Mendonça
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leonardo Peroni de Jesus
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010 Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Martinus Theodorus van de Bilt
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Wagner Farid Gattaz
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.
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Butter S, Shevlin M, McBride O, Bentall RP, Hyland P, Leavey G, Murphy J. Functioning, symptom expression and risk along the psychosis continuum. Psychol Med 2023; 53:7407-7417. [PMID: 37092866 PMCID: PMC10719677 DOI: 10.1017/s0033291723001046] [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: 08/22/2022] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'. METHODS Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed']. RESULTS A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault. CONCLUSIONS The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.
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Affiliation(s)
- Sarah Butter
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Richard P. Bentall
- Department of Psychology, The University of Sheffield, Sheffield, England
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Gerard Leavey
- School of Psychology, Ulster University, Coleraine, Northern Ireland
- Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, Northern Ireland
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Caballero N, Machiraju S, Diomino A, Kennedy L, Kadivar A, Cadenhead KS. Recent Updates on Predicting Conversion in Youth at Clinical High Risk for Psychosis. Curr Psychiatry Rep 2023; 25:683-698. [PMID: 37755654 PMCID: PMC10654175 DOI: 10.1007/s11920-023-01456-2] [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] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in the prediction and treatment of psychotic conversion. Over the past 25 years, research into the prodromal phase of psychotic illness has expanded with the promise of early identification of individuals at clinical high risk (CHR) for psychosis who are likely to convert to psychosis. RECENT FINDINGS Meta-analyses highlight conversion rates between 20 and 30% within 2-3 years using existing clinical criteria while research into more specific risk factors, biomarkers, and refinement of psychosis risk calculators has exploded, improving our ability to predict psychotic conversion with greater accuracy. Recent studies highlight risk factors and biomarkers likely to contribute to earlier identification and provide insight into neurodevelopmental abnormalities, CHR subtypes, and interventions that can target specific risk profiles linked to neural mechanisms. Ongoing initiatives that assess longer-term (> 5-10 years) outcome of CHR participants can provide valuable information about predictors of later conversion and diagnostic outcomes while large-scale international biomarker studies provide hope for precision intervention that will alter the course of early psychosis globally.
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Affiliation(s)
- Noe Caballero
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Siddharth Machiraju
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Anthony Diomino
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Leda Kennedy
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Armita Kadivar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA.
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Formica MJC, Fuller-Tyszkiewicz M, Hickie I, Olive L, Wood SJ, Purcell R, Yung AR, Phillips LJ, Nelson B, Pantelis C, McGorry PD, Hartmann JA. The relationship between subjective sleep disturbance and attenuated psychotic symptoms after accounting for anxiety and depressive symptoms. Schizophr Res 2023; 258:84-93. [PMID: 37536174 DOI: 10.1016/j.schres.2023.07.019] [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: 09/09/2022] [Revised: 05/10/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND HYPOTHESES Sleep disturbances are increasingly recognized as cooccurring with psychotic symptoms. The potential importance of this relationship is complicated when considering the effects of anxiety and depressive symptoms which commonly present in early-stage illness states. This study aimed to investigate the relationship between self-reported sleep disturbance on the development of attenuated psychotic symptoms (APS) cross-sectionally and longitudinally while adjusting for roles of anxiety and depressive symptoms. DESIGN Eight-hundred and two help-seeking young people aged 12 to 25 years who engaged with our Australian early intervention services were included in the study (the "Transitions" cohort). Cross sectional mediation and cross-lagged longitudinal (12-month) mediation models were developed with outcomes being different APS domains. RESULTS Only baseline excessive daytime sleepiness predicted later APS when accounting for previous APS, anxiety and depressive symptomatology. Cross sectionally, self-reported sleep disturbance showed both direct and indirect predictive relationships with all APS domains. Partial mediation through anxiety and depression was shown for unusual thought content, perceptual abnormalities, and disorganised speech, while full mediation through depression was shown for non-bizarre ideas. CONCLUSIONS The specificity of the relationship between self-reported sleep disturbance on APS highlights the potential for different roles in mechanistic models of psychotic symptom expression. This further indicates the need for further experimental research to illuminate potential causal pathways. Future research should continue to use continuous, symptom level approaches across a range of timeframes to more accurately model the complex dynamics present in the sleep-psychosis relationship.
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Affiliation(s)
- M J C Formica
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology, Deakin University, Burwood, Australia.
| | | | - I Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - L Olive
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology, Deakin University, Burwood, Australia
| | - S J Wood
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology, University of Birmingham, Birmingham, England
| | - R Purcell
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - A R Yung
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Medicine, Deakin University, Burwood, Australia
| | - L J Phillips
- School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - B Nelson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - P D McGorry
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - J A Hartmann
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Department of Public Mental Health, Central Institute of Mental Health, Heidelberg Univeristy, Mannheim, Germany
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Georgiades A, Almuqrin A, Rubinic P, Mouhitzadeh K, Tognin S, Mechelli A. Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:38. [PMID: 37330526 DOI: 10.1038/s41537-023-00362-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.
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Affiliation(s)
- A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, 27-29 Fairlight Avenue, London, NW10 8AL, UK.
| | - A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - P Rubinic
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - K Mouhitzadeh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - S Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - A Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
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Gupta T, Antezana L, Porter C, Mayanil T, Bylsma LM, Maslar M, Horton LE. Skills program for awareness, connectedness, and empowerment: A conceptual framework of a skills group for individuals with a psychosis-risk syndrome. Front Psychiatry 2023; 14:1083368. [PMID: 37025348 PMCID: PMC10072161 DOI: 10.3389/fpsyt.2023.1083368] [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] [Received: 10/28/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Intervention strategies for those diagnosed with psychotic disorders such as schizophrenia can be effective in reducing symptoms and improving quality of life. While strides have been made in developing prevention and intervention strategies earlier on in the disease progression, among those at clinical high-risk (CHR) for psychosis, challenges with heterogeneity can limit symptom and diagnosis specific treatment. Here, we discuss a newly developed therapy skills group called the Skills Program for Awareness, Connectedness, and Empowerment (SPACE) that integrates different types of behavioral skills - standard and radically open dialectical behavioral therapy as well as cognitive behavioral therapy - for CHR youth between the ages of 13-18 years. With the diathesis-stress framework serving as a foundation, the intervention is divided into three stages. These stages target specific signs and symptoms contributing to the progression of CHR symptoms. Stage 1 targets stress (with the goal of developing awareness and reducing distress), stage 2 targets self-disturbances (with a goal of increasing self-connectedness), and stage 3 targets social connectedness (with a goal of improving social domains of functioning). The focus of this article is to introduce the theoretical framework underlying the pilot skills group and discuss ongoing progress. Clinical Trial Registration NCT05398120; https://clinicaltrials.gov/ct2/show/NCT05398120.
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Affiliation(s)
- Tina Gupta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ligia Antezana
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Christian Porter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tushita Mayanil
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Lauren M. Bylsma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Michael Maslar
- The Family Institute at Northwestern University, Evanston, IL, United States
| | - Leslie E. Horton
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Investigation of social and cognitive predictors in non-transition ultra-high-risk' individuals for psychosis using spiking neural networks. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:10. [PMID: 36792634 PMCID: PMC9931713 DOI: 10.1038/s41537-023-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
Finding predictors of social and cognitive impairment in non-transition Ultra-High-Risk individuals (UHR) is critical in prognosis and planning of potential personalised intervention strategies. Social and cognitive functioning observed in youth at UHR for psychosis may be protective against transition to clinically relevant illness. The current study used a computational method known as Spiking Neural Network (SNN) to identify the cognitive and social predictors of transitioning outcome. Participants (90 UHR, 81 Healthy Control (HC)) completed batteries of neuropsychological tests in the domains of verbal memory, working memory, processing speed, attention, executive function along with social skills-based performance at baseline and 4 × 6-month follow-up intervals. The UHR status was recorded as Remitters, Converters or Maintained. SNN were used to model interactions between variables across groups over time and classify UHR status. The performance of SNN was examined relative to other machine learning methods. Higher interaction between social and cognitive variables was seen for the Maintained, than Remitter subgroup. Findings identified the most important cognitive and social variables (particularly verbal memory, processing speed, attention, affect and interpersonal social functioning) that showed discriminative patterns in the SNN models of HC vs UHR subgroups, with accuracies up to 80%; outperforming other machine learning models (56-64% based on 18 months data). This finding is indicative of a promising direction for early detection of social and cognitive impairment in UHR individuals that may not anticipate transition to psychosis and implicate early initiated interventions to stem the impact of clinical symptoms of psychosis.
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Strauss GP, Bartolomeo LA, Luther L. Reduced willingness to expend effort for rewards is associated with risk for conversion and negative symptom severity in youth at clinical high-risk for psychosis. Psychol Med 2023; 53:714-721. [PMID: 34120660 DOI: 10.1017/s003329172100204x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and predictive of conversion to illness. Mechanisms underlying negative symptoms are unclear in the CHR population. METHODS The current study evaluated whether CHR participants demonstrated deficits in the willingness to expend effort for rewards and whether these impairments are associated with negative symptoms and greater risk for conversion. Participants included 44 CHR participants and 32 healthy controls (CN) who completed the Effort Expenditure for Reward Task (EEfRT). RESULTS Compared to CN, CHR participants displayed reduced likelihood of exerting high effort for high probability and magnitude rewards. Among CHR participants, reduced effort expenditure was associated with greater negative symptom severity and greater probability of conversion to a psychotic disorder on a cross-sectional risk calculator. CONCLUSIONS Findings suggest that effort-cost computation is a marker of illness liability and a transphasic mechanism underlying negative symptoms in the SZ spectrum.
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Affiliation(s)
| | | | - Lauren Luther
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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11
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Cheng N, Lin A, Bowden S, Gao C, Yung AR, Nelson B, Thompson A, Yuen HP, Brewer WJ, Cagliarini D, Bruxner A, Simmons M, Broussard C, Pantelis C, McGorry PD, Allott K, Wood SJ. Intelligence trajectories in individuals at ultra-high risk for psychosis: An 8-year longitudinal analysis. Schizophr Res 2022; 248:140-148. [PMID: 36055017 DOI: 10.1016/j.schres.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/29/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Cognitive impairment is a well-documented predictor of transition to a full-threshold psychotic disorder amongst individuals at ultra-high risk (UHR) for psychosis. However, less is known about whether change in cognitive functioning differs between those who do and do not transition. Studies to date have not examined trajectories in intelligence constructs (e.g., acquired knowledge and fluid intelligence), which have demonstrated marked impairments in individuals with schizophrenia. This study aimed to examine intelligence trajectories using longitudinal data spanning an average of eight years, where some participants completed assessments over three time-points. Participants (N = 139) at UHR for psychosis completed the Wechsler Abbreviated Scale of Intelligence (WASI) at each follow-up. Linear mixed-effects models mapped changes in WASI Full-Scale IQ (FSIQ) and T-scores on Vocabulary, Similarities, Block Design, and Matrix Reasoning subtests. The sample showed stable and improving trajectories for FSIQ and all subtests. There were no significant differences in trajectories between those who did and did not transition to psychosis and between individuals with good and poor functional outcomes. However, although not significant, the trajectories of the acquired knowledge subtests diverged between transitioned and non-transitioned individuals (β = -0.12, 95 % CI [-0.29, 0.05] for Vocabulary and β = -0.14, 95 % CI [-0.33, 0.05] for Similarities). Overall, there was no evidence for long-term deterioration in intelligence trajectories in this UHR sample. Future studies with a larger sample of transitioned participants may be needed to explore potential differences in intelligence trajectories between UHR transition groups and other non-psychosis outcomes.
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Affiliation(s)
- Nicholas Cheng
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Caroline Gao
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison R Yung
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Division of Psychology and Mental Health, University of Manchester, Manchester, England, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England, UK; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew Thompson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Warrick J Brewer
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Annie Bruxner
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Magenta Simmons
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christina Broussard
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology, University of Birmingham, Edgbaston, UK.
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12
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Lee TY, Hwang WJ, Kim NS, Park I, Lho SK, Moon SY, Oh S, Lee J, Kim M, Woo CW, Kwon JS. Prediction of psychosis: model development and internal validation of a personalized risk calculator. Psychol Med 2022; 52:2632-2640. [PMID: 33315005 PMCID: PMC9647536 DOI: 10.1017/s0033291720004675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years. METHODS Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis. RESULTS The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels. CONCLUSIONS Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Nahrie S. Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Inkyung Park
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong-Wan Woo
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
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13
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Karcher NR, Merchant J, Pine J, Kilciksiz CM. Cognitive Dysfunction as a Risk Factor for Psychosis. Curr Top Behav Neurosci 2022; 63:173-203. [PMID: 35989398 DOI: 10.1007/7854_2022_387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The current chapter summarizes recent evidence for cognition as a risk factor for the development of psychosis, including the range of cognitive impairments that exist across the spectrum of psychosis risk symptoms. The chapter examines several possible theories linking cognitive deficits with the development of psychotic symptoms, including evidence that cognitive deficits may be an intermediate risk factor linking genetic and/or neural metrics to psychosis spectrum symptoms. Although there is not strong evidence for unique cognitive markers associated specifically with psychosis compared to other forms of psychopathology, psychotic disorders are generally associated with the greatest severity of cognitive deficits. Cognitive deficits precede the development of psychotic symptoms and may be detectable as early as childhood. Across the psychosis spectrum, both the presence and severity of psychotic symptoms are associated with mild to moderate impairments across cognitive domains, perhaps most consistently for language, cognitive control, and working memory domains. Research generally indicates the size of these cognitive impairments worsens as psychosis symptom severity increases. The chapter points out areas of unclarity and unanswered questions in each of these areas, including regarding the mechanisms contributing to the association between cognition and psychosis, the timing of deficits, and whether any cognitive systems can be identified that function as specific predictors of psychosis risk symptoms.
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Affiliation(s)
- Nicole R Karcher
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jaisal Merchant
- Department of Brain and Psychological Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacob Pine
- Department of Brain and Psychological Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Can Misel Kilciksiz
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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14
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Hamilton HK, Roach BJ, Bachman PM, Belger A, Carrión RE, Duncan E, Johannesen JK, Light GA, Niznikiewicz MA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Cannon TD, Mathalon DH. Mismatch Negativity in Response to Auditory Deviance and Risk for Future Psychosis in Youth at Clinical High Risk for Psychosis. JAMA Psychiatry 2022; 79:780-789. [PMID: 35675082 PMCID: PMC9178501 DOI: 10.1001/jamapsychiatry.2022.1417] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Although clinical criteria for identifying youth at risk for psychosis have been validated, they are not sufficiently accurate for predicting outcomes to inform major treatment decisions. The identification of biomarkers may improve outcome prediction among individuals at clinical high risk for psychosis (CHR-P). Objective To examine whether mismatch negativity (MMN) event-related potential amplitude, which is deficient in schizophrenia, is reduced in young people with the CHR-P syndrome and associated with outcomes, accounting for effects of antipsychotic medication use. Design, Setting, and Participants MMN data were collected as part of the multisite case-control North American Prodrome Longitudinal Study (NAPLS-2) from 8 university-based outpatient research programs. Baseline MMN data were collected from June 2009 through April 2013. Clinical outcomes were assessed throughout 24 months. Participants were individuals with the CHR-P syndrome and healthy controls with MMN data. Participants with the CHR-P syndrome who developed psychosis (ie, converters) were compared with those who did not develop psychosis (ie, nonconverters) who were followed up for 24 months. Analysis took place between December 2019 and December 2021. Main Outcomes and Measures Electroencephalography was recorded during a passive auditory oddball paradigm. MMN elicited by duration-, pitch-, and duration + pitch double-deviant tones was measured. Results The CHR-P group (n = 580; mean [SD] age, 19.24 [4.39] years) included 247 female individuals (42.6%) and the healthy control group (n = 241; mean age, 20.33 [4.74] years) included 114 female individuals (47.3%). In the CHR-P group, 450 (77.6%) were not taking antipsychotic medication at baseline. Baseline MMN amplitudes, irrespective of deviant type, were deficient in future CHR-P converters to psychosis (n = 77, unmedicated n = 54) compared with nonconverters (n = 238, unmedicated n = 190) in both the full sample (d = 0.27) and the unmedicated subsample (d = 0.33). In the full sample, baseline medication status interacted with group and deviant type indicating that double-deviant MMN, compared with single deviants, was reduced in unmedicated converters compared with nonconverters (d = 0.43). Further, within the unmedicated subsample, deficits in double-deviant MMN were most strongly associated with earlier conversion to psychosis (hazard ratio, 1.40 [95% CI, 1.03-1.90]; P = .03], which persisted over and above positive symptom severity. Conclusions and Relevance This study found that MMN amplitude deficits were sensitive to future psychosis conversion among individuals at risk of CHR-P, particularly those not taking antipsychotic medication at baseline, although associations were modest. While MMN shows limited promise as a biomarker of psychosis onset on its own, it may contribute novel risk information to multivariate prediction algorithms and serve as a translational neurophysiological target for novel treatment development in a subgroup of at-risk individuals.
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Affiliation(s)
- Holly K. Hamilton
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | - Brian J. Roach
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Peter M. Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ricardo E. Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Erica Duncan
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jason K. Johannesen
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Gregory A. Light
- Department of Psychiatry, University of California, San Diego, La Jolla
- Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Margaret A. Niznikiewicz
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
| | - Jean Addington
- Hotchkiss Brain Institute Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles
- Department of Psychology, University of California, Los Angeles, Los Angeles
| | | | - Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
| | - Thomas H. McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Elaine F. Walker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Scott W. Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
| | - Tyrone D. Cannon
- Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale University, School of Medicine, New Haven, Connecticut
| | - Daniel H. Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
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15
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Nieto L, Domínguez-Martínez T, Rosel-Vales M, Saracco-Alvarez R, Celada-Borja C, Rascón-Gasca ML. Clinical and Functional Differences Between Mexican Youth at Clinical High Risk for Psychosis and With Familial High Risk. Front Psychol 2022; 13:911030. [PMID: 35859823 PMCID: PMC9289544 DOI: 10.3389/fpsyg.2022.911030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Few studies have explored the differences in clinical psychopathology between youth at high risk for psychosis and those at familial high risk for psychosis. This study seeks to describe and compare the sociodemographic, clinical, and functional characteristics of At-Risk Mental State (ARMS) for psychosis youth and those with a first- or second-degree relative with psychosis (Familial High-Risk: FHR) in a Mexican sample. Twenty-one ARMS individuals and 21 with FHR were evaluated for sociodemographic characteristics, psychopathological symptoms, and functional impairment. ARMS individuals were significantly younger, had fewer years of schooling, and were more likely to be male than those in the FHR group. Groups did not differ as regards marital status or occupation. The ARMS group showed greater severity of prodromal symptoms, schizotypal personality traits, and general psychopathology than the FHR group. In addition, they reported more premorbid adjustment deficit from early adolescence than the FHR group. Current overall social and role functioning was significantly lower in the ARMS group. Findings are consistent with ARMS studies from other countries. First- or second-degree relatives of patients with psychosis should be considered a vulnerable group as they display several symptoms of general psychopathology and may experience social adjustment problems in their adult lives. The lack of early detection and intervention psychosis programs in Mexico underlines the need to prioritize the development of preventive strategies to help close the care gap.
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Affiliation(s)
- Lourdes Nieto
- Division of Epidemiological and Psychosocial Research, Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- *Correspondence: Lourdes Nieto,
| | - Tecelli Domínguez-Martínez
- Division of Epidemiological and Psychosocial Research, Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mauricio Rosel-Vales
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ricardo Saracco-Alvarez
- Department of Clinical Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Cesar Celada-Borja
- Schizophrenia Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - María Luisa Rascón-Gasca
- Division of Epidemiological and Psychosocial Research, Department of Social Sciences in Health, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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16
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Hedges EP, Dickson H, Tognin S, Modinos G, Antoniades M, van der Gaag M, de Haan L, McGorry P, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BP, van Os J, Valmaggia LR, McGuire P, Kempton MJ. Verbal memory performance predicts remission and functional outcome in people at clinical high-risk for psychosis. Schizophr Res Cogn 2022; 28:100222. [PMID: 35242602 PMCID: PMC8861401 DOI: 10.1016/j.scog.2021.100222] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 10/26/2022]
Abstract
Robust deficits in cognitive functioning are present in people with psychosis and are evident in the early stages of the disorder. Impairments in verbal memory and verbal fluency are reliably seen in individuals at clinical high-risk for psychosis (CHR) compared to healthy populations. As previous studies have shown a relationship between cognition and longer-term outcomes in schizophrenia, the aim of this paper was to explore whether verbal memory and verbal fluency performance predicted outcomes in a large CHR sample recruited as part of the EU-GEI High Risk Study. Participants included 316 CHR individuals, 90.8% of whom were not currently on antipsychotic medication, and 60 healthy controls. Verbal memory and verbal fluency performance were measured at baseline. At two-year follow-up, CHR individuals were assessed by three different outcome measures, those who did and did not (1) transition to psychosis, (2) experience burdening impairment or disabilities, or (3) remit clinically from CHR status. Individuals with CHR displayed significant verbal memory and verbal fluency deficits at baseline compared to healthy controls (Hedges' g effect size = 0.24 to 0.66). There were no significant differences in cognitive performance of those who did and did not transition to psychosis. However, impaired immediate verbal recall predicted both functional disability and non-remission from the CHR state. Results remained significant when analyses were restricted to only include antipsychotic-free CHR participants. These findings may inform the development of early interventions designed to improve cognitive deficits in the early stages of psychosis.
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Affiliation(s)
- Emily P. Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Corresponding author at: Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF, United Kingdom.
| | - Hannah Dickson
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Mathilde Antoniades
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, United States
| | - Mark van der Gaag
- VU University, Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and EMGO+ Institute for Health and Care Research, van der Boechorststraat 1, 1081, BT, Amsterdam, the Netherlands
- Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512, HN, The Hague, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, Department Early Psychosis, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands
- Arkin Amsterdam, the Netherlands
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 485 3052, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Carlton South, Vic, Australia
| | | | - Rodrigo Bressan
- LiNC - Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Spain
| | - Marie-Odile Krebs
- University of Paris, GHU Psychiatrie et Neurosciences of Paris, Sainte-Anne, C’JAAD, pôle PEPIT, Inserm 1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Austria
| | - Bart P. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD 464 Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, P.O. Box 616, 6200 MD 464 Maastricht, the Netherlands
| | | | - Lucia R. Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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17
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West ML, Parrish EM, Friedman-Yakoobian M. Treatment outcomes for young people at clinical high risk for psychosis: Data from a specialized clinic. Early Interv Psychiatry 2022; 16:500-508. [PMID: 34309198 DOI: 10.1111/eip.13187] [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: 10/22/2020] [Revised: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
AIM Treatment for youth exhibiting signs of clinical high risk for psychosis (CHR-P) has been emphasized in recent years, but there is need for a greater understanding of the course of symptoms and functioning across treatment. The aim of this study is to describe 10 years of naturalistic treatment outcomes in a real-world, specialized CHR-P outpatient clinic, the Center for Early Detection, Assessment, and Response to Risk (CEDAR) Clinic. METHODS The CEDAR Clinic routinely collects client outcomes data for the purposes of program development, monitoring treatment effectiveness, and characterizing the clinic population. Clients are assessed at baseline, every 6 months (for up to 2 years depending on duration of treatment), and at the end of treatment. A series of mixed-effects models were performed to analyse change over time in outcomes (symptoms and functioning) between baseline and follow-up time points. RESULTS Over time, clients' (N = 123) positive (F = 11.8, p < .001) and negative (F = 4.91, p = .002) symptoms declined relative to their baseline. Social functioning improved over time (F = 2.50, p = .049), as did depression (F = 8.60, p < .001) and hopelessness (F = 4.21, p = .004). Clients' total CEDAR treatment hours ranged across type of treatment service, but the amount of treatment clients received was not associated with any clinical outcomes. CONCLUSIONS Over the course of treatment at this real-world, specialized CHR-P program, clients exhibited significant improvement in clinical outcomes and did not significantly decline in any measured outcomes. We discuss this study in the context of current understanding and guidelines for specialized coordinated specialty care treatment for CHR-P.
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Affiliation(s)
- Michelle L West
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Emma M Parrish
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Michelle Friedman-Yakoobian
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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18
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Iorio M, Casini E, Damiani S, Fusar-Poli P, Borgatti R, Mensi MM. Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target. Front Psychiatry 2022; 13:861201. [PMID: 35492727 PMCID: PMC9051044 DOI: 10.3389/fpsyt.2022.861201] [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: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of a positive family relationship has been suggested as a protective factor from parental stress and from the development of full-blown psychosis. However, to date, there is limited research on family functioning in adolescents with psychosis and at clinical high risk for psychosis (CHR-P). This study is aimed at comparing family functioning and perceived stress in parents of adolescents with either CHR-P, early onset psychosis (EOP), or other psychiatric disorders (no CHR-P). As a secondary aim, it will correlate family functioning with parental perceived stress in order to find critical targets of intervention. We conducted a Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD)-compliant, real-world, cross-sectional study. One-hundred and eleven adolescents aged 12-17 who access the institute of hospitalization and care with scientific character (IRCCS) Mondino Foundation Neuropsychiatric services (Pavia, Italy) between 2017 and 2020 and their parents (n = 222) were included. Sociodemographic characteristics of adolescents and their parents were collected. Family functioning was evaluated through the Family Adaptability and Cohesion Evaluation Scale-IV (FACES-IV) and the level of stress through the Perceived Stress Scale (PSS). Twenty adolescents had EOP, 38 had CHR-P, and 59 had no CHR-P. In total, 2.6% of CHR-P adolescents were adopted, 76.3% had separated-divorced parents, and 34.2% of parents had a depressive disorder. Among the FACES-IV sub-scale, maternal rigidity was progressively increased from no-CHR-P to CHR-P to EOP group, with statistical differences between EOP and the other two groups (p = 0.01). CHR-P mothers and fathers showed a high level of PSS values, without group difference. Lastly, PSS values correlated positively with the Rigidity, Disengagement, and Chaos scale of FACES-IV and negatively with the Communication scale (p < 0.05). Our results suggest that family functioning has a central role and could represent a worthwhile target of intervention for adolescents at CHR-P, leading the way to new preventive approaches.
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Affiliation(s)
- Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Erica Casini
- Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - 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.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
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19
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Addington J, Liu L, Santesteban-Echarri O, Brummitt K, Braun A, Cadenhead KS, Cornblatt BA, Holden JL, Granholm E. Cognitive behavioural social skills training: Methods of a randomized controlled trial for youth at risk of psychosis. Early Interv Psychiatry 2021; 15:1626-1636. [PMID: 33398922 DOI: 10.1111/eip.13102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
AIM Poor functioning has become a hallmark of many youth at clinical high-risk (CHR) of psychosis. Even for those who do not make the transition to psychosis remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address social and role functioning in CHR. METHODS This was a randomized controlled trial of cognitive-behavioural social skills training (CBSST) versus a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence-based treatments for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. RESULTS Two hundred and three participants were recruited for this study. Results include initial baseline data. CONCLUSION This article describes the baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this significant problem.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Olga Santesteban-Echarri
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kali Brummitt
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, New York, USA
| | - Jason L Holden
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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20
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Cui G, Qing Y, Li M, Sun L, Zhang J, Feng L, Li J, Chen T, Wang J, Wan C. Salivary Metabolomics Reveals that Metabolic Alterations Precede the Onset of Schizophrenia. J Proteome Res 2021; 20:5010-5023. [PMID: 34618462 DOI: 10.1021/acs.jproteome.1c00504] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Schizophrenia is a complex and highly heterogeneous mental illness with a prodromal period called clinical high risk (CHR) for psychosis before onset. Metabolomics is greatly promising in analyzing the pathology of complex diseases and exploring diagnostic biomarkers. Therefore, we conducted salivary metabolomics analysis in 83 first-episode schizophrenia (FES) patients, 42 CHR individuals, and 78 healthy controls with ultrahigh-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. The mass spectrometry raw data have been deposited on the MetaboLights (ID: MTBLS3463). We found downregulated aromatic amino acid metabolism, disturbed glutamine and nucleotide metabolism, and upregulated tricarboxylic acid cycle in FES patients, which existed even in the CHR stage and became more intense with the onset of the schizophrenia. Moreover, differential metabolites can be considered as potential diagnostic biomarkers and indicate the severity of the different clinical stages of disease. Furthermore, three disordered pathways were closely related to peripheral indicators of inflammatory response, oxidative stress, blood-brain barrier damage, and salivary microbiota. These results indicate that the disorder of oral metabolism occurs earlier than the onset of schizophrenia and is concentrated and intensified with the onset of disease, which may originate from the dysbiotic salivary microbiota and cause the onset of schizophrenia through the peripheral inflammatory response and redox system, suggesting the importance of oral-brain connection in the pathogenesis of schizophrenia.
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Affiliation(s)
- Gaoping Cui
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ying Qing
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Minghui Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Liya Sun
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Juan Zhang
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Feng
- Instrumental Analysis Center, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jing Li
- Department of Bioinformatics and Biostatistics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Tianlu Chen
- Shanghai Key Laboratory of Diabetes Mellitus and Center for Translational Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jijun Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China
| | - Chunling Wan
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
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21
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Addington J, Liu L, Farris MS, Goldstein BI, Wang JL, Kennedy SH, Bray S, Lebel C, MacQueen G. Clinical staging for youth at-risk for serious mental illness: A longitudinal perspective. Early Interv Psychiatry 2021; 15:1188-1196. [PMID: 33037783 DOI: 10.1111/eip.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/01/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to identify a sample of youth in distinct stages of risk for the development of a serious mental illness (SMI) according to a published clinical staging model and to follow this sample longitudinally to determine clinical changes over time. This article reports the 6- and 12-month follow-up of the cohort. METHODS This study recruited 243 youth, ages 12 to 25. The sample included (a) 42 healthy controls, (b) 41 nonhelpseeking individuals with no mental illness but some risk of SMI, for example, having a first-degree relative with an SMI (stage 0), (c) 53 youth experiencing distress and mild symptoms of anxiety or depression (stage 1a), and (d) 107 youth with attenuated symptoms of SMIs such as bipolar disorder or psychosis (stage 1b). Participants completed a range of measures assessing depression, anxiety, mania, suicide ideation, attenuated psychotic symptoms, negative symptoms, anhedonia and beliefs about oneself at baseline, 6- and 12-months. RESULTS There were few changes for healthy controls and stage 0 participants, although approximately 7% did move to a symptomatic stage within 12-months. Of stage 1a participants, 50% remained symptomatic, with 7.5% moving to stage 1b or developing a SMI. Approximately 9% of stage 1byouth developed a SMI within 12-months and approximately one-third had remission of symptoms during the follow-up. CONCLUSIONS Results suggest that the implementation of a transdiagnostic staging model may be useful in youth mental health and support consideration of clinical stage-based treatment for youth with early features of risk.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Megan S Farris
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Jian Li Wang
- Work and Mental Health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada.,Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Signe Bray
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child and Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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22
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Sanfelici R, Antonucci LA, Dwyer DB, Koutsouleris N. Reply to: Individualized Diagnostic and Prognostic Models for Psychosis Risk Syndromes: Do Not Underestimate Antipsychotic Exposure. Biol Psychiatry 2021; 90:e37-e38. [PMID: 34001369 DOI: 10.1016/j.biopsych.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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23
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Schirmbeck F, van der Burg NC, Blankers M, Vermeulen JM, McGuire P, Valmaggia LR, Kempton MJ, van der Gaag M, Riecher-Rössler A, Bressan RA, Barrantes-Vidal N, Nelson B, Amminger GP, McGorry P, Pantelis C, Krebs MO, Ruhrmann S, Sachs G, Rutten BPF, van Os J, Nordentoft M, Glenthøj B, Fusar-Poli P, de Haan L. Impact of Comorbid Affective Disorders on Longitudinal Clinical Outcomes in Individuals at Ultra-high Risk for Psychosis. Schizophr Bull 2021; 48:100-110. [PMID: 34417795 PMCID: PMC8781381 DOI: 10.1093/schbul/sbab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Diagnoses of anxiety and/or depression are common in subjects at Ultra-High Risk for Psychosis (UHR) and associated with extensive functional impairment. Less is known about the impact of affective comorbidities on the prospective course of attenuated psychotic symptoms (APS). METHOD Latent class mixed modelling identified APS trajectories in 331 UHR subjects assessed at baseline, 6, 12, and 24 months follow-up. The prognostic value of past, baseline, and one-year DSM-IV depressive or anxiety disorders on trajectories was investigated using logistic regression, controlling for confounders. Cox proportional hazard analyses investigated associations with transition risk. RESULTS 46.8% of participants fulfilled the criteria for a past depressive disorder, 33.2% at baseline, and 15.1% at one-year follow-up. Any past, baseline, or one-year anxiety disorder was diagnosed in 42.9%, 37.2%, and 27.0%, respectively. Participants were classified into one of three latent APS trajectory groups: (1) persistently low, (2) increasing, and (3) decreasing. Past depression was associated with a higher risk of belonging to the increasing trajectory group, compared to the persistently low (OR = 3.149, [95%CI: 1.298-7.642]) or decreasing group (OR = 3.137, [1.165-8.450]). In contrast, past (OR = .443, [.179-1.094]) or current (OR = .414, [.156-1.094]) anxiety disorders showed a trend-level association with a lower risk of belonging to the increasing group compared to the persistently low group. Past depression was significantly associated with a higher risk of transitioning to psychosis (HR = 2.123, [1.178-3.828]). CONCLUSION A past depressive episode might be a particularly relevant risk factor for an unfavorable course of APS in UHR individuals. Early affective disturbances may be used to advance detection, prognostic, and clinical strategies.
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Affiliation(s)
- Frederike Schirmbeck
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands,Arkin Institute for Mental Health, Amsterdam, the Netherlands,To whom correspondence should be addressed; Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands; tel: (0)20 8913639, fax: (0)20 8913702, e-mail:
| | - Nadine C van der Burg
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands,GGZ Centraal, Amersfoort, the Netherlands
| | - Matthijs Blankers
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands,Arkin Institute for Mental Health, Amsterdam, the Netherlands,Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mark van der Gaag
- Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Amsterdam Public Mental Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Psychosis Research Institute, Parnassia Group, The Hague, the Netherlands
| | | | - Rodrigo A Bressan
- Depto Psiquiatria, Escola Paulista de Medicina, LiNC-Lab Interdisciplinar Neurociências Clínicas, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain,Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Spain
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia
| | - Marie-Odile Krebs
- University of Paris, GHU-Paris, Sainte-Anne, C’JAAD, Inserm U1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - 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 Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | | | - Paolo Fusar-Poli
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Department of Psychosis Studies, Early Psychosis: Intervention and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, UK
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands,Arkin Institute for Mental Health, Amsterdam, the Netherlands
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24
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Burkhardt E, Berger M, Yolken RH, Lin A, Yuen HP, Wood SJ, Francey SM, Thompson A, McGorry PD, Nelson B, Yung AR, Amminger GP. Toxoplasma gondii, Herpesviridae and long-term risk of transition to first-episode psychosis in an ultra high-risk sample. Schizophr Res 2021; 233:24-30. [PMID: 34225023 DOI: 10.1016/j.schres.2021.06.012] [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: 10/29/2020] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ultra high-risk (UHR) criteria were introduced to identify people at imminent risk of developing psychosis. To improve prognostic accuracy, additional clinical and biological risk factors have been researched. Associations between psychotic disorders and infections with Toxoplasma gondii and Herpesviridae have been found. It is unknown if exposure to those pathogens increases the risk of transition to psychosis in UHR cohorts. METHODS We conducted a long-term follow-up of 96 people meeting UHR criteria, previously seen at the Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service in Melbourne, Australia. Transition to psychosis was assessed using the Comprehensive Assessment of the At-Risk Mental State (CAARMS) and state public mental health records. The relationship between IgG antibodies to Herpesviridae (HSV-1, HSV-2, CMV, EBV, VZV) and Toxoplasma gondii and risk for transition was examined with Cox regression models. RESULTS Mean follow-up duration was 6.46 (±3.65) years. Participants who transitioned to psychosis (n = 14) had significantly higher antibody titers for Toxoplasma gondii compared to those who did not develop psychosis (p = 0.03). After adjusting for age, gender and year of baseline assessment, seropositivity for Toxoplasma gondii was associated with a 3.6-fold increase in transition hazard in multivariate Cox regression models (HR = 3.6; p = 0.036). No significant association was found between serostatus for Herpesviridae and risk of transition. CONCLUSIONS Exposure to Toxoplasma gondii may contribute to the manifestation of positive psychotic symptoms and increase the risk of transitioning to psychosis in UHR individuals.
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Affiliation(s)
- E Burkhardt
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - M Berger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - R H Yolken
- John Hopkins University School of Medicine, Stanley Division of Developmental Neurovirology, Baltimore, USA
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - H P Yuen
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S J Wood
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S M Francey
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A Thompson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - P D McGorry
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - B Nelson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A R Yung
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Health Sciences, University of Manchester, UK
| | - G P Amminger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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25
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Omelchenko MA, Atadzhykova YA, Migalina VV, Nikiforova IY, Kaleda VG. [Clinical and pathopsychological features of youth depression with attenuated schizophrenic symptoms]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:12-18. [PMID: 34184472 DOI: 10.17116/jnevro202112105112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the clinical and pathopsychological features of youth depressions with attenuated schizophrenic symptoms (ASS), and their significance for early differential diagnostic and nosological assessment. MATERIAL AND METHODS Twenty young patients (19.7±3.7 years) with the first depressive episode with attenuated schizophrenic symptoms (ASS) (ICD-10 items F32.1, F32.2, F32.3) (basic group) were divided into subgroup 1 with attenuated positive symptoms - APS (19.3%) and subgroup 2 with attenuated negative symptoms - ANS (45.1%). Eleven young patients (19.4±2.9 years) with the classic depressive episode without ASS (ICD-10 items F32.1, F32.2) were included in a control group. Psychometric scales HDRS, SOPS, SANS, pathopsychological methods and Adult Personality Traits Questionnaire (APTQ) were used. RESULTS Statistically significant differences in the severity of depression were not found. A higher SOPS total score (p=0.006) and a greater severity of negative symptoms on SANS (p=0.006) were detected in patients of clinical groups compared with the comparison group. Distortion of the generalization process was detected in 60% of cases, impairments of immediate memorization were found in 30%, and the non-constructive nature of associations in 10%. Indirect data on greater emotional integrity of patients from the comparison group was obtained. CONCLUSION The presence of similar clinical and psychological abnormalities in the youth depressions with ASS allows us to attribute these phenomena to the possible risk factors for the development of schizophrenia.
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Affiliation(s)
| | | | | | | | - V G Kaleda
- Mental Health Research Centre, Moscow, Russia
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26
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O'Donoghue B, Geros H, Sizer H, Addington J, Amminger GP, Beaden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Berger GE, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Ising HK, Lavoie S, Lin A, Markulev C, Mathalon DH, McGlashan TH, Mifsud NG, Mossaheb N, Nieman DH, Nordentoft M, Perkins DO, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Seidman LJ, Smesny S, Thompson A, Tsuang MT, van der Gaag M, Verma S, Walker EF, Wood SJ, Woods SW, Yuen HP, Yung AR, McGorry PD, Nelson B. The association between migrant status and transition in an ultra-high risk for psychosis population. Soc Psychiatry Psychiatr Epidemiol 2021; 56:943-952. [PMID: 33399885 DOI: 10.1007/s00127-020-02012-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Migrant status is one of the most replicated and robust risk factors for developing a psychotic disorder. This study aimed to determine whether migrant status in people identified as Ultra-High Risk for Psychosis (UHR) was associated with risk of transitioning to a full-threshold psychotic disorder. METHODS Hazard ratios for the risk of transition were calculated from five large UHR cohorts (n = 2166) and were used to conduct a meta-analysis using the generic inverse-variance method using a random-effects model. RESULTS 2166 UHR young people, with a mean age of 19.1 years (SD ± 4.5) were included, of whom 221 (10.7%) were first-generation migrants. A total of 357 young people transitioned to psychosis over a median follow-up time of 417 days (I.Q.R.147-756 days), representing 17.0% of the cohort. The risk of transition to a full-threshold disorder was not increased for first-generation migrants, (HR = 1.08, 95% CI 0.62-1.89); however, there was a high level of heterogeneity between studies The hazard ratio for second-generation migrants to transition to a full-threshold psychotic disorder compared to the remainder of the native-born population was 1.03 (95% CI 0.70-1.51). CONCLUSIONS This meta-analysis did not find a statistically significant association between migrant status and an increased risk for transition to a full-threshold psychotic disorder; however, several methodological issues could explain this finding. Further research should focus on examining the risk of specific migrant groups and also ensuring that migrant populations are adequately represented within UHR clinics.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, Melbourne, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Hellen Geros
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Holly Sizer
- Orygen, Melbourne, 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
| | - G Paul Amminger
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Carrie E Beaden
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Gregor Emanuel Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zürich, Switzerland
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Jessica A Hartmann
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Helga K Ising
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Suzie Lavoie
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Connie Markulev
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, USA.,SFVA Medical Center, San Francisco, CA, USA
| | | | - Nathan G Mifsud
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nilufar Mossaheb
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | | | - Miriam R Schäfer
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Stephan Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - Andrew Thompson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - 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, The Netherlands
| | - Swapna Verma
- Institute of Mental Health, Singapore, Singapore
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Stephen J Wood
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Alison Ruth Yung
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Patrick D McGorry
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Calkins ME, Woods SW, Bearden CE, Liu L, Moore TM, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Mathalon DH, Keshavan M, Stone WS, Addington J. Concordance and factor structure of subthreshold positive symptoms in youth at clinical high risk for psychosis. Schizophr Res 2021; 227:72-77. [PMID: 32943313 DOI: 10.1016/j.schres.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022]
Abstract
Prevailing models of psychosis risk incorporate positive subthreshold symptoms as defining features of risk or transition to psychotic disorders. Despite this, relatively few studies have focused on characterizing longitudinal symptom features, such as prevalence, concordance and structure, which may aid in refining methods and enhancing classification and prediction efforts. The present study aimed to fill these gaps using longitudinal 24-month follow-up data from the well-characterized NAPLS-2 multi-site investigation of youth at clinical high risk (CHR) who had (n = 86) and had not (n = 268) transitioned to a threshold psychotic disorder since baseline. At baseline, among sub-delusional ideas, unusual thought content and suspicious/persecutory thinking were very common in CHR youth, and were highly concordant. Perceptual abnormalities (P4) were also common across youth regardless of symptom course and eventual transition to psychosis. Grandiose ideas were rare. Exploratory factor analysis extracted two constituent factors at multiple follow-up intervals, but there was marked instability in the structure over 24 months, and clear indicators for a single positive symptom factor. Together these findings support suggestions to combine sub-delusional symptoms into a single symptom category for classification purposes, in efforts to reduce clinical heterogeneity and ease measurement burden.
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Affiliation(s)
- Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | - Lu Liu
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | | | - Tyrone D Cannon
- Department of Psychology, 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
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, La Jolla, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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28
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Carrión RE, Auther AM, McLaughlin D, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman L, Stone W, Tsuang M, Walker EF, Woods SW, Torous J, Cornblatt BA. Social decline in the psychosis prodrome: Predictor potential and heterogeneity of outcome. Schizophr Res 2021; 227:44-51. [PMID: 33131983 DOI: 10.1016/j.schres.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND While an established clinical outcome of high importance, social functioning has been emerging as possibly having a broader significance to the evolution of psychosis and long term disability. In the current study we explored the association between social decline, conversion to psychosis, and functional outcome in individuals at clinical high risk (CHR) for psychosis. METHODS 585 subjects collected in the North American Prodrome Longitudinal Study (NAPLS2) were divided into 236 Healthy Controls (HCs), and CHR subjects that developed psychosis (CHR + C, N = 79), or those that did not (Non-Converters, CHR-NC, N = 270). CHR + C subjects were further divided into those that experienced an atypical decline in social functioning prior to baseline (beyond typical impairment levels) when in min-to-late adolescence (CHR + C-SD, N = 39) or those that did not undergoing a decline (CHR + C-NSD, N = 40). RESULTS Patterns of poor functional outcomes varied across the CHR subgroups: CHR-NC (Poor Social 36.3%, Role 42.2%) through CHR + C-NSD (Poor Social 50%, Poor Role 67.5%) to CHR + C-SD (Poor Social 76.9%, Poor Role 89.7%) functioning. The two Converter subgroups had comparable positive symptoms at baseline. At 12 months, the CHR + C-SD group stabilized, but social functioning levels remained significantly lower than the other two subgroups. CONCLUSIONS The current study demonstrates that pre-baseline social decline in mid-to-late adolescence predicts psychosis. In addition, we found that this social decline in converters is strongly associated with especially poor functional outcome and overall poorer prognosis. Role functioning, in contrast, has not shown similar predictor potential, and rather appears to be an illness indicator that worsens over time.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, United States
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Ming Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - John Torous
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
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29
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Wiedmann M, Kuitunen-Paul S, Basedow LA, Roessner V, Golub Y. Attenuated Psychotic Symptoms in Adolescents With Chronic Cannabis and MDMA Use. Front Psychiatry 2021; 12:696133. [PMID: 35126190 PMCID: PMC8814345 DOI: 10.3389/fpsyt.2021.696133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Both substance use, on the one hand, and the first signs of psychosis, on the other, commonly begin in adolescence. Adolescents with substance use disorder (SUD) frequently show recreational use of cannabis and 3,4-methylenedioxymethamphetamine (MDMA). When attenuated psychotic symptoms (APS) occur during the course of SUD, they are commonly attributed to the cannabis use, neglecting the role of other substances abused, such as MDMA in the risk of psychosis. METHODS We analyzed retrospective self-reports on APS (Prodromal Questionnaire, PQ-16) and amount of cannabis and MDMA use in n = 46 adolescent psychiatry outpatients with SUD. N = 17 (35%) individuals reported MDMA consume additional to cannabis. Furthermore, we examined the associations of APS with cannabis and MDMA use in stepwise hierarchical regressions while controlling for trauma history, birth complications and gender. RESULTS APS were not related to cannabis (B = 0.04, p = 0.842), but to MDMA use (B = 4.88, p = 0.001) and trauma history (B = 0.72, p = 0.001). Gender (B = -0.22, p = 0.767) and birth complications (B = -0.68, p = 0.178) were not associated with APS. DISCUSSION Our results indicate that MDMA use additional to cannabis use is associated with APS among adolescent SUD patients. Contrary to our expectations, we did not see an association of cannabis use and APS. We speculate that cannabis increases the risk for psychosis after a longer period of use and in combination with other risk factors, such as trauma history. Clinicians should screen for APS among SUD patients using MDMA and cannabis in order to adapt treatment plans of SUDs. Future research should validate these findings in longitudinal studies including polysubstance use and trauma history.
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Affiliation(s)
- Melina Wiedmann
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Predicting the individual risk of psychosis conversion in at-risk mental state (ARMS): a multivariate model reveals the influence of nonpsychotic prodromal symptoms. Eur Child Adolesc Psychiatry 2020; 29:1525-1535. [PMID: 31872289 DOI: 10.1007/s00787-019-01461-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/16/2019] [Indexed: 01/11/2023]
Abstract
To improve the prediction of the individual risk of conversion to psychosis in UHR subjects, by considering all CAARMS' symptoms at first presentation and using a multivariate machine learning method known as logistic regression with Elastic-net shrinkage. 46 young individuals who sought help from the specialized outpatient unit at Sainte-Anne hospital and who met CAARMS criteria for UHR were assessed, among whom 27 were reassessed at follow-up (22.4 ± 6.54 months) and included in the analysis. Elastic net logistic regression was trained, using CAARMS items at baseline to predict individual evolution between converters (UHR-P) and non-converters (UHR-NP). Elastic-net was used to select the few CAARMS items that best predict the clinical evolution. All validations and significances of predictive models were computed with non-parametric re-sampling strategies that provide robust estimators even when the distributional assumption cannot be guaranteed. Among the 25 CAARMS items, the Elastic net selected 'obsessive-compulsive symptoms' and 'aggression/dangerous behavior' as risk factors for conversion while 'anhedonia' and 'mood swings/lability' were associated with non-conversion at follow-up. In the ten-fold stratified cross-validation, the classification achieved 81.8% of sensitivity (P = 0.035) and 93.7% of specificity (P = 0.0016). Non-psychotic prodromal symptoms bring valuable information to improve the prediction of conversion to psychosis. Elastic net logistic regression applied to clinical data is a promising way to switch from group prediction to an individualized prediction.
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Santesteban-Echarri O, Tang J, Shakeel MK, Fernandes J, Addington J. A mobile-based app to monitor social functioning among youth at-risk for psychosis: Single-arm feasibility and acceptability study. Gen Hosp Psychiatry 2020; 67:148-149. [PMID: 32317101 DOI: 10.1016/j.genhosppsych.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Olga Santesteban-Echarri
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Jacky Tang
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Mohammed K Shakeel
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Jaydon Fernandes
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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32
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Progression from being at-risk to psychosis: next steps. NPJ SCHIZOPHRENIA 2020; 6:27. [PMID: 33020486 PMCID: PMC7536226 DOI: 10.1038/s41537-020-00117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
Over the past 20 years there has been a great deal of research into those considered to be at risk for developing psychosis. Much has been learned and studies have been encouraging. The aim of this paper is to offer an update of the current status of research on risk for psychosis, and what the next steps might be in examining the progression from CHR to psychosis. Advances have been made in accurate prediction, yet there are some methodological issues in ascertainment, diagnosis, the use of data-driven selection methods and lack of external validation. Although there have been several high-quality treatment trials the heterogeneity of this clinical high-risk population has to be addressed so that their treatment needs can be properly met. Recommendations for the future include more collaborative research programmes, and ensuring they are accessible and harmonized with respect to criteria and outcomes so that the field can continue to move forward with the development of large collaborative consortiums as well as increased funding for multisite projects.
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33
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Gupta T, Cowan HR, Strauss GP, Walker EF, Mittal VA. Deconstructing Negative Symptoms in Individuals at Clinical High-Risk for Psychosis: Evidence for Volitional and Diminished Emotionality Subgroups That Predict Clinical Presentation and Functional Outcome. Schizophr Bull 2020; 47:54-63. [PMID: 32955097 PMCID: PMC7825091 DOI: 10.1093/schbul/sbaa084] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Negative symptoms are characteristic of schizophrenia and closely linked to numerous outcomes. A body of work has sought to identify homogenous negative symptom subgroups-a strategy that can promote mechanistic understanding and precision medicine. However, our knowledge of negative symptom subgroups among individuals at clinical high-risk (CHR) for psychosis is limited. Here, we investigated distinct negative symptom profiles in a large CHR sample (N = 244) using a cluster analysis approach. Subgroups were compared on external validators that are (1) commonly observed in the schizophrenia literature and/or (2) may be particularly relevant for CHR individuals, informing early prevention and prediction. We observed 4 distinct negative symptom subgroups, including individuals with (1) lower symptom severity, (2) deficits in emotion, (3) impairments in volition, and (4) global elevations. Analyses of external validators suggested a pattern in which individuals with global impairments and volitional deficits exhibited more clinical pathology. Furthermore, the Volition group endorsed more disorganized, anxious, and depressive symptoms and impairments in functioning compared to the Emotion group. These data suggest there are unique negative symptom profiles in CHR individuals, converging with studies in schizophrenia indicating motivational deficits may be central to this symptom dimension. Furthermore, observed differences in CHR relevant external validators may help to inform early identification and treatment efforts.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
- To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | - Henry R Cowan
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | | | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA
| | - Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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34
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Individualized Diagnostic and Prognostic Models for Patients With Psychosis Risk Syndromes: A Meta-analytic View on the State of the Art. Biol Psychiatry 2020; 88:349-360. [PMID: 32305218 DOI: 10.1016/j.biopsych.2020.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The clinical high risk (CHR) paradigm has facilitated research into the underpinnings of help-seeking individuals at risk for developing psychosis, aiming at predicting and possibly preventing transition to the overt disorder. Statistical methods such as machine learning and Cox regression have provided the methodological basis for this research by enabling the construction of diagnostic models (i.e., distinguishing CHR individuals from healthy individuals) and prognostic models (i.e., predicting a future outcome) based on different data modalities, including clinical, neurocognitive, and neurobiological data. However, their translation to clinical practice is still hindered by the high heterogeneity of both CHR populations and methodologies applied. METHODS We systematically reviewed the literature on diagnostic and prognostic models built on Cox regression and machine learning. Furthermore, we conducted a meta-analysis on prediction performances investigating heterogeneity of methodological approaches and data modality. RESULTS A total of 44 articles were included, covering 3707 individuals for prognostic studies and 1052 individuals for diagnostic studies (572 CHR patients and 480 healthy control subjects). CHR patients could be classified against healthy control subjects with 78% sensitivity and 77% specificity. Across prognostic models, sensitivity reached 67% and specificity reached 78%. Machine learning models outperformed those applying Cox regression by 10% sensitivity. There was a publication bias for prognostic studies yet no other moderator effects. CONCLUSIONS Our results may be driven by substantial clinical and methodological heterogeneity currently affecting several aspects of the CHR field and limiting the clinical implementability of the proposed models. We discuss conceptual and methodological harmonization strategies to facilitate more reliable and generalizable models for future clinical practice.
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Hamilton HK, Boos AK, Mathalon DH. Electroencephalography and Event-Related Potential Biomarkers in Individuals at Clinical High Risk for Psychosis. Biol Psychiatry 2020; 88:294-303. [PMID: 32507388 PMCID: PMC8300573 DOI: 10.1016/j.biopsych.2020.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023]
Abstract
Clinical outcomes vary among youths at clinical high risk for psychosis (CHR-P), with approximately 20% progressing to full-blown psychosis over 2 to 3 years and 30% achieving remission. Recent research efforts have focused on identifying biomarkers that precede psychosis onset and enhance the accuracy of clinical outcome prediction in CHR-P individuals, with the ultimate goal of developing staged treatment approaches based on the individual's level of risk. Identifying such biomarkers may also facilitate progress toward understanding pathogenic mechanisms underlying psychosis onset, which may support the development of mechanistically informed early interventions for psychosis. In recent years, electroencephalography-based event-related potential measures with established sensitivity to schizophrenia have gained traction in the study of CHR-P and its clinical outcomes. In this review, we describe the evidence for event-related potential abnormalities in CHR-P and discuss how they inform our understanding of information processing deficits as vulnerability markers for emerging psychosis and as indicators of future outcomes. Among the measures studied, P300 and mismatch negativity are notable because deficits predict conversion to psychosis and/or CHR-P remission. However, the accuracy with which these and other measures predict outcomes in CHR-P has been obscured in the prior literature by the tendency to only report group-level differences, underscoring the need for inclusion of individual predictive accuracy metrics in future studies. Nevertheless, both P300 and mismatch negativity show promise as electrophysiological markers of risk for psychosis, as target engagement measures for clinical trials, and as potential translational bridges between human studies and animal models focused on novel drug development for early psychosis.
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Affiliation(s)
- Holly K Hamilton
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Alison K Boos
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Northern California Institute for Research and Education, San Francisco, California
| | - Daniel H Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California.
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Boldrini T, Pontillo M, Tanzilli A, Giovanardi G, Di Cicilia G, Salcuni S, Vicari S, Lingiardi V. An attachment perspective on the risk for psychosis: Clinical correlates and the predictive value of attachment patterns and mentalization. Schizophr Res 2020; 222:209-217. [PMID: 32513546 DOI: 10.1016/j.schres.2020.05.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In a longitudinal design, the present study examined: (a) the nature of attachment patterns and reflective functioning (RF) in individuals at ultra-high risk for psychosis (UHR); (b) the association between RF and subclinical psychotic symtoms; and (c) the psychosis-predictive value of attachment patterns, RF, and the interaction between these factors. METHOD The sample comprised 57 UHR subjects and 53 clinical controls (non-UHR). UHR subjects were followed over a mean period of 14 months (SD = 2.7; range 11-19), during which time 11.5% developed psychosis. Attachment patterns and RF were measured. Hierarchical logistic regression was used to examine the predictive value of variables in the transition to psychosis. RESULTS At baseline, significant differences were found between groups in secure attachment patterns and RF. RF was negatively associated with the attenuated psychotic symptoms described by the Unusual Thought Content/Delusional Ideas, Suspiciousness/Persecutory Ideas, and Disorganized Communication subscales. Moreover, poor mentalization was related to an increased likelihood of developing a psychotic disorder (OR = 0.427, 95% CI [0.188, 0.970]); conversely, no predictive effects of the attachment variables and their interaction with RF on the transition to psychosis were found. Notably, an optimal threshold value of RF = 1.25 was found to distinguish UHR subjects who made the transition to psychosis from those who did not develop this pathology. CONCLUSION The results suggest that aberrant mentalizing patterns can predict the development of psychosis. Clinical implications of these results for the development of preventive treatments are discussed.
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Affiliation(s)
- Tommaso Boldrini
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy; Department of Developmental Psychology and Socialization, University of Padua, Via Venezia, 8, 35131 Padua, Italy.
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy.
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico, 31, 81100 Caserta, Italy.
| | - Giuseppe Di Cicilia
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia, 8, 35131 Padua, Italy.
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
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Kheirkhah M, Brodoehl S, Leistritz L, Götz T, Baumbach P, Huonker R, Witte OW, Volk GF, Guntinas-Lichius O, Klingner CM. Abnormal Emotional Processing and Emotional Experience in Patients with Peripheral Facial Nerve Paralysis: An MEG Study. Brain Sci 2020; 10:E147. [PMID: 32143383 PMCID: PMC7139433 DOI: 10.3390/brainsci10030147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
Abnormal emotional reactions of the brain in patients with facial nerve paralysis have not yet been reported. This study aims to investigate this issue by applying a machine-learning algorithm that discriminates brain emotional activities that belong either to patients with facial nerve paralysis or to healthy controls. Beyond this, we assess an emotion rating task to determine whether there are differences in their experience of emotions. MEG signals of 17 healthy controls and 16 patients with facial nerve paralysis were recorded in response to picture stimuli in three different emotional categories (pleasant, unpleasant, and neutral). The selected machine learning technique in this study was the logistic regression with LASSO regularization. We demonstrated significant classification performances in all three emotional categories. The best classification performance was achieved considering features based on event-related fields in response to the pleasant category, with an accuracy of 0.79 (95% CI (0.70, 0.82)). We also found that patients with facial nerve paralysis rated pleasant stimuli significantly more positively than healthy controls. Our results indicate that the inability to express facial expressions due to peripheral motor paralysis of the face might cause abnormal brain emotional processing and experience of particular emotions.
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Affiliation(s)
- Mina Kheirkhah
- Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany; (M.K.); (S.B.); (T.G.); (R.H.)
| | - Stefan Brodoehl
- Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany; (M.K.); (S.B.); (T.G.); (R.H.)
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany;
| | - Lutz Leistritz
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07740 Jena, Germany;
| | - Theresa Götz
- Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany; (M.K.); (S.B.); (T.G.); (R.H.)
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07740 Jena, Germany;
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany;
| | - Ralph Huonker
- Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany; (M.K.); (S.B.); (T.G.); (R.H.)
| | - Otto W. Witte
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany;
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (G.F.V.); (O.G.-L.)
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (G.F.V.); (O.G.-L.)
| | - Carsten M. Klingner
- Biomagnetic Center, Jena University Hospital, 07747 Jena, Germany; (M.K.); (S.B.); (T.G.); (R.H.)
- Hans Berger Department of Neurology, Jena University Hospital, 07747 Jena, Germany;
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- B Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - H P Yuen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G P Amminger
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C Markulev
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Polari
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - M R Schäfer
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Tedja
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Thompson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A R Yung
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - P D McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
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Breitborde NJK, Guirgis H, Stearns W, Carpenter KM, Lteif G, Pine JG, Storey N, Wastler H, Moe AM. The Ohio State University Early Psychosis Intervention Center (EPICENTER) step-based care programme for individuals at clinical high risk for psychosis: study protocol for an observational study. BMJ Open 2020; 10:e034031. [PMID: 31992606 PMCID: PMC7045181 DOI: 10.1136/bmjopen-2019-034031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In October 2018, the Substance Abuse and Mental Health Services Administration funded 21 sites throughout the USA to develop, implement and evaluate specialised care programmes for individuals at clinical high risk for developing a psychotic disorder (CHR-P). Per the funding requirements, such programmes were required to provide 'step-based care'-a model in which individuals are initially provided with low-intensity, non-psychosis-specific and more benign (ie, least side effects) interventions and only progress onto higher-intensity, psychosis-specific interventions with a greater risk of more severe side effects should they not meet a priori criteria for clinical response to such lower-intensity interventions. Here, we outline the evaluation component of the step-based care programme for individuals at CHR-P at The Ohio State University Early Psychosis Intervention Center (EPICENTER). METHODS AND ANALYSES The EPICENTER CHR-P programme provides a step-based care model comprising psychotherapy, medication management, family support/education, peer support and vocational/educational support. All participants who opt to receive care at the EPICENTER will complete a standardised assessment battery as part of usual care. This battery will be administered on enrolment and will be re-administered at 6-month intervals throughout individuals' participation in EPICENTER clinical services. Participants will have the opportunity to allow for data from these usual care assessments to be used as part of an evaluation project for this new clinical service. The primary outcome for this evaluation project is time to remission of symptomatic and functional deficits commonly experienced by individuals at CHR-P. Participants will also have the opportunity to participate in a supplemental research project designed to further evaluate treatment outcomes and patient characteristics among individuals participating in EPICENTER clinical services. ETHICS AND DISSEMINATION This project was approved by The Ohio State University Institutional Review Board. Results from this project will be disseminated through publications and presentations. TRIAL REGISTRATION NUMBER NCT03970005; Pre-results.
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Affiliation(s)
- Nicholas J K Breitborde
- Psychiatry and Behavioral Health & Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Hossam Guirgis
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Walter Stearns
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Kristen M Carpenter
- Psychiatry and Behavioral Health, Psychology, & Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, USA
| | - Ghada Lteif
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Jacob G Pine
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Nichole Storey
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Heather Wastler
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Aubrey M Moe
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Nelson B, McGorry P. The Prodrome of Psychotic Disorders: Identification, Prediction, and Preventive Treatment. Child Adolesc Psychiatr Clin N Am 2020; 29:57-69. [PMID: 31708053 DOI: 10.1016/j.chc.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Twenty-five years ago "at risk" for psychosis criteria were introduced to the field. Prediction studies have identified a range of risk factors involved in transition from "at risk" status to first episode psychotic illness, with recent interest in dynamic and multimodal prediction models. Treatment studies have indicated that risk of transition to psychotic disorder can at least be delayed in this clinical population. Although the strongest evidence to date is for cognitive behavioral therapy, the optimal type and sequence of treatment remains an active area of research.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia.
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia
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Tyson JW, House EM, Donovan AL. Assessing Youth with Psychotic Experiences: A Phenomenological Approach. Child Adolesc Psychiatr Clin N Am 2020; 29:1-13. [PMID: 31708039 DOI: 10.1016/j.chc.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psychotic experiences may be part of normal development or indicate a wide range of mental disorders. This article shows how a systematic, domain-based, phenomenological approach to assessing psychotic symptoms in youth facilitates the gathering of the nuanced clinical information necessary to understand a child's specific experience. Mapping this information onto a narrative timeline, while understanding the evolution and developmental context of psychotic experiences, is essential in making an accurate diagnostic formulation and appropriate treatment plan for youth presenting with psychotic experiences.
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Affiliation(s)
- John W Tyson
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA.
| | - Ellen M House
- Augusta University/University of Georgia Medical Partnership, Health Science Campus, Russell Hall, 1425 Prince Avenue, Athens, GA 30602, USA
| | - Abigail L Donovan
- First Episode and Early Psychosis Program, Massachusetts General Hospital, 32 Fruit Street, Yawkey 6A, Boston, MA 02114, USA
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Metacognition in youth at-risk for psychosis. Schizophr Res 2019; 210:303-305. [PMID: 31296413 DOI: 10.1016/j.schres.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/22/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
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Vargas T, Zou DS, Conley RE, Mittal VA. Assessing Developmental Environmental Risk Factor Exposure in Clinical High Risk for Psychosis Individuals: Preliminary Results Using the Individual and Structural Exposure to Stress in Psychosis-Risk States Scale. J Clin Med 2019; 8:jcm8070994. [PMID: 31323940 PMCID: PMC6678455 DOI: 10.3390/jcm8070994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Exposure to cumulative environmental risk factors across development has been linked to a host of adverse health/functional outcomes. This perspective incorporating information regarding exposure at differing developmental periods is lacking in research surrounding individuals at Clinical High Risk (CHR) for developing a psychotic disorder. METHODS CHR individuals (n = 35) and healthy volunteers (n = 28) completed structured clinical interviews as well as our group's newly developed Individual and Structural Exposure to Stress in Psychosis-risk-states (ISESP) interview. Lifetime cumulative scores were calculated, and severity of stress was reported for multiple developmental periods/ages. Group differences were tested, and associations with current symptom domains were examined. RESULTS Significant group differences were not observed for lifetime cumulative events, though CHR trended toward endorsing more events and greater stress severity. For stress severity across development, there were trending group differences for the 11-13 age range, and significant group differences for the 14-18 age range; notably, comparisons for earlier time points did not approach statistical significance. Associations between negative symptoms and cumulative severity of exposure were observed. DISCUSSION Results suggest exploring exposure to cumulative environmental risk factors/stressors and stress severity across developmental periods is generally informative and possibly specifically so for predictive models and diathesis-stress psychosis risk conceptualizations.
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Affiliation(s)
- Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
| | - Denise S Zou
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Rachel E Conley
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Vijay A Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
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