1
|
Lundin NB, Blouin AM, Cowan HR, Moe AM, Wastler HM, Breitborde NJK. Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians. Psychol Res Behav Manag 2024; 17:1365-1383. [PMID: 38529082 PMCID: PMC10962362 DOI: 10.2147/prbm.s423865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.
Collapse
Affiliation(s)
- Nancy B Lundin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Alexandra M Blouin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Henry R Cowan
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aubrey M Moe
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
2
|
Mamah D, Mutiso V, Musyimi C, Harms MP, Anokhin AP, Chen S, Torous J, Muyela L, Nashed J, Al-Hosni Y, Odera A, Yarber A, Golosheykin S, Faghankhani M, Sneed M, Ndetei DM. Kenya Psychosis-Risk Outcomes Study (KePROS): Development of an Accelerated Medicine Partnership Schizophrenia-Aligned Project in Africa. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae009. [PMID: 39144113 PMCID: PMC11207935 DOI: 10.1093/schizbullopen/sgae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis The Accelerating Medicines Partnership Schizophrenia (AMP SCZ) funds a longitudinal study of 43 research sites across 5 continents to develop tools to stratify developmental trajectories of youth at clinical high risk for psychosis (CHR) and identify homogenous targets for future clinical trials. However, there are no sites in Africa, leaving a critical gap in our knowledge of clinical and biological outcomes among CHR individuals. Study Design We describe the development of the Kenya Psychosis-Risk Outcomes Study (KePROS), a 5-year NIH-funded project in Kenya designed to harmonize with AMP SCZ. The study will recruit over 100 CHR and 50 healthy participants and conduct multiple clinical and biomarker assessments over 2 years. Capacity building is a key component of the study, including the construction of an electroencephalography (EEG) laboratory and the upgrading of a local 3 T magnetic resonance imaging (MRI) machine. We detail community recruitment, study methodologies and protocols, and unique challenges with this pioneering research in Africa. Study Results This paper is descriptive only. Planned future analyses will investigate possible predictors of clinical outcomes and will be compared to results from other global populations. Conclusions KePROS will provide the research community with a rich longitudinal clinical and biomarker dataset from an African country in the developing Global South, which can be used alongside AMP SCZ data to delineate CHR outcome groups for future treatment development. Training in mental health assessment and investment in cutting-edge biomarker assessment and other technologies is needed to facilitate the inclusion of African countries in large-scale research consortia.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Victoria Mutiso
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Michael P Harms
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Andrey P Anokhin
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - ShingShiun Chen
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center at Harvard Medical School, Boston, MA, USA
| | - Levi Muyela
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Jerome Nashed
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Yazen Al-Hosni
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Arthur Odera
- African Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Alaina Yarber
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Semyon Golosheykin
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Masoomeh Faghankhani
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Megan Sneed
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - David M Ndetei
- African Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
3
|
Awhangansi S, Okewole A, Archard PJ, O’Reilly M. Perspective on clinical high-risk for psychosis in Africa. Front Psychiatry 2023; 14:1226012. [PMID: 37743999 PMCID: PMC10514491 DOI: 10.3389/fpsyt.2023.1226012] [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: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Clinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psychosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising assessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma.
Collapse
Affiliation(s)
| | - Adeniran Okewole
- Neuropsychiatric Hospital Aro, Abeokuta, Nigeria
- Pembroke College, University of Cambridge, Cambridge, United Kingdom
| | - Philip John Archard
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
- University of Leicester, Leicester, United Kingdom
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Michelle O’Reilly
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
- University of Leicester, Leicester, United Kingdom
| |
Collapse
|
4
|
Zaks I, Dekel R, Zuckerman YS, Horesh D. Study protocol: A multimethod psychophysiological randomized controlled trial of a couple therapy for post-traumatic stress disorder. Contemp Clin Trials 2023; 132:107280. [PMID: 37419309 DOI: 10.1016/j.cct.2023.107280] [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] [Received: 02/03/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.
Collapse
Affiliation(s)
- Ilil Zaks
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel.
| | - Rachel Dekel
- Bar-Ilan University School of Social Work, Ramat Gan 590002, Israel.
| | | | - Danny Horesh
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel; Grossman School of Medicine, Department of Psychiatry, New York University, 550 First Avenue, New York, NY 10016, USA.
| |
Collapse
|
5
|
Mamah D, Mutiso VN, Ndetei DM. Longitudinal and cross-sectional validation of the WERCAP screen for assessing psychosis risk and conversion. Schizophr Res 2022; 241:201-209. [PMID: 35144059 PMCID: PMC10448956 DOI: 10.1016/j.schres.2022.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was developed to assess risk for developing psychosis. Its validity has not been investigated in a large population-based study or with longitudinal analyses. METHODS 825 participants, aged 14-25, were recruited from Kenya. Symptoms were assessed using the WERCAP Screen, as experienced over the prior 3-months (3MO), 12-months (12MO) or lifetime (LIF). ROC curve analysis was used to determine the validity of the WERCAP Screen against the Structured Interview of Psychosis-Risk Syndromes. Longitudinal validity was assessed by comparing baseline p-WERCAP scores in psychotic disorder converters and non-converters, and using ROC curve analysis. Relationship of the p-WERCAP was examined against clinical variables. RESULTS ROC curve analyses against SIPS showed an AUC of 0.83 for 3MO, 0.79 for 12MO and 0.65 for LIF psychosis scores. The optimal cut-point on 3MO was a score of >12 (sens: 0.78; spec: 0.77; ppv: 0.41), and >32 for 12MO (sens: 0.71; spec: 0.74; ppv: 0.24). Baseline 3MO scores (but not LIF scores) were higher in converters compared to high-risk non-converters (p = 0.02). 3MO scores against conversion status had an AUC of 0.75, with an optimal cutoff point of >16 (sens: 1.0; spec: 0.53). All p-WERCAP scores significantly correlated with substance use and stress severity. 12 MO scores were most related to cognitive impairment. CONCLUSIONS The WERCAP Screen is a valid instrument for assessing psychosis severity and conversion risk. It can be used in the community to identify those who may require clinical assessment and care, and for recruitment in psychosis-risk research.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
| |
Collapse
|
6
|
Mamah D, Mutiso VN, Ndetei DM. Psychotic-like experiences among 9,564 Kenyan adolescents and young adults. Psychiatry Res 2021; 302:113994. [PMID: 34029986 DOI: 10.1016/j.psychres.2021.113994] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 05/07/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the prevalence and characteristics of psychotic-like experiences (PLE) in a large cohort of Kenyan adolescents and young adults. METHOD The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was used to the study the 12-month prevalence of PLE's among 9,564 Kenyan youths (aged 15-25 yrs), and the rates of psychosis high-risk (HR) and medium-risk (MR) cases, based on cut-off scores. Relationships with clinical, demographic and economic profiles were investigated. RESULTS Across all participants, 72% reported having had at least one PLE over the last year. 4.6% and 30.6% were HR and MR based on symptom scores. There were similar PLE rates in females and males. PLE severity correlated with mood (r=0.67), stress (r=0.46), and autistic traits (r=0.18). PLE severity was also related to poverty, lower education attainment, and underemployment. Compared to controls, HR and MR youths were more likely to report lifetime substance use and to have more significant use. CONCLUSION Psychosis screening can provide valuable information about individuals and may help identify those who may require clinical assessment and intervention to improve outcomes. This is particularly relevant in many parts of Africa where the resources are limited for treating more advanced illness.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, 660 S. Euclid, Saint Louis, Missouri, 63110, USA.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
| |
Collapse
|
7
|
Adjorlolo S, Setordzi M. Psychosis in adolescents in Africa: A scoping review for current understanding and future directions. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1949173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Research and Grant Institute of Ghana, Accra, Ghana
| | | |
Collapse
|
8
|
Mamah D, Mutiso VN, Ndetei DM. Neurocognition in Kenyan youth at clinical high risk for psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 25:100198. [PMID: 34094888 PMCID: PMC8167199 DOI: 10.1016/j.scog.2021.100198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
Introduction Cognitive deficits are typically seen in schizophrenia and in the prodrome, and are a major predictor of functional outcomes in patients. In Africa, few studies have investigated neurocognition in psychosis, which presents a gap in our understanding of the heterogeneity of the illness. In this study, we assessed neurocognition among the largest sample of psychosis-risk participants recruited in the continent to date. Methods The study was conducted in Kenya, and involved 295 psychiatric medication-naïve participants at clinical high-risk (CHR) for psychosis and healthy controls, aged 15–25 yrs. Psychosis-risk status was determined separately using the Structured Interview of Psychosis-Risk Syndromes (i.e. CHR) and by self-report with the Washington Early Recognition Center Affectivity and Psychosis Screen. Eleven tests were administered using the University of Pennsylvania Computerized Neurocognitive Battery. Test performance across groups were investigated, as well as demographic and clinical effects. Results Fewer participants were designated as being at psychosis-risk with structured interview (n = 47; CHR) than with self-report (n = 155). A MANOVA of cognitive test performance was significant only when groups were ascertained based on self-report (p = 0.03), with decreased performance in the risk group on verbal intelligence (p = 0.003; d = 0.39), emotion recognition (p = 0.003; d = 0.36), sensorimotor processing (p = 0.01; d = 0.31) and verbal memory (p = 0.035; d = 0.21). Only verbal intelligence was significantly worse in the CHR group compared to controls (p = 0.036; d = 0.45). There were no significant age and gender relationships. Conclusion Deficits across multiple cognitive domains are present in Kenyan psychosis-risk youth, most significantly in verbal intelligence. The pattern of cognitive deficits and an absence of gender effects may represent ethnicity-specific phenotypes of the psychosis-risk state. Longitudinal studies of neurocognition in Kenyan patients who convert to psychosis may enhance risk prediction in this population, and facilitate targeted interventions.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Kenya
| |
Collapse
|
9
|
Mamah D, Cloninger CR, Mutiso VN, Gitonga I, Tele A, Ndetei DM. Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character. ACTA ACUST UNITED AC 2020; 1:sgaa051. [PMID: 33215089 PMCID: PMC7656989 DOI: 10.1093/schizbullopen/sgaa051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n = 268) and controls (n = 251), aged 15–25 years. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student’s t-tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity, and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (ie, higher novelty seeking [NS]) and asocial (ie, lower reward dependence) than controls. They were also more schizotypal (ie, high self-transcendence [ST] and lower self-directedness [SD] and cooperativeness [CO] than controls). CO was related to logical reasoning, abstraction, and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial, and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder and to require early intervention to improve outcomes.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - C Robert Cloninger
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
10
|
Taylor JH, Calkins ME, Gur RE. Markers of Psychosis Risk in the General Population. Biol Psychiatry 2020; 88:337-348. [PMID: 32220500 DOI: 10.1016/j.biopsych.2020.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/17/2019] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
The categorical approach to defining schizophrenia spectrum disorders requires meeting established criteria. To advance early identification and intervention in young people, the field has progressed to studying help-seeking individuals who are at clinical high risk based on subthreshold psychosis spectrum symptoms, and criteria have been articulated for qualifying individuals as at risk. A broader dimensional examination of psychosis has been applied to population-based studies on non-help seekers. This review highlights the ascertainment and assessment approaches to such population-based studies. Most studies are cross-sectional and rely on questionnaires with limited overlap of tools. However, several consistent findings emerge on symptoms, neurocognitive deficits, and neuroimaging parameters and other biomarkers associated with emergence and persistence of psychotic features. The findings are consistent with the literature on abnormalities associated with schizophrenia, including the presence of neurocognitive deficits; abnormalities in brain structure, function, and connectivity that are related to distress; impairment; and functional outcome. These findings support the validity of studying psychosis experiences during development in a way that can chart the emergence of psychosis in the context of general psychopathology. Such studies are necessary for establishing developmental trajectories that characterize this emergence and for identifying risk and resilience biomarkers moderating or modulating the full range of schizophrenia-related manifestations. More community-based studies are needed, with better standardization and harmonization of measures and incorporating longitudinal follow-up, to establish mechanistic links between cellular-molecular aberrations and specific manifestations of psychosis as envisioned by the precision medicine agenda.
Collapse
Affiliation(s)
- Jerome H Taylor
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
| |
Collapse
|
11
|
Kim SW, Kim JK, Han JH, Jhon M, Kim JW, Lee JY, Kim JM, Na HJ, Kang YS, Chung YC, Yoon JS. Validation of the Korean Version of the 15-Item Community Assessment of Psychic Experiences in a College Population. Psychiatry Investig 2020; 17:306-311. [PMID: 32200606 PMCID: PMC7176566 DOI: 10.30773/pi.2019.0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/20/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15 item positive scale (CAPE-15) in college students. METHODS This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument's diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. RESULTS Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant. CONCLUSION The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validation of this scale could contribute to the early identification of psychosis in the Korean community.
Collapse
Affiliation(s)
- Sung-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Jae-Kyeong Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Ji Hun Han
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyun Ju Na
- Department of Nursing, Dong Kang University, Gwangju, Republic of Korea
| | - Young-Shin Kang
- Department of Psychology, Chonnam National University, Gwangju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
12
|
Dooley N, O'Hanlon E, Healy C, Adair A, McCandless C, Coppinger D, Kelleher I, Clarke M, Leemans A, Frodl T, Cannon M. Psychotic experiences in childhood are associated with increased structural integrity of the left arcuate fasciculus - A population-based case-control study. Schizophr Res 2020; 215:378-384. [PMID: 31495700 DOI: 10.1016/j.schres.2019.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/26/2019] [Accepted: 08/19/2019] [Indexed: 01/03/2023]
Abstract
Around 1 in 5 children under 13 years old experience sub-clinical psychotic experiences (PEs) like hallucinations and delusions. While PEs in childhood are a significant risk factor for adult psychotic disorders, the majority of those experiencing childhood PEs do not develop a psychotic disorder. Individual differences in regional brain maturation rates may be responsible for this age-related and often transient emergence of PEs. Fronto-temporal association tracts undergo extensive maturation and myelination throughout childhood and adolescence, thus we focus on individual differences in one such tract, the arcuate fasciculus. A normative population-based sample of children (aged 11-13) attended a clinical interview and MRI (n = 100), 25 of whom were identified as reporting strong PEs. This group had reduced mean and radial diffusivity in the arcuate fasciculus compared with a group of matched controls (n = 25) who reported no PEs. The group difference was greater in the left hemisphere than the right. Mediation analyses showed that this group difference was driven predominantly by perceptual disturbances and an along-tract analysis showed that the group difference was greatest approximately halfway between the frontal and temporal termination points of the tract (adjacent to the left lateral ventricle). This study is the first to investigate links between arcuate fasciculus diffusivity and psychotic experiences in a population sample of children.
Collapse
Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Erik O'Hanlon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Amy Adair
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - Conor McCandless
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - David Coppinger
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, the Netherlands.
| | - Thomas Frodl
- Otto-von-Guericke University Magdeburg, Department of Psychiatry and Psychotherapy, Magdeburg, Germany.
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
13
|
Ndetei D, Pike K, Mutiso V, Tele A, Gitonga I, Rebello T, Musyimi C, Mamah D. The psychometric properties of the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen in adults in the Kenyan context: Towards combined large scale community screening for affectivity and psychosis. Psychiatry Res 2019; 282:112569. [PMID: 31727439 DOI: 10.1016/j.psychres.2019.112569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
Abstract
There is a need for screening for early symptoms of psychosis and affectivity at community level to promote early diagnosis and management. Any screening instrument should have good psychometric properties. One such instrument is the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen that has been used in the USA, Kenya and Rwanda. However, its properties have not been studied outside the USA, and not in adults. The study aims to document the psychometric properties of the WERCAP Screen in Kenyan adults with positive screens on the WHO mental health treatment GAP- Intervention Guidelines (mhGAP-IG). We administered the WERCAP Screen and a gold standard - the Mini-International Neuropsychiatric Interview (MINI-Plus) section on psychosis to 674 Kenyan adults who had screened positive on the WHO mhGAP-IG. Out of these, 464 (68.84%) scored positive for both affectivity and psychosis sections on the MINI-Plus. The WERCAP affectivity and psychosis scales had good psychometric properties as screening measures, with a cut-off point of 22 for affectivity and 20 for psychosis. The WERCAP Screen has the potential for combined scale up screening for affectivity and psychosis in Kenyan population.
Collapse
Affiliation(s)
- David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - Kathleen Pike
- Global Mental Health Program, Columbia University, New York, USA
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Tahilia Rebello
- Global Mental Health Program, Columbia University, New York, USA
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | |
Collapse
|
14
|
Rouhakhtar PJR, Pitts SC, Schiffman J. Associations between Race, Discrimination, Community Violence, Traumatic Life Events, and Psychosis-Like Experiences in a Sample of College Students. J Clin Med 2019; 8:E1573. [PMID: 31581531 PMCID: PMC6832877 DOI: 10.3390/jcm8101573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/16/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022] Open
Abstract
Self-report tools of psychosis-like experiences contribute to the understanding of psychosis and may aid in identification and prevention efforts across the severity spectrum. Current tools are likely limited by biases, leading to potential systematic health disparities. Principal component analyses in diverse samples of community participants reporting psychosis-like experiences may aid in the detection of measurement biases. The current study evaluated the fit of a two-component model for the Prime Screen, a self-report psychosis-like experiences measure, in a sample of Black (n = 82) and White (n = 162) community participants, and subsequently evaluated the relation of these components with measures of mental well-being, traumatic life experiences, community violence, and experiences of discrimination. Analyses indicated limited support for a two-component model of the Prime Screen, with four of the items showing high cross-loading across both components ("poor fit" items). Although many Prime Screen items correlated with mental well-being as expected, correlations between item scores and mental well-being were non-significant for poor fit items. Community violence emerged as a significant predictor of some individual item scores for both good and poor fit items, while discrimination predicted only some poor fit item scores. Results highlight the potential limitations of current self-report tools of psychosis-like experiences, as well as possible considerations for improvement for use in diverse populations.
Collapse
Affiliation(s)
| | - Steven C Pitts
- Psychology Department, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jason Schiffman
- Psychology Department, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| |
Collapse
|
15
|
Mutiso VN, Pike KM, Musyimi CW, Gitonga I, Tele A, Rebello TJ, Thornicroft G, Ndetei DM. Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya. Gen Hosp Psychiatry 2019; 59:20-29. [PMID: 31096165 DOI: 10.1016/j.genhosppsych.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.
Collapse
Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA.
| | - C W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA.
| | | | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
| |
Collapse
|
16
|
Veling W, Burns JK, Makhathini EM, Mtshemla S, Nene S, Shabalala S, Mbatha N, Tomita A, Baumgartner J, Susser I, Hoek HW, Susser E. Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments. Soc Psychiatry Psychiatr Epidemiol 2019; 54:303-312. [PMID: 30413848 PMCID: PMC6440845 DOI: 10.1007/s00127-018-1623-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.
Collapse
Affiliation(s)
- W Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J K Burns
- University of Exeter, Exeter, UK
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - E M Makhathini
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Mtshemla
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - S Nene
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - S Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - N Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - J Baumgartner
- Duke Global Health Institute, Duke University, Durham, USA
| | - I Susser
- Department of Anthropology, Hunter College and Graduate Center, City University of New York, New York, USA
- Department of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - H W Hoek
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - E Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| |
Collapse
|
17
|
Jang YE, Lee TY, Hur JW, Kwon JS. Validation of the Korean Version of the Prodromal Questionnaire-Brief Version in Non-Help-Seeking Individuals. Psychiatry Investig 2019; 16:109-114. [PMID: 30808116 PMCID: PMC6393747 DOI: 10.30773/pi.2018.10.23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In this study, we examined the reliability and validity of the Korean version of the Prodromal Questionnaire-Brief (PQ-B), a self-report screening instrument for clinical high risk for psychosis (CHR). METHODS A total of 3,400 middle, high school and college students participated, and 261 subjects with a PQ-B total score ≥3 completed both the PQ-B and the Structured Interview for Prodromal Syndromes (SIPS). Receiver operating characteristic (ROC) curves were used to examine the psychometric properties of the PQ-B. RESULTS A cut-off of 7 for the PQ-B total score and a cut-off of 22 for the PQ-B distress score showed the best balance of sensitivity (72.2%, 77.8%) and specificity (71.4%, 75.0%). CONCLUSION The Korean version of the PQ-B showed good reliability and validity for predicting prodromal risk symptoms in the community population.
Collapse
Affiliation(s)
- Young Eun Jang
- Department of Nursing, Korea University, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Hur
- Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| |
Collapse
|
18
|
Maijer K, Hayward M, Fernyhough C, Calkins ME, Debbané M, Jardri R, Kelleher I, Raballo A, Rammou A, Scott JG, Shinn AK, Steenhuis LA, Wolf DH, Bartels-Velthuis AA. Hallucinations in Children and Adolescents: An Updated Review and Practical Recommendations for Clinicians. Schizophr Bull 2019; 45:S5-S23. [PMID: 30715540 PMCID: PMC6357982 DOI: 10.1093/schbul/sby119] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hallucinations in children and adolescents are now known to occur on a continuum from healthy to psychopathology-related phenomena. Although hallucinations in young populations are mostly transient, they can cause substantial distress. Despite hallucinations being widely investigated, research so far has had limited implications for clinical practice. The present article has 3 main aims: (1) to review research findings since 2014 (when the last major review of the area was published); (2) to present assessment tools validated to measure hallucinations in children and adolescents; and (3) to discuss therapeutic strategies and clinical issues. We conclude by presenting a tailored care model for clinicians and outline future challenges for research.
Collapse
Affiliation(s)
- Kim Maijer
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands,Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands,De Bascule, Amsterdam, the Netherlands,To whom correspondence should be addressed; University Medical Center Utrecht, Psychiatry department, HP A00.241, Heidelberglaan 100, 3485CX Utrecht, the Netherlands; tel: +31 88 7558180, fax: +31 88 755 54 43, e-mail:
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK,Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland,Developmental NeuroImaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Renaud Jardri
- Univ Lille, CNRS UMR-9193, SCALab (PsyCHIC Team) & CHU Lille, CURE Platform, Fontan Hospital, Lille, France
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrea Raballo
- Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy
| | - Aikaterini Rammou
- School of Psychology, University of Sussex, Brighton, UK,Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - James G Scott
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia,Metro North Mental Health, Herston, Australia,Queensland Centre for Mental Health Research, Wacol, Australia
| | - Ann K Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Laura A Steenhuis
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Daniel H Wolf
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| |
Collapse
|
19
|
Abstract
AIMS War and conflict are known to adversely affect mental health, although their effects on risk symptoms for psychosis development in youth in various parts of the world are unclear. The Rwandan genocide of 1994 and Civil War had widespread effects on the population. Despite this, there has been no significant research on psychosis risk in Rwanda. Our goal in the present study was to investigate the potential effects of genocide and war in two ways: by comparing Rwandan youth born before and after the genocide; and by comparing Rwandan and Kenyan adolescents of similar age. METHODS A total of 2255 Rwandan students and 2800 Kenyan students were administered the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen. Prevalence, frequency and functional impairment related to affective and psychosis-risk symptoms were compared across groups using univariate and multivariate statistics. RESULTS Rwandan students born before the end of the genocide and war in 1994 experienced higher psychotic and affective symptom load (p's < 0.001) with more functional impairment compared with younger Rwandans. 5.35% of older Rwandan students met threshold for clinical high-risk of psychosis by the WERCAP Screen compared with 3.19% of younger Rwandans (χ 2 = 5.36; p = 0.02). Symptom severity comparisons showed significant (p < 0.001) group effects between Rwandan and Kenyan secondary school students on affective and psychotic symptom domains with Rwandans having higher symptom burden compared with Kenyans. Rwandan female students also had higher rates of psychotic symptoms compared with their male counterparts - a unique finding not observed in the Kenyan sample. CONCLUSIONS These results suggest extreme conflict and disruption to country from genocide and war can influence the presence and severity of psychopathology in youth decades after initial traumatic events.
Collapse
|
20
|
Kim SW, Chung YC, Kang YS, Kim JK, Jang JE, Jhon M, Lee JY, Kim JM, Shin IS, Yoon JS. Validation of the Korean version of the 16-Item Prodromal Questionnaire in a Non-Help-Seeking College Population. Psychiatry Investig 2018; 15:111-117. [PMID: 29475231 PMCID: PMC5900395 DOI: 10.30773/pi.2017.04.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/24/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the reliability and validity of the Korean version of the 16-item Prodromal Questionnaire (KPQ-16) in non-help-seeking university students. METHODS Among 2,246 university students participated in the initial screening, 257 subjects with KPQ-16 scores ≥4 were interviewed. The criteria for ultra-high risk (UHR) of psychosis of the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. An exploratory modified version of the questionnaire (mKPQ-16), to which three items from the Eppendorf Schizophrenia Inventory were added, was also used to compensate for items on thought and cognitive problems. RESULTS Seventeen subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve (AUROC) was highest for the mKPQ-16 total score (AUROC=0.831, p<0.001). The use of cutoff total scores of 7 for the mKPQ-16 and 6 for the KPQ-16 resulted in the best balance of sensitivity (76.5% and 64.7%, respectively) and specificity (75.4% and 71.2%, respectively). CONCLUSION The Korean versions of the PQ-16 are good instruments for screening for psychosis risk in university students. This validation of a questionnaire version with a small number of items may make it feasible to screen large numbers of young adults in the community.
Collapse
Affiliation(s)
- Sung-Wan Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Young-Shin Kang
- Department of Psychology, Chonnam National University, Gwangju, Republic of Korea
| | - Jae-Kyeong Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Ji-Eun Jang
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Mental Health Commission, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
21
|
Kanemoto K, Tsuda H, Goji H, Tadokoro Y, Oshima T, Tachimori H, DeToffol B. Delusional experience awareness gap between patients and treating doctors - Self-reported EPDS questionnaire. Epilepsy Behav 2015; 51:60-4. [PMID: 26262934 DOI: 10.1016/j.yebeh.2015.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/02/2015] [Accepted: 06/17/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Although early and rapid recognition of a psychotic trend in patients with epilepsy certainly pay dividends, there is no handy assessment instrument for screening because of multiple intrinsic difficulties such as lack of a standard screener as well as a reliability gap for screeners between help-seeking and general populations. On the other hand, the predominance of positive symptoms at the initial stage of psychosis is a promising aspect of this specific group. The following specific questions were examined. Is there a measurable difference between the assessment of the treating doctor and the real feelings of the patient? How well does the attained score correspond to the clinical diagnosis? METHODS The self-reported Emotions with Persecutory Delusions Scale (EPDS) questionnaire, previously validated in a general population, was used as the assessment tool for psychotic trend in 79 outpatients with epilepsy. Independent from scoring by the patients, the treating doctors also expressed their impressions about the same patients using the same scoring tool. RESULTS Stepwise multiple regression analysis of the EPDS scores of both doctors and patients revealed that a clinical diagnosis of psychosis was the only independent variable significantly related to EPDS score. Also, there was a significant difference between the EPDS scores of the patients and those of the doctors, in favor of the former. SIGNIFICANCE Clinical diagnosis of psychosis proved to be the most powerful determinant of EPDS score independent from other clinical factors. The awareness gap between doctors and patients based on EPDS score revealed that treating doctors often clearly underestimate the psychotic trend of their patients. Our findings suggest that such simple tests as EPDS, with a narrow focus on attenuated delusional symptoms, may help screen for an early psychotic episode in patients with epilepsy that may otherwise not be diagnosed by their physicians.
Collapse
Affiliation(s)
- Kousuke Kanemoto
- Aichi Medical University, Department of Neuropsychiatry, Nagoya, Japan.
| | | | - Hiroko Goji
- Aichi Medical University, Department of Neuropsychiatry, Nagoya, Japan
| | - Yukari Tadokoro
- Aichi Medical University, Department of Neuropsychiatry, Nagoya, Japan
| | - Tomohiro Oshima
- Aichi Medical University, Department of Neuropsychiatry, Nagoya, Japan
| | | | | |
Collapse
|
22
|
Du Z. Predisposition to Schizophrenia: An Update of Current Understanding. Cell Biochem Biophys 2015; 73:187-90. [PMID: 25711187 DOI: 10.1007/s12013-015-0614-8] [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: 10/23/2022]
Abstract
Within the field of mental health, the concept of predisposition or that of being "at risk" has been properly addressed by Mrazek and Haggarty. This period prior to clear diagnosis of psychosis has been referred by several names like 'premorbid' phase, at-risk individuals, predisposed individuals, prodromal phase, etc. The premorbid phase is perhaps the most debated term in this list because this term suggests that the morbidity arises only in the overt illness phase. However, evidences arising from several different lines of observations suggest that this may not be the case. In spite of the fact that it has been generally accepted that the prodromal phase precedes the clinical phase, identification of this phase remains a challenge. The real challenge in identifying the onset of the prepsychotic phase is the differentiation of 'normal' experiences from these 'abnormal' experiences. Much fewer studies have been conducted for the assessment of cognitive functions in prodromal phase or predisposed phases of schizophrenia. Cognitive deficits, particularly in memory and attentional functions, are among the most extensively documented aspects of psychosis. Regarding the somatosensory abnormalities in the high-risk individuals, so far there has been only one study conducted which involved somatosensory evoked potentials in these patients.
Collapse
Affiliation(s)
- Zhongxiang Du
- Department of Psychiatry, The First Hospital of Xuzhou, Xuzhou, Jiangsu, China.
| |
Collapse
|
23
|
Morris SE, Heinssen RK. Informed consent in the psychosis prodrome: ethical, procedural and cultural considerations. Philos Ethics Humanit Med 2014; 9:19. [PMID: 25403748 PMCID: PMC4289308 DOI: 10.1186/1747-5341-9-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/24/2014] [Indexed: 05/12/2023] Open
Abstract
Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts.
Collapse
Affiliation(s)
- Sarah E Morris
- />Division of Adult Translational Research, National Institute of Mental Health, 6001 Executive Blvd, North Bethesda, MD 20892 USA
| | - Robert K Heinssen
- />Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Blvd, North Bethesda, MD 20892 USA
| |
Collapse
|
24
|
Mamah D, Owoso A, Sheffield JM, Bayer C. The WERCAP Screen and the WERC Stress Screen: psychometrics of self-rated instruments for assessing bipolar and psychotic disorder risk and perceived stress burden. Compr Psychiatry 2014; 55:1757-71. [PMID: 25128205 DOI: 10.1016/j.comppsych.2014.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Identification of individuals in the prodromal phase of bipolar disorder and schizophrenia facilitates early intervention and promises an improved prognosis. There are no current assessment tools for clinical risk symptoms of bipolar disorder, and psychosis-risk assessment generally involves semi-structured interviews, which are time consuming and rater dependent. We present psychometric data on two novel quantitative questionnaires: the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen for assessing bipolar and psychotic disorder risk traits, and the accompanying WERC Stress Screen for assessing individual and total psychosocial stressor severities. METHODS Prevalence rates of the WERCAP Screen were evaluated among 171 community youth (aged 13-24 years); internal consistency was assessed and k-means cluster analysis was used to identify symptom groups. In 33 participants, test-retest reliability coefficients were assessed, and ROC curve analysis was used to determine the validity of the psychosis section of the WERCAP Screen (pWERCAP) against the Structured Interview of Psychosis-Risk Symptoms (SIPS). Correlations of the pWERCAP, the affectivity section of the WERCAP Screen (aWERCAP) and the WERC Stress Screen were examined to determine the relatedness of scores with cognition and clinical measures. RESULTS Cluster analysis identified three groups of participants: a normative (47%), a psychosis-affectivity (18%) and an affectivity only (35%) group. Internal consistency of the aWERCAP and pWERCAP resulted in alphas of 0.87 and 0.92, and test-retest reliabilities resulted in intraclass correlation coefficients of 0.76 and 0.86 respectively. ROC curve analysis showed the optimal cut-point on the pWERCAP as a score of >30 (sensitivity: 0.89; specificity: 1.0). There was a significant negative correlation between aWERCAP scores and total cognition (R=-0.42), and between pWERCAP scores and sensorimotor processing speed. Total stress scores correlated significantly with scores on the aWERCAP (R=0.88), pWERCAP (R=0.62) and total cognition (R=-0.44). CONCLUSIONS Our results show that the WERCAP Screen and the WERC Stress Screen are easy to administer and derived scores are related to cognitive and clinical traits. This suggests that their use could have particular benefits for epidemiologic studies and in busy clinical settings. Longitudinal studies would be required to evaluate clinical outcomes with high questionnaire scores.
Collapse
Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University, St. Louis, Missouri.
| | - Akinkunle Owoso
- Department of Psychiatry, Washington University, St. Louis, Missouri
| | - Julia M Sheffield
- Department of Psychology, Washington University, St. Louis, Missouri
| | - Chelsea Bayer
- Department of Psychiatry, Washington University, St. Louis, Missouri
| |
Collapse
|
25
|
Kline E, Schiffman J. Psychosis risk screening: a systematic review. Schizophr Res 2014; 158:11-8. [PMID: 25034762 DOI: 10.1016/j.schres.2014.06.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 01/03/2023]
Abstract
Despite the wealth of evidence linking duration of untreated psychosis to critical illness outcomes, most clinicians do not utilize any formal evaluation tools to identify attenuated or emerging psychotic symptoms. Given the costs associated with training and administration, interview-based assessments such as the Structured Interview for Psychosis Risk Syndromes (SIPS) are not likely to be widely adopted for clinical use. The ability to identify high-risk individuals through low-cost, brief methods is essential to the success of scalable prevention efforts. The aim of this article is to present a comprehensive review of the use of self-report forms as psychosis risk "screeners." A literature search revealed 34 investigations in which authors used a self-report questionnaire as a first-step screener in a clinical high-risk assessment protocol. Information about each screener, including reported psychometric data, is presented within the review. Psychosis risk screeners have been used in diverse samples with the goals of validating assessments, screening populations for clinical referral, recruiting samples of interest for research participation, and estimating symptom prevalence and severity. Screeners focusing on attenuated psychotic experiences appear to measure a reliable construct with variable prevalence in help-seeking and general population samples. Administration of screeners to help-seeking populations can identify enriched samples with substantially elevated likelihood of meeting CHR criteria and transitioning to psychosis over time. More research is needed, however, to establish reliable norms and screening thresholds, as score elevations indicating a likely high-risk respondent appear to be unreliable across populations and settings.
Collapse
Affiliation(s)
- Emily Kline
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, United States
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, United States.
| |
Collapse
|