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Rinaldi G, Osman N, Kaess M, Schimmelmann BG, Kindler J, Schultze-Lutter F, Michel C. Exploring the complex relationships between coping strategies, locus of control and self-esteem with psychopathology: structural equation modeling with a special focus on clinical high-risk of psychosis. Eur Psychiatry 2023; 66:e88. [PMID: 37848406 PMCID: PMC10755569 DOI: 10.1192/j.eurpsy.2023.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Coping strategies, competence, and locus of control (LOC) beliefs are important predictors of mental health (MH). However, research into their complex interactions has produced mixed results. Our study investigated them further in the previously unexplored context of clinical high-risk (CHR) of psychosis. METHODS We tested six alternative structural equation models in a community sample (N = 523), hypothesizing a mediating role of coping and treating CHR symptoms as (i) an additional mediator or (ii) a specific outcome. Our measurement model included two latent factors of MH: (1) psychopathology (PP), consisting of presence of mental disorders, global and psychosocial functioning, and (2) self-rated health (SRH) status. RESULTS In the model with the best Akaike Information Criterion and the latent factors as outcome variables, maladaptive coping completely mediated the impact of maladaptive LOC on PP and SRH. Additionally, CHR symptoms partially mediated the effect of maladaptive coping on PP and SRH in the community sample, as long as sex was not entered into the model. In the clinical sample (N = 371), the model did not support a mediation by CHR symptoms, despite significant pathways with both coping and MH outcomes; further, competence beliefs directly impacted SRH. CONCLUSIONS Coping strategies are an important intervention target for MH promotion, especially in the community. In clinical populations, interventions focusing on coping strategies may improve CHR symptoms, thus potentially supporting better MH, especially SRH. Additionally, due to their mostly cascading effects on MH, improving competence and LOC beliefs may also promote psychological well-being.
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Affiliation(s)
- Giulia Rinaldi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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2
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Solmi M, Soardo L, Kaur S, Azis M, Cabras A, Censori M, Fausti L, Besana F, Salazar de Pablo G, Fusar-Poli P. Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment. Mol Psychiatry 2023; 28:2291-2300. [PMID: 37296309 PMCID: PMC10611568 DOI: 10.1038/s41380-023-02029-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 06/12/2023]
Abstract
Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. We conducted a PRISMA/MOOSE-compliant systematic meta-analysis, searching PubMed/PsycInfo up to June 21st, 2021 for observational studies/randomized controlled trials reporting on comorbid DSM/ICD-mental disorders in CHR-P subjects ( protocol ). The primary and secondary outcomes were baseline and follow-up prevalence of comorbid mental disorders. We also explored the association of comorbid mental disorders compared with CHR-P versus psychotic/non-psychotic control groups, their impact on baseline functioning and transition to psychosis. We conducted random-effects meta-analyses, meta-regression, and assessed heterogeneity/publication bias/quality (Newcastle Ottawa Scale, NOS). We included 312 studies (largest meta-analyzed sample = 7834, any anxiety disorder, mean age = 19.98 (3.40), females = 43.88%, overall NOS > 6 in 77.6% of studies). The prevalence was 0.78 (95% CI = 0.73-0.82, k = 29) for any comorbid non-psychotic mental disorder, 0.60 (95% CI = 0.36-0.84, k = 3) for anxiety/mood disorders, 0.44 (95% CI = 0.39-0.49, k = 48) for any mood disorders, 0.38 (95% CI = 0.33-0.42, k = 50) for any depressive disorder/episode, 0.34 (95% CI = 0.30-0.38, k = 69) for any anxiety disorder, 0.30 (95% CI 0.25-0.35, k = 35) for major depressive disorders, 0.29 (95% CI, 0.08-0.51, k = 3) for any trauma-related disorder, 0.23 (95% CI = 0.17-0.28, k = 24) for any personality disorder, and <0.23 in other mental disorders (I2 > 50% in 71.01% estimates). The prevalence of any comorbid mental disorder decreased over time (0.51, 95% CI = 0.25-0.77 over 96 months), except any substance use which increased (0.19, 95% CI = 0.00-0.39, k = 2, >96 months). Compared with controls, the CHR-P status was associated with a higher prevalence of anxiety, schizotypal personality, panic, and alcohol use disorders (OR from 2.90 to 1.54 versus without psychosis), a higher prevalence of anxiety/mood disorders (OR = 9.30 to 2.02) and lower prevalence of any substance use disorder (OR = 0.41, versus psychosis). Higher baseline prevalence of alcohol use disorder/schizotypal personality disorder was negatively associated with baseline functioning (beta from -0.40 to -0.15), while dysthymic disorder/generalized anxiety disorder with higher functioning (beta 0.59 to 1.49). Higher baseline prevalence of any mood disorder/generalized anxiety disorder/agoraphobia (beta from -2.39 to -0.27) was negatively associated with transition to psychosis. In conclusion, over three-quarters of CHR-P subjects have comorbid mental disorders, which modulate baseline functionig and transition to psychosis. Transdiagnostic mental health assessment should be warranted in subjects at CHR-P.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track, First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Matilda Azis
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Anna Cabras
- Sapienza University of Rome, Department of Neurology and Psychiatry, Roma, Italy
| | - Marco Censori
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Dipartimento di Salute Mentale, Azienda ULSS 3 Serenissima, Venezia, Italy
| | - Luigi Fausti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Sapienza University of Rome, Department of Neurology and Psychiatry, Roma, Italy
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London UK, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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3
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Hagler MA, Ferrara M, Yoviene Sykes LA, Li F, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, Powers AR, Allen AR, Srihari VH, Woods SW. Sampling from different populations: Sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high-risk individuals who progressed to psychosis. Schizophr Res 2023; 255:239-245. [PMID: 37028205 PMCID: PMC10207144 DOI: 10.1016/j.schres.2023.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Over the past two decades, research and clinical resources on clinical high risk (CHR) for psychosis have both expanded, with goals to better understanding risk and protective factors on the course of illness and inform early intervention efforts. However, some studies have highlighted potential sampling bias among CHR research studies, raising questions about generalizability of findings and inequitable access to early detection and intervention. The current study sought to explore these questions by comparing 94 participants in a CHR longitudinal monitoring study across North America (NAPLS-2) who converted to syndromal psychosis over the course of the study (CHR-CV) to 171 participants who presented for treatment at a localized first-episode psychosis service (FES) after converting. CHR-CV participants were significantly more likely to be White and have a college-educated parent, while FES participants were more likely to be Black and first- or second-generation immigrants. On average, CHR-CV participants were younger at onset of attenuated positive symptoms, had a longer period of attenuated symptoms prior to conversion, and were more likely to be treated with antipsychotics prior to conversion compared to those in FES programs. After controlling for time since conversion, CHR-CV participants had higher global functioning and were less likely to have experienced recent psychiatric hospitalization. Findings suggest that CHR research and FES clinics may be sampling from different populations, although conclusions are limited by inconsistent sampling frames and methods. Integrated early detection that targets defined geographic catchments may deliver more epidemiologically representative samples to both CHR research and FES.
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Affiliation(s)
- Matthew A Hagler
- Department of Psychiatry, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry, Yale University, New Haven, CT, United States of America; Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Fangyong Li
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Adrienne R Allen
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
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4
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Bröcker AL, Zimmermann J, Stuke F, Just S, Bayer S, Mielau J, Bertram G, Funcke J, Maaßen E, Hadzibegovic J, Lempa G, von Haebler D, Montag C. Exploring the Latent Structure and Convergent and Incremental Validity of the Metacognition Assessment Scale - Abbreviated in a Sample of Patients with Non-Affective Psychosis. J Pers Assess 2023; 105:100-110. [PMID: 35363095 DOI: 10.1080/00223891.2022.2048843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale - Abbreviated (MAS-A). In this study, we investigated the latent structure as well as the interrater reliability and convergent and incremental validity of the MAS-A in a sample of patients with non-affective psychosis. Analyses indicated that the scale might be one-dimensional. Interrater reliability of the MAS-A total score was good. In terms of convergent validity, correlational analyses showed significant associations of MAS-A metacognition with the Operationalized Psychodynamic Diagnosis Level of Structural Integration Axis (OPD-LSIA) and the Levels of Emotional Awareness Scale (LEAS). In terms of construct validity, a significant association was observed between MAS-A metacognition and a short version of the International Classification of Functioning, Disability and Health (MINI-ICF), which persisted after self-report measures of impairments in structural capacities (Structure Questionnaire of Operationalized Psychodynamic Diagnosis [OPD-SQS]) and mentalizing abilities (Mentalization Questionnaire [MZQ]) were included as covariates, but not after symptom dimensions were included. There was a significant correlation with the current living situation, but not with other external criteria like diagnosis or duration of illness. Future studies should explore alternative outcomes and replicate results in longitudinal designs.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | | | - Frauke Stuke
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Samuel Bayer
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Eva Maaßen
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Jasmina Hadzibegovic
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany.,International Psychoanalytic University, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
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5
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Ma WF, Yeh TP, Ho YF, Chang SM, Lin YP. The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university. Perspect Psychiatr Care 2022; 58:1372-1380. [PMID: 34462933 DOI: 10.1111/ppc.12939] [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: 11/11/2020] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS This screen model can be used in early detection for undergraduates with HRDP from large general samples.
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Affiliation(s)
- Wei-Fen Ma
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,College of Health Care, Ph.D Program for Health Science and Industry, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Tzu-Pei Yeh
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Ya-Fang Ho
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Shan-Mei Chang
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Yun-Ping Lin
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
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6
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Monego E, Cremonese C, Gentili F, Fusar-Poli P, Shah JL, Solmi M. Clinical high at-risk mental state in young subjects accessing a mental disorder prevention service in Italy. Psychiatry Res 2022; 316:114710. [PMID: 35878479 DOI: 10.1016/j.psychres.2022.114710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/19/2022]
Abstract
We aim to assess how functioning, depressive symptoms, and psychotic symptoms are associated with different numbers of Clinical High At-Risk Mental State (CHARMS) categories. In this cross-sectional study, we assessed 62 help-seeking subjects aged 15-24 with a drop in functioning, with Structured Clinical Interview for DSM-5, Social and Occupational Functioning Assessment Scale (SOFAS), Comprehensive Assessment of At-Risk Mental State to define risk for psychosis, Hamilton Depression Rating scale (HAM-D), Positive and Negative Symptoms Scale, 6 items (PANSS-6). CHARMS criteria were assessed via retrospective chart review. Overall, 30.6% did not meet any CHARMS component criteria at baseline (CHARMS-), 27.4%, 33.9% and 8.1% met one, two, and three or more CHARMS groups. Overall, 48.8% met criteria for ultra-high risk for psychosis (17.7% without other CHARMS categories), 25.8% risk of borderline personality disorder (3.2% alone), 35.5% mild depression (8.1% alone), 11.3% risk of bipolar disorder (1.6% alone). SOFAS score and HAM-D score worsened from CHARMS- to three or more CHARMS categories, whilst PANSS-6 score did not. In a multivariate regression only PANSS-6 (beta=-1.105, p<0.001) was associated with SOFAS (R2=0.385). Help-seeking youth with poor functioning present symptoms meeting CHARMS criteria. Meeting criteria for multiple CHARMS categories is associated with increased depressive, but not psychotic symptoms, while psychotic symptoms play a prominent role in determining functional impairment. Results should be interpreted within the limitations of the study including the small sample size and the cross-sectional design, and need further replications.
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Affiliation(s)
- Enrico Monego
- Neurosciences Department, University of Padua, Italy
| | | | | | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Jai L Shah
- PEPP-Montreal, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa Ontario; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
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7
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Oliver D, Arribas M, Radua J, Salazar de Pablo G, De Micheli A, Spada G, Mensi MM, Kotlicka-Antczak M, Borgatti R, Solmi M, Shin JI, Woods SW, Addington J, McGuire P, Fusar-Poli P. Prognostic accuracy and clinical utility of psychometric instruments for individuals at clinical high-risk of psychosis: a systematic review and meta-analysis. Mol Psychiatry 2022; 27:3670-3678. [PMID: 35665763 PMCID: PMC9708585 DOI: 10.1038/s41380-022-01611-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023]
Abstract
Accurate prognostication of individuals at clinical high-risk for psychosis (CHR-P) is an essential initial step for effective primary indicated prevention. We aimed to summarise the prognostic accuracy and clinical utility of CHR-P assessments for primary indicated psychosis prevention. Web of Knowledge databases were searched until 1st January 2022 for longitudinal studies following-up individuals undergoing a psychometric or diagnostic CHR-P assessment, reporting transition to psychotic disorders in both those who meet CHR-P criteria (CHR-P + ) or not (CHR-P-). Prognostic accuracy meta-analysis was conducted following relevant guidelines. Primary outcome was prognostic accuracy, indexed by area-under-the-curve (AUC), sensitivity and specificity, estimated by the number of true positives, false positives, false negatives and true negatives at the longest available follow-up time. Clinical utility analyses included: likelihood ratios, Fagan's nomogram, and population-level preventive capacity (Population Attributable Fraction, PAF). A total of 22 studies (n = 4 966, 47.5% female, age range 12-40) were included. There were not enough meta-analysable studies on CHR-P diagnostic criteria (DSM-5 Attenuated Psychosis Syndrome) or non-clinical samples. Prognostic accuracy of CHR-P psychometric instruments in clinical samples (individuals referred to CHR-P services or diagnosed with 22q.11.2 deletion syndrome) was excellent: AUC = 0.85 (95% CI: 0.81-0.88) at a mean follow-up time of 34 months. This result was driven by outstanding sensitivity (0.93, 95% CI: 0.87-0.96) and poor specificity (0.58, 95% CI: 0.50-0.66). Being CHR-P + was associated with a small likelihood ratio LR + (2.17, 95% CI: 1.81-2.60) for developing psychosis. Being CHR-P- was associated with a large LR- (0.11, 95%CI: 0.06-0.21) for developing psychosis. Fagan's nomogram indicated a low positive (0.0017%) and negative (0.0001%) post-test risk in non-clinical general population samples. The PAF of the CHR-P state is 10.9% (95% CI: 4.1-25.5%). These findings consolidate the use of psychometric instruments for CHR-P in clinical samples for primary indicated prevention of psychosis. Future research should improve the ability to rule in psychosis risk.
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Affiliation(s)
- Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Maite Arribas
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London & Maudsley NHS Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Giulia Spada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Childhood and Adolescent Neuropsychiatry Unit, Pavia, Italy
| | - Magdalena Kotlicka-Antczak
- Early Psychosis Diagnosis and Treatment Lab, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Childhood and Adolescent Neuropsychiatry Unit, Pavia, Italy
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON, Canada
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Philip McGuire
- OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
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8
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Dondé C, Jaffiol A, Khouri C, Pouchon A, Tamisier R, Lejoyeux M, d'Ortho MP, Polosan M, Geoffroy PA. Sleep disturbances in early clinical stages of psychotic and bipolar disorders: A meta-analysis. Aust N Z J Psychiatry 2022; 56:1068-1079. [PMID: 34971518 DOI: 10.1177/00048674211068395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide a qualitative view and quantitative measure of sleep disturbances across and between early stages - clinical ultra high-risk and first episode - of psychotic and bipolar disorders. METHODS Electronic databases (PubMed, Cochrane, Embase, PsychINFO) were searched up to March 2021 for studies comparing sleep measures between individuals with an early stage and controls. Standard mean deviations (Cohen's d effect sizes) were calculated for all comparisons and pooled with random-effects models. Chi-square tests were used for direct between-subgroups (ultra high-risk vs first episode) comparisons of standard mean deviations. The effects of age, sex ratio, symptoms and treatment were examined in meta-regression analyses. RESULTS A database search identified 13 studies that contrasted sleep measures between individuals with an early stage (N = 537) and controls (N = 360). We observed poorer subjective sleep quality (standard mean deviation = 1.32; 95% confidence interval, [1.01, 1.62]), shorter total sleep time (standard mean deviation =-0.44; 95% confidence interval, [-0.67, -0.21]), lower sleep efficiency (standard mean deviation = -0.72; 95% confidence interval, [-1.08, -0.36]), longer sleep onset latency (standard mean deviation = 0.75; 95% confidence interval, [0.45, 1.06]) and longer duration of wake after sleep onset (standard mean deviation = 0.49; 95% confidence interval, [0.21, 0.77]) were observed in early stages compared to controls. No significant differences were observed for any of the reported electroencephalographic parameters of sleep architecture. No significant between-subgroups differences were observed. Meta-regressions revealed a significant effect of the age and the antipsychotic status on subjective measures of sleep. CONCLUSION The early stage population presents with significant impairments of subjective sleep quality continuity, duration and initiation. Systematic assessments of sleep in early intervention settings may allow early identification and treatment of sleep disturbances in this population.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Antoine Jaffiol
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Adult Psychiatry Department, 38000 Grenoble, France
| | - Charles Khouri
- Univ. Grenoble Alpes, CHU Grenoble Alpes, HP2, Clinical Pharmacology Department, INSERM CIC1406, 38000 Grenoble, France
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Pneumology and Physiology Department, Thorax and vessels pole, 38000 Grenoble, France
| | - Michel Lejoyeux
- Université de Paris, Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Bichat Hospital - Claude Bernard, GHU Paris - Psychiatry & Neurosciences, Paris, France
| | - Marie-Pia d'Ortho
- Université de Paris, NeuroDiderot, Inserm U1141, Sleep Medicine and Clinical Physiology Department, AP-HP, GHU Paris Nord, DMU DREAM, Bichat Hospital, Paris, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Adult Psychiatry Department, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Pierre A Geoffroy
- Université de Paris, Psychiatry and Addictology Department, AP-HP, GHU Paris Nord, DMU Neurosciences, Bichat Hospital - Claude Bernard, GHU Paris - Psychiatry & Neurosciences, Paris, France.,Université de Paris, NeuroDiderot, Inserm U1141, Sleep Medicine and Clinical Physiology Department, AP-HP, GHU Paris Nord, DMU DREAM, Bichat Hospital, Paris, France
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9
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Millman ZB, Roemer C, Vargas T, Schiffman J, Mittal VA, Gold JM. Neuropsychological Performance Among Individuals at Clinical High-Risk for Psychosis vs Putatively Low-Risk Peers With Other Psychopathology: A Systematic Review and Meta-Analysis. Schizophr Bull 2022; 48:999-1010. [PMID: 35333372 PMCID: PMC9434467 DOI: 10.1093/schbul/sbac031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND HYPOTHESIS Youth at clinical high-risk (CHR) for psychosis present with neuropsychological impairments relative to healthy controls (HC), but whether these impairments are distinguishable from those seen among putatively lower risk peers with other psychopathology remains unknown. We hypothesized that any excess impairment among CHR cohorts beyond that seen in other clinical groups is minimal and accounted for by the proportion who transition to psychosis (CHR-T). STUDY DESIGN We performed a systematic review and meta-analysis of studies comparing cognitive performance among CHR youth to clinical comparators (CC) who either sought mental health services but did not meet CHR criteria or presented with verified nonpsychotic psychopathology. STUDY RESULTS Twenty-one studies were included representing nearly 4000 participants. Individuals at CHR showed substantial cognitive impairments relative to HC (eg, global cognition: g = -0.48 [-0.60, -0.34]), but minimal impairments relative to CC (eg, global cognition: g = -0.13 [-0.20, -0.06]). Any excess impairment among CHR was almost entirely attributable to CHR-T; impairment among youth at CHR without transition (CHR-NT) was typically indistinguishable from CC (eg, global cognition, CHR-T: g = -0.42 [-0.64, -0.19], CHR-NT: g = -0.09 [-0.18, 0.00]; processing speed, CHR-T: g = -0.59 [-0.82, -0.37], CHR-NT: g = -0.12 [-0.25, 0.07]; working memory, CHR-T: g = -0.42 [-0.62, -0.22], CHR-NT: g = -0.03 [-0.14, 0.08]). CONCLUSIONS Neurocognitive impairment in CHR cohorts should be interpreted cautiously when psychosis or even CHR status is the specific clinical syndrome of interest as these impairments most likely represent a transdiagnostic vs psychosis-specific vulnerability.
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Affiliation(s)
- Zachary B Millman
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Caroline Roemer
- Psychology Department, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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Smesny S, Gussew A, Schack S, Langbein K, Wagner G, Reichenbach JR. Neurometabolic patterns of an "at risk for mental disorders" syndrome involve abnormalities in the thalamus and anterior midcingulate cortex. Schizophr Res 2022; 243:285-295. [PMID: 32444202 DOI: 10.1016/j.schres.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The ultra-high risk (UHR) paradigm allows the investigation of individuals at increased risk of developing psychotic or other mental disorders with the aim of making prevention and early intervention as specific as possible in terms of the individual outcome. METHODS Single-session 1H-/31P-Chemical Shift Imaging of thalamus, prefrontal (DLPFC) and anterior midcingulate (aMCC) cortices was applied to 69 UHR patients for psychosis and 61 matched healthy controls. N-acetylaspartate (NAA), glutamate/glutamine complex (Glx), energy (PCr, ATP) and phospholipid metabolites were assessed, analysed by ANOVA (or ANCOVA [with covariates]) and correlated with symptomatology (SCL-90R). RESULTS The thalamus showed decreased NAA, inversely correlated with self-rated aggressiveness, as well as increased PCr, and altered phospholipid breakdown. While the aMCC showed a pattern of NAA decrease and PCr increase, the DLPFC showed PCr increase only in the close-to-psychosis patient subgroup. There were no specific findings in transition patients. CONCLUSION The results do not support the notion of a specific pre-psychotic neurometabolic pattern, but likely reflect correlates of an "at risk for mental disorders syndrome". This includes disturbed neuronal (mitochondrial) metabolism in the thalamus and aMCC, with emphasis on left-sided structures, and altered PL remodeling across structures.
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Affiliation(s)
- Stefan Smesny
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany.
| | - Alexander Gussew
- Department of Radiology, Halle University Hospital, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Stephan Schack
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Kerstin Langbein
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Gerd Wagner
- Department of Psychiatry, Jena University Hospital, Philosophenweg 3, D-07743 Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Philosophenweg 3, D-07740 Jena, Germany
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11
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Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e9. [PMID: 35042573 PMCID: PMC8786617 DOI: 10.1017/s2045796021000639] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. METHODS "Preferred Reporting Items for Systematic reviews and Meta-Analyses" and "Meta-analysis Of Observational Studies in Epidemiology"-compliant meta-analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs. those who did transition to psychosis at follow-up. We conducted random-effects model meta-analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). RESULTS Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β = -0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β = -0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. CONCLUSIONS Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.
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12
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Estradé A, Spencer TJ, De Micheli A, Murguia-Asensio S, Provenzani U, McGuire P, Fusar-Poli P. Mapping the implementation and challenges of clinical services for psychosis prevention in England. Front Psychiatry 2022; 13:945505. [PMID: 36660464 PMCID: PMC9844094 DOI: 10.3389/fpsyt.2022.945505] [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: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Indicated primary prevention of psychosis is recommended by NICE clinical guidelines, but implementation research on Clinical High Risk for Psychosis (CHR-P) services is limited. METHODS Electronic audit of CHR-P services in England, conducted between June and September 2021, addressing core implementation domains: service configuration, detection of at-risk individuals, prognostic assessment, clinical care, clinical research, and implementation challenges, complemented by comparative analyses across service model. Descriptive statistics, Fisher's exact test and Mann-Whitney U-tests were employed. RESULTS Twenty-four CHR-P clinical services (19 cities) were included. Most (83.3%) services were integrated within other mental health services; only 16.7% were standalone. Across 21 services, total yearly caseload of CHR-P individuals was 693 (average: 33; range: 4-115). Most services (56.5%) accepted individuals aged 14-35; the majority (95.7%) utilized the Comprehensive Assessment of At Risk Mental States (CAARMS). About 65% of services reported some provision of NICE-compliant interventions encompassing monitoring of mental state, cognitive-behavioral therapy (CBT), and family interventions. However, only 66.5 and 4.9% of CHR-P individuals actually received CBT and family interventions, respectively. Core implementation challenges included: recruitment of specialized professionals, lack of dedicated budget, and unmet training needs. Standalone services reported fewer implementation challenges, had larger caseloads (p = 0.047) and were more likely to engage with clinical research (p = 0.037) than integrated services. DISCUSSION While implementation of CHR-P services is observed in several parts of England, only standalone teams appear successful at detection of at-risk individuals. Compliance with NICE-prescribed interventions is limited across CHR-P services and unmet needs emerge for national training and investments.
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Affiliation(s)
- Andrés Estradé
- 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
| | - Tom John Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrea De Micheli
- 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.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Silvia Murguia-Asensio
- Tower Hamlets Early Detection Service (THEDS), East London NHS Foundation Trust, London, United Kingdom
| | - Umberto Provenzani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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13
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Fekih-Romdhane F, Hallit S, Cheour M, Jahrami H. The nature, consequences, mechanisms, and management of sleep disturbances in individuals at-risk for psychosis. Front Psychiatry 2022; 13:1011963. [PMID: 36203842 PMCID: PMC9530454 DOI: 10.3389/fpsyt.2022.1011963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
There is strong evidence that sleep disturbances are commonly experienced by people with psychosis. Evidence has also shown that sleep disturbances are present since the very early stages of the disease, even during the pre-diagnostic phase. More recently, research involving young individuals at ultra-high risk (UHR) for psychosis documented frequent occurrence of sleep disturbances in this group. The very early onset of sleep disturbances in the course of psychosis has drawn attention to the possible links between sleep parameters and the risk of psychosis. To date, the nature of sleep disturbances characterizing the UHR stage remains unclear, with available studies having yielded mixed findings. In this regard, we performed this review to update the body of literature on the nature of sleep disturbances, their underlying mechanisms, their clinical and functional consequences, the prevention and intervention strategies in the at-risk for psychosis population. Our findings provided further support to the presence of disturbed sleep in UHR individuals as evidenced by subjective and objective sleep measures such as polysomnography, sleep electroencephalograms, and actigraphy. Reviewing the possible mechanisms underlying the relationship between sleep and psychosis emphasized its complex and multifactorial nature which is yet to be determined and understood. Further research is warranted to determine which facets of sleep disturbances are most detrimental to this specific population, and to what extent they can be causal factors or markers of psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.,Department of Psychiatry, Ministry of Health, Manama, Bahrain
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14
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Salokangas RKR, From T, Ilonen T, Luutonen S, Heinimaa M, Armio RL, Laurikainen H, Walta M, Paju J, Toivonen A, Jalo P, Tuominen L, Hietala J. Short-term functional outcome in psychotic patients: results of the Turku early psychosis study (TEPS). BMC Psychiatry 2021; 21:602. [PMID: 34856968 PMCID: PMC8641211 DOI: 10.1186/s12888-021-03516-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Functional recovery of patients with clinical and subclinical psychosis is associated with clinical, neuropsychological and developmental factors. Less is known about how these factors predict functional outcomes in the same models. We investigated functional outcomes and their predictors in patients with first-episode psychosis (FEP) or a confirmed or nonconfirmed clinical high risk of psychosis (CHR-P vs. CHR-N). METHODS Altogether, 130 patients with FEP, 60 patients with CHR-P and 47 patients with CHR-N were recruited and extensively examined at baseline (T0) and 9 (T1) and 18 (T2) months later. Global Assessment of Functioning (GAF) at T0, T1 and T2 and psychotic, depression, and anxiety symptoms at T1 and T2 were assessed. Functional outcomes were predicted using multivariate repeated ANOVA. RESULTS During follow-up, the GAF score improved significantly in patients with FEP and CHR-P but not in patients with CHR-N. A single marital status, low basic education level, poor work situation, disorganization symptoms, perceptual deficits, and poor premorbid adjustment in patients with FEP, disorganization symptoms and poor premorbid adjustment in patients with CHR-P, and a low basic education level, poor work situation and general symptoms in patients with CHR-N predicted poor functional outcomes. Psychotic symptoms at T1 in patients with FEP and psychotic and depression symptoms at T1 and anxiety symptoms at T2 in patients with CHR-P were associated with poor functioning. CONCLUSIONS In patients with FEP and CHR-P, poor premorbid adjustment and disorganization symptomatology are common predictors of the functional outcome, while a low education level and poor work situation predict worse functional outcomes in patients with FEP and CHR-N. Interventions aimed at improving the ability to work and study are most important in improving the functioning of patients with clinical or subclinical psychosis.
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Affiliation(s)
- Raimo K R Salokangas
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland.
| | - Tiina From
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Sinikka Luutonen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, Turku, Finland
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Reetta-Liina Armio
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Heikki Laurikainen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Maija Walta
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Janina Paju
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Anna Toivonen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
| | - Päivi Jalo
- Department of Psychiatry, Turku University Hospital, Turku, Finland
| | - Lauri Tuominen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
- Royal Ottawa Mental Health Centre, Ottawa, Canada
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, FIN-20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, Turku, Finland
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15
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Provenzani U, Salazar de Pablo G, Arribas M, Pillmann F, Fusar-Poli P. Clinical outcomes in brief psychotic episodes: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2021; 30:e71. [PMID: 35698876 PMCID: PMC8581951 DOI: 10.1017/s2045796021000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with brief psychotic episodes (BPE) have variable and fluctuating clinical outcomes which challenge psychiatric care. Our meta-analysis aims at providing a comprehensive summary of several clinical outcomes in this patient group. METHODS A multistep systematic PRISMA/MOOSE-compliant literature search was performed for articles published from inception until 1st March 2021. Web of Science database was searched, complemented by manual search of original articles reporting relevant outcomes (psychotic recurrence, prospective diagnostic change or stability, remission, quality of life, functional status, mortality and their predictors) for patients diagnosed with acute and transient psychotic disorders (ATPD), brief psychotic disorders (BPD), brief intermittent psychotic symptoms (BIPS) and brief limited intermittent psychotic symptoms (BLIPS). Random-effects methods and Q-statistics were employed, quality assessment with Newcastle-Ottawa Scale, assessment of heterogeneity with I2 index, sensitivity analyses (acute polymorphic psychotic disorders, APPD) and multiple meta-regressions, assessment of publication bias with funnel plot, Egger's test and meta-regression (psychotic recurrence and sample size). RESULTS A total of 91 independent articles (n = 94 samples) encompassed 37 ATPD, 24 BPD, 19 BLIPS and 14 BIPS samples, totalling 15 729 individuals (mean age: 30.89 ± 7.33 years, mean female ratio: 60%, 59% conducted in Europe). Meta-analytical risk of psychotic recurrence for all BPE increased from 15% (95% confidence interval (CI) 12-18) at 6 months, 25% (95% CI 22-30) at 12 months, 30% (95% CI 27-33) at 24 months and 33% (95% CI 30-37) at ⩾36 months follow-up, with no differences between ATPD, BPD, BLIPS and BIPS after 2 years of follow-up. Across all BPE, meta-analytical proportion of prospective diagnostic stability (average follow-up 47 months) was 49% (95% CI 42-56); meta-analytical proportion of diagnostic change (average follow-up 47 months) to schizophrenia spectrum psychoses was 19% (95% CI 16-23), affective spectrum psychoses 5% (95% CI 3-7), other psychotic disorders 7% (95% CI 5-9) and other (non-psychotic) mental disorders 14% (95% CI 11-17). Prospective diagnostic change within APPD without symptoms of schizophrenia was 34% (95% CI 24-46) at a mean follow-up of 51 months: 18% (95% CI 11-30) for schizophrenia spectrum psychoses and 17% (95% CI 10-26) for other (non-psychotic) mental disorders. Meta-analytical proportion of baseline employment was 48% (95% CI 38-58), whereas there were not enough data to explore the other outcomes. Heterogeneity was high; female ratio and study quality were negatively and positively associated with risk of psychotic recurrence, respectively. There were no consistent factor predicting clinical outcomes. CONCLUSIONS Short-lived psychotic episodes are associated with a high risk of psychotic recurrences, in particular schizophrenia spectrum disorders. Other clinical outcomes remain relatively underinvestigated. There are no consistent prognostic/predictive factors.
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Affiliation(s)
- U. Provenzani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - G. Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. Arribas
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - F. Pillmann
- AWO Center of Psychatry, Halle, Germany
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | - P. Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
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16
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Di Biase MA, Cetin-Karayumak S, Lyall AE, Zalesky A, Cho KIK, Zhang F, Kubicki M, Rathi Y, Lyons MG, Bouix S, Billah T, Anticevic A, Schleifer C, Adkinson BD, Ji JL, Tamayo Z, Addington J, Bearden CE, Cornblatt BA, Keshavan MS, Mathalon DH, McGlashan TH, Perkins DO, Cadenhead KS, Tsuang MT, Woods SW, Stone WS, Shenton ME, Cannon TD, Pasternak O. White matter changes in psychosis risk relate to development and are not impacted by the transition to psychosis. Mol Psychiatry 2021; 26:6833-6844. [PMID: 34024906 PMCID: PMC8611104 DOI: 10.1038/s41380-021-01128-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/14/2021] [Indexed: 02/04/2023]
Abstract
Subtle alterations in white matter microstructure are observed in youth at clinical high risk (CHR) for psychosis. However, the timing of these changes and their relationships to the emergence of psychosis remain unclear. Here, we track the evolution of white matter abnormalities in a large, longitudinal cohort of CHR individuals comprising the North American Prodrome Longitudinal Study (NAPLS-3). Multi-shell diffusion magnetic resonance imaging data were collected across multiple timepoints (1-5 over 1 year) in 286 subjects (aged 12-32 years): 25 CHR individuals who transitioned to psychosis (CHR-P; 61 scans), 205 CHR subjects with unknown transition outcome after the 1-year follow-up period (CHR-U; 596 scans), and 56 healthy controls (195 scans). Linear mixed effects models were fitted to infer the impact of age and illness-onset on variation in the fractional anisotropy of cellular tissue (FAT) and the volume fraction of extracellular free water (FW). Baseline measures of white matter microstructure did not differentiate between HC, CHR-U and CHR-P individuals. However, age trajectories differed between the three groups in line with a developmental effect: CHR-P and CHR-U groups displayed higher FAT in adolescence, and 4% lower FAT by 30 years of age compared to controls. Furthermore, older CHR-P subjects (20+ years) displayed 4% higher FW in the forceps major (p < 0.05). Prospective analysis in CHR-P did not reveal a significant impact of illness onset on regional FAT or FW, suggesting that transition to psychosis is not marked by dramatic change in white matter microstructure. Instead, clinical high risk for psychosis-regardless of transition outcome-is characterized by subtle age-related white matter changes that occur in tandem with development.
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Affiliation(s)
- Maria A Di Biase
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia.
| | - Suheyla Cetin-Karayumak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amanda E Lyall
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, VIC, Australia
| | - Kang Ik Kevin Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Monica G Lyons
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvain Bouix
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tashrif Billah
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Anticevic
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | | | - Brendan D Adkinson
- Yale Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
| | - Jie Lisa Ji
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Zailyn Tamayo
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Barbara A Cornblatt
- Department of Psychiatry and Psychology, The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Psychology, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
- The Zucker Hillside Hospital, New York, NY, USA
| | - Matcheri S Keshavan
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel H Mathalon
- University of California, San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Thomas H McGlashan
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Diana O Perkins
- Department of Psychology, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
- University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Kristen S Cadenhead
- Department of Psychiatry, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Scott W Woods
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - William S Stone
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyrone D Cannon
- Department of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Damiani S, Rutigliano G, Fazia T, Merlino S, Berzuini C, Bernardinelli L, Politi P, Fusar-Poli P. Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study. Schizophr Bull 2021; 47:1695-1705. [PMID: 34172999 PMCID: PMC8530399 DOI: 10.1093/schbul/sbab070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy.
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Affiliation(s)
- Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, Pisa, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Carlo Berzuini
- Center for Biostatistics, The University of Manchester, Manchester, UK
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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18
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Salazar de Pablo G, Radua J, Pereira J, Bonoldi I, Arienti V, Besana F, Soardo L, Cabras A, Fortea L, Catalan A, Vaquerizo-Serrano J, Coronelli F, Kaur S, Da Silva J, Shin JI, Solmi M, Brondino N, Politi P, McGuire P, Fusar-Poli P. Probability of Transition to Psychosis in Individuals at Clinical High Risk: An Updated Meta-analysis. JAMA Psychiatry 2021; 78:970-978. [PMID: 34259821 PMCID: PMC8281006 DOI: 10.1001/jamapsychiatry.2021.0830] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research. OBJECTIVE To quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P. DATA SOURCES PubMed and Web of Science databases until November 1, 2020. Manual search of references from previous articles. STUDY SELECTION Longitudinal studies reporting transition risks in individuals at CHR-P. DATA EXTRACTION AND SYNTHESIS Meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines; independent data extraction, manually and through digitalization of Kaplan-Meier curves. MAIN OUTCOME AND MEASURES Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years' follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. These analyses were complemented by meta-analytical Kaplan-Meier curves and speed of transition to psychosis (hazard rate). Random-effects meta-analysis, between-study heterogeneity analysis, study quality assessment, and meta-regressions were conducted. RESULTS A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male. The cumulative transition risk was 0.09 (95% CI, 0.07-0.10; k = 37; n = 6485) at 0.5 years, 0.15 (95% CI, 0.13-0.16; k = 53; n = 7907) at 1 year, 0.20 (95% CI, 0.17-0.22; k = 30; n = 5488) at 1.5 years, 0.19 (95% CI, 0.17-0.22; k = 44; n = 7351) at 2 years, 0.25 (95% CI, 0.21-0.29; k = 19; n = 3114) at 2.5 years, 0.25 (95% CI, 0.22-0.29; k = 29; n = 4029) at 3 years, 0.27 (95% CI, 0.23-0.30; k = 16; n = 2926) at 4 years, and 0.28 (95% CI, 0.20-0.37; k = 14; n = 2301) at more than 4 years. The cumulative Kaplan-Meier transition risk was 0.08 (95% CI, 0.08-0.09; n = 4860) at 0.5 years, 0.14 (95% CI, 0.13-0.15; n = 3408) at 1 year, 0.17 (95% CI, 0.16-0.19; n = 2892) at 1.5 years, 0.20 (95% CI, 0.19-0.21; n = 2357) at 2 years, 0.25 (95% CI, 0.23-0.26; n = 1444) at 2.5 years, 0.27 (95% CI, 0.25-0.28; n = 1029) at 3 years, 0.28 (95% CI, 0.26-0.29; n = 808) at 3.5 years, 0.29 (95% CI, 0.27-0.30; n = 737) at 4 years, and 0.35 (95% CI, 0.32-0.38; n = 114) at 10 years. The hazard rate only plateaued at 4 years' follow-up. Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%). CONCLUSIONS AND RELEVANCE In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Joana Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Ilaria Bonoldi
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Vincenzo Arienti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Besana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livia Soardo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Cabras
- Department of Neurology and Psychiatry, University of Rome La Sapienza, Rome, Italy
| | - Lydia Fortea
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Bizkaia, Spain
| | - Julio Vaquerizo-Serrano
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Francesco Coronelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simi Kaur
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Josette Da Silva
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
| | - Jae Il Shin
- Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Neurosciences Department, University of Padova, Padova, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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19
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Svancer P, Spaniel F. Brain ventricular volume changes in schizophrenia. A narrative review. Neurosci Lett 2021; 759:136065. [PMID: 34146640 DOI: 10.1016/j.neulet.2021.136065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Brain ventricles are among the most studied structures in psychotic illness. In our mini-review we present available evidence on brain ventricle changes during the course of schizophrenia, from high-risk subjects and the first episode of schizophrenia to patients with chronic schizophrenia. We present current findings on the relationship between ventricle changes and level of psychopathology. The potential pathophysiological background of ventricle changes is also discussed. Understanding the dynamics of brain ventricle changes could resolve long-standing questions on the proportion of neurodegenerative and neurodevelopmental processes in the pathophysiology of schizophrenia.
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Affiliation(s)
- Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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20
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Dondé C, Laprévote V, Lavallé L, Haesebaert F, Fakra E, Brunelin J. Cognitive insight in individuals with an at-risk mental state for psychosis: A meta-analysis. Early Interv Psychiatry 2021; 15:449-456. [PMID: 32452629 DOI: 10.1111/eip.12993] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/09/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
AIM To compare cognitive insight abilities measured with the Beck Cognitive Insight Scale (BCIS) between individuals with an at-risk mental state (ARMS) and healthy controls. METHOD Review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A search for articles investigating cognitive insight in ARMS in the MEDLINE and ScienceDirect databases revealed five studies including 303 ARMS and 376 controls. Regarding BCIS subscales, ARMS individuals displayed significant higher scores for self-certainty than controls with a small-to-moderate effect size (ESg = 0.45 [0.23;0.67], P < .005), whereas no significant difference was observed for self-reflectiveness (ESg = -0.56 [-0.18;1.29], P = .14). No significant differences were observed between ARMS and controls for overall cognitive insight abilities as indexed by the BCIS composite score (ESg = -0.24 [-0.43;0.91], P = .45). CONCLUSIONS Self-certainty abnormalities seem to predate the expression of full-blown psychotic episode and to be higher in ARMS than in healthy controls. By contrast, ARMS did not display abnormal self-reflectiveness and overall cognitive insight abilities.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Vincent Laprévote
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.,Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Layla Lavallé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Eric Fakra
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jerome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, PSYR2 Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
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21
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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22
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Chang WC, Ng CM, Chan KN, Lee HC, Chan SI, Chiu SS, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Chan CWH, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Psychiatric comorbidity in individuals at-risk for psychosis: Relationships with symptoms, cognition and psychosocial functioning. Early Interv Psychiatry 2021; 15:616-623. [PMID: 32441490 DOI: 10.1111/eip.12992] [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: 01/08/2020] [Revised: 04/01/2020] [Accepted: 04/28/2020] [Indexed: 02/04/2023]
Abstract
AIM Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals. METHODS One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS). Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition non-psychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted. RESULTS Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. CONCLUSION Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings underscore a potential critical role of psychiatric comorbidity in determining social functioning and subjective QoL in at-risk individuals. Further longitudinal research is required to clarify trajectories of comorbid disorder status and its prospective impact on clinical and functional outcomes in ARMS populations.
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Affiliation(s)
- Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Chung Mun Ng
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwun Nam Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hoi Ching Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Suet In Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Shirley Sanyin Chiu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | | | - Kwok Ling Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Wai Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Lam Wai Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Shiu Yin Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Man Wa Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Tak Lam Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Man Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Lap Tak Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Wai Chung Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Yip Chau Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Wai Sau Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Yi Man Mo
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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23
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Mensi MM, Molteni S, Iorio M, Filosi E, Ballante E, Balottin U, Fusar-Poli P, Borgatti R. Prognostic Accuracy of DSM-5 Attenuated Psychosis Syndrome in Adolescents: Prospective Real-World 5-Year Cohort Study. Schizophr Bull 2021; 47:1663-1673. [PMID: 33939829 PMCID: PMC8530398 DOI: 10.1093/schbul/sbab041] [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] [Indexed: 12/15/2022]
Abstract
There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 ± 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell's C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.
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Affiliation(s)
- Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neuropsychiatry Unit, ASST Lariana, Como, Italy
| | - Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia,Italy,BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; via Mondino 2, 27100 Pavia, Italy; tel: +390382430211, fax: +390382430236, e-mail:
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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24
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McIlwaine SV, Shah J. Mental Health Services Research Targeting the Clinical High-Risk State for Psychosis: Lessons, Future Directions and Integration with Patient Perspectives. Curr Psychiatry Rep 2021; 23:11. [PMID: 33533984 DOI: 10.1007/s11920-021-01224-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW We summarize the history of the clinical high-risk stage of psychosis (CHR), current research on this stage and recent critiques of the field, and evaluate current CHR guidelines and frameworks. RECENT FINDINGS Following its identification and characterization, CHR services have successfully been developed in North America, Europe, Australia and elsewhere. As reflected in guidelines, these services and their orientation largely emerged as an outgrowth of the framework pioneered by early intervention services for first-episode psychosis. We critically discuss what is known so far about the subjective experience of the CHR syndrome, the meaning of this "unofficial" diagnosis as well as what is known and unknown about the service-related needs. While a range of outstanding questions remain in the field, there is a particular need for patient-oriented work and to investigate the service-related needs of young people at CHR.
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Affiliation(s)
- Sarah V McIlwaine
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Programme for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 7070 boul. Champlain, Verdun, Montreal, QC, H4H 1A8, Canada
| | - Jai Shah
- Prevention and Early Intervention Programme for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, 7070 boul. Champlain, Verdun, Montreal, QC, H4H 1A8, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
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25
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Law H, Izon E, Au-Yeung K, Morrison AP, Byrne R, Notley C, Yung A, Norrie J, French P. Combined individual and family therapy in comparison to treatment as usual for people at-risk of psychosis: A feasibility study (IF CBT): Trial rationale, methodology and baseline characteristics. Early Interv Psychiatry 2021; 15:140-148. [PMID: 31876397 DOI: 10.1111/eip.12922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/29/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
AIMS Current National Institute for Health and Care Excellence (NICE) guidelines for psychosis recommend psychological therapy with or without family intervention for individuals at-risk of developing psychosis. NICE guidelines have a specific research recommendation to investigate the clinical and cost effectiveness of combined individual and family intervention. We report the rationale, design and baseline characteristics of a feasibility study which aimed to investigate combined Individual and Family Cognitive Behavioural Therapy (IFCBT) for those at-risk of developing psychosis. METHODS The IFCBT study was a single blind, pilot randomized controlled trial (RCT) to compare a combined individual and family Cognitive Behavioural Therapy (CBT) intervention to treatment as usual. Participants were assessed using the Comprehensive Assessment of the At-risk Mental State (CAARMS) and randomly allocated to either therapy or enhanced treatment as usual (ETAU). All participants were followed up at 6 and 12 months. Primary feasibility outcomes were recruitment and retention of participants. Secondary outcomes included transition to psychosis and assessment of mood, anxiety and the relationship of the individual and nominated family member. RESULTS We report data showing entry into the study from initial enquiry to randomization. We report the characteristics of the recruited sample of individuals (n = 70) and family members (n = 70) at baseline. CONCLUSIONS The study recruited to 92% of target demonstrating it is feasible to identify and recruit participants. Our study aimed to add to the current evidence base regarding the utility of family interventions for people at-risk of psychosis.
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Affiliation(s)
- Heather Law
- Greater Manchester Mental Health NHS Foundation Trust, Research and Development, UK.,University of Manchester, UK
| | - Emma Izon
- Greater Manchester Mental Health NHS Foundation Trust, Research and Development, UK.,University of Manchester, UK
| | - Karmen Au-Yeung
- Greater Manchester Mental Health NHS Foundation Trust, Research and Development, UK
| | - Anthony P Morrison
- Greater Manchester Mental Health NHS Foundation Trust, Research and Development, UK.,University of Manchester, UK
| | - Rory Byrne
- Greater Manchester Mental Health NHS Foundation Trust, Research and Development, UK.,University of Manchester, UK
| | | | | | - John Norrie
- University of Edinburgh, Centre for Population Health Sciences, UK
| | - Paul French
- Manchester Metropolitan University, UK.,Pennine Care NHS Foundation Trust, UK
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26
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Salazar de Pablo G, Estradé A, Cutroni M, Andlauer O, Fusar-Poli P. Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry 2021; 11:43. [PMID: 33441556 PMCID: PMC7807021 DOI: 10.1038/s41398-020-01165-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and provides guidelines for translational implementation. We conducted a PRISMA/MOOSE-compliant (PROSPERO-CRD42020163640) systematic review of Web of Science to identify studies until 4/05/2020 reporting on CHR-P service configuration, outreach strategy and referrals, service user characteristics, interventions, and outcomes. Fifty-six studies (1998-2020) were included, encompassing 51 distinct CHR-P services across 15 countries and a catchment area of 17,252,666 people. Most services (80.4%) consisted of integrated multidisciplinary teams taking care of CHR-P and other patients. Outreach encompassed active (up to 97.6%) or passive (up to 63.4%) approaches: referrals came mostly (90%) from healthcare agencies. CHR-P individuals were more frequently males (57.2%). Most (70.6%) services accepted individuals aged 12-35 years, typically assessed with the CAARMS/SIPS (83.7%). Baseline comorbid mental conditions were reported in two-third (69.5%) of cases, and unemployment in one third (36.6%). Most services provided up to 2-years (72.4%), of clinical monitoring (100%), psychoeducation (81.1%), psychosocial support (73%), family interventions (73%), individual (67.6%) and group (18.9%) psychotherapy, physical health interventions (37.8%), antipsychotics (87.1%), antidepressants (74.2%), anxiolytics (51.6%), and mood stabilisers (38.7%). Outcomes were more frequently ascertained clinically (93.0%) and included: persistence of symptoms/comorbidities (67.4%), transition to psychosis (53.5%), and functional status (48.8%). We provide ten practical recommendations for implementation of CHR-P services. Health service knowledge summarised by the current study will facilitate translational efforts for implementation of CHR-P services worldwide.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical and Health Psychology, Catholic University, Montevideo, Uruguay
| | - Marcello Cutroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Olivier Andlauer
- Heads UP Service, East London NHS Foundation Trust, London, UK
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
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27
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Clarke L, Chisholm K, Cappuccio FP, Tang NKY, Miller MA, Elahi F, Thompson AD. Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis. Schizophr Res 2021; 227:81-91. [PMID: 32646803 DOI: 10.1016/j.schres.2020.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and investigate how sleep disturbances relate to psychotic symptoms, functioning and Quality of Life (QoL) in At Risk Mental State (ARMS) youth. METHOD A comprehensive search of six databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and CENTRAL) was conducted. Eligible studies provided data on sleep disturbances or disorders in ARMS patients. RESULTS Sixteen studies met the inclusion criteria (n = 1962 ARMS patients) including 7 cross-sectional studies, 2 RCT's and 7 cohort studies. Narrative synthesis revealed that self-reported sleep (e.g., general disturbances, fragmented night time sleep and nightmares) was poorer among ARMS patients compared to healthy controls. In the limited studies (n = 4) including objective measurements of sleep disturbances, ARMS patients experienced higher levels of movement during sleep, more daytime naps and increased sleep latency compared to controls. Furthermore, sleep disturbances were associated with attenuated psychotic symptoms and functional outcomes cross-sectionally and longitudinally. Only one study investigated the relationship between sleep and QoL. The exploratory meta-analysis revealed a significant difference in self-reported sleep disturbances measured by the PSQI (mean difference in score: 3.30 (95% CI 1.87, 4.74), p < 0.00001) and SIPS (mean difference in score: 1.58 (95% CI 0.80, 2.35), p < 0.00001) of ARMS patients compared to control groups. CONCLUSIONS ARMS individuals report impaired sleep quality and reduced sleep quantity compared to healthy controls. However, further research is needed to explore the longitudinal relationship between sleep disruptions and QoL in early psychosis. Significant variations in how sleep is measured across studies highlight a need to assess disturbances to sleep using robust and consistent approaches in this patient group.
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Affiliation(s)
- Latoya Clarke
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Francesco P Cappuccio
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Michelle A Miller
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Farah Elahi
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew D Thompson
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
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28
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Hinterbuchinger B, Mossaheb N. Psychotic-Like Experiences: A Challenge in Definition and Assessment. Front Psychiatry 2021; 12:582392. [PMID: 33854445 PMCID: PMC8039445 DOI: 10.3389/fpsyt.2021.582392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Abstract
Assuming a continuum between psychotic experiences and psychotic symptoms aligned between healthy individuals and patients with non-psychotic and psychotic disorders, recent research has focused on subclinical psychotic experiences. The wide variety of definitions, assessment tools, and concepts of psychotic-like experiences (PLEs) might contribute to the mixed findings concerning prevalence and persistence rates and clinical impact. In this narrative review, we address the panoply of terminology, definitions, and assessment tools of PLEs and associated concerns with this multitude. Moreover, the ambiguous results of previous studies regarding the clinical relevance of PLEs are described. In conclusion, we address clinical implications and highly suggest conceptual clarity and consensus concerning the terminology and definition of PLEs. The development of an agreed upon use of a "gold standard" assessment tool seems essential for more comparable findings in future research.
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Affiliation(s)
- Barbara Hinterbuchinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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29
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Wang FG, Lou ML, Lu SH, Yen WJ, Tsai CL, Ma WF. A preliminary study on the effectiveness of a stress management program for healthcare-related undergraduates with at-risk mental state. Perspect Psychiatr Care 2021; 57:88-97. [PMID: 32394496 DOI: 10.1111/ppc.12528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/12/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to examine the effects of a stress management program on stress perception and coping strategies for healthcare-related undergraduates with at-risk mental state (ARMS). DESIGN AND METHODS A randomized experimental design with pretest and posttest was used. Of the 2812 students screened, 65 were identified as having ARMS, 52 enrolled in the study, and 49 (75%) completed the study. FINDINGS Significance was found for subjects with schizotypal traits in emotion expression and problem-avoidance coping strategies. Subjects with trait anxiety improved significantly in interpersonal deficits after the program. PRACTICE IMPLICATIONS Students with different trait risks reported benefits in different stress-coping strategies from the program.
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Affiliation(s)
- Fong-Gang Wang
- Department of Forensic Psychiatry, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Criminology, National Chung Cheng University, Chiayi County, Taiwan
| | - Mei-Ling Lou
- Department of Public Health (in Nursing), China Medical University, Taichung City, Taiwan.,Department of Nursing, Hungkuang University, Taichung City, Taiwan
| | - Siang-Han Lu
- School of Nursing, China Medical University, Taichung City, Taiwan
| | - Wen-Jiuan Yen
- School of Nursing, Chung-Shan Medical University, Taichung City, Taiwan
| | - Ching-Lun Tsai
- Department of Public Health (in Epidemiology and Preventive Medicine), China Medical University, Taichung City, Taiwan
| | - Wei-Fen Ma
- School of Nursing, China Medical University, Taichung City, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung City, Taiwan
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30
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Woods SW, Bearden CE, Sabb FW, Stone WS, Torous J, Cornblatt BA, Perkins DO, Cadenhead KS, Addington J, Powers AR, Mathalon DH, Calkins ME, Wolf DH, Corcoran CM, Horton LE, Mittal VA, Schiffman J, Ellman LM, Strauss GP, Mamah D, Choi J, Pearlson GD, Shah JL, Fusar-Poli P, Arango C, Perez J, Koutsouleris N, Wang J, Kwon JS, Walsh BC, McGlashan TH, Hyman SE, Gur RE, Cannon TD, Kane JM, Anticevic A. Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit. Schizophr Res 2021; 227:10-17. [PMID: 32402605 PMCID: PMC8218020 DOI: 10.1016/j.schres.2020.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. METHOD Response to points of critique. RESULTS We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. DISCUSSION Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA.
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Department Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Fred W Sabb
- Lewis Center for Neuroimaging, University of Oregon, Eugene, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - John Torous
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Daniel Mamah
- Department of Psychiatry, Washington University in Saint Louis, MO, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, UK; Department of Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Celso Arango
- Dept. of Child and Adolescent Psychiatry, Universidad Complutense de Madrid, Spain
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, UK
| | | | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, South Korea
| | - Barbara C Walsh
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | | | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
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Kotlicka-Antczak M, Podgórski M, Oliver D, Maric NP, Valmaggia L, Fusar-Poli P. Worldwide implementation of clinical services for the prevention of psychosis: The IEPA early intervention in mental health survey. Early Interv Psychiatry 2020; 14:741-750. [PMID: 32067369 DOI: 10.1111/eip.12950] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 12/31/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical research into the Clinical High Risk state for Psychosis (CHR-P) has allowed primary indicated prevention in psychiatry to improve outcomes of psychotic disorders. The strategic component of this approach is the implementation of clinical services to detect and take care of CHR-P individuals, which are recommended by several guidelines. The actual level of implementation of CHR-P services worldwide is not completely clear. AIM To assess the global geographical distribution, core characteristics relating to the level of implementation of CHR-P services; to overview of the main barriers that limit their implementation at scale. METHODS CHR-P services worldwide were invited to complete an online survey. The survey addressed the geographical distribution, general implementation characteristics and implementation barriers. RESULTS The survey was completed by 47 CHR-P services offering care to 22 248 CHR-P individuals: Western Europe (51.1%), North America (17.0%), East Asia (17.0%), Australia (6.4%), South America (6.4%) and Africa (2.1%). Their implementation characteristics included heterogeneous clinical settings, assessment instruments and length of care offered. Most CHR-P patients were recruited through mental or physical health services. Preventive interventions included clinical monitoring and crisis management (80.1%), supportive therapy (70.2%) or structured psychotherapy (61.7%), in combination with pharmacological treatment (in 74.5%). Core implementation barriers were staffing and financial constraints, and the recruitment of CHR-P individuals. The dynamic map of CHR-P services has been implemented on the IEPA website: https://iepa.org.au/list-a-service/. CONCLUSIONS Worldwide primary indicated prevention of psychosis in CHR-P individuals is possible, but the implementation of CHR-P services is heterogeneous and constrained by pragmatic challenges.
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Affiliation(s)
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nadja P Maric
- Faculty of Medicine, University of Belgrade, Belgrade & Clinic for Psychiatry Clinical Centre of Serbia, Belgrade, Serbia
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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32
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Fusar-Poli P, De Micheli A, Signorini L, Baldwin H, Salazar de Pablo G, McGuire P. Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care. EClinicalMedicine 2020; 28:100578. [PMID: 33294806 PMCID: PMC7700893 DOI: 10.1016/j.eclinm.2020.100578] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Most services for individuals at Clinical High Risk for Psychosis (CHR-P) provide short-term clinical care. This study determines the real-world and long-term clinical outcomes beyond transition to psychosis in a large cohort of CHR-P individuals. METHOD Retrospective RECORD-compliant real-world Electronic Health Records (EHR) cohort study in secondary mental health care (the South London and the Maudsley -SLaM- NHS Foundation Trust). All CHR-P patients accessing the CHR-P service at SLaM in the period 2001-2018 were included. Main outcomes were long-term cumulative risk of first: (i) developing an ICD-10 psychotic disorder (primary outcome), receiving a treatment with (iia) antipsychotic medication, (iib) benzodiazepines, (iic) other psychotropic medications, (iid) psychotherapy, receiving an (iiia) informal or (iiib) compulsory admission into a mental health hospital, and the time to these events; (iiic) number of days spent in hospital and (iv) cumulative risk of death for any reason and age/gender Standardised Mortality Ratio (SMR). Data were extracted from the EHR and analysed with Kaplan Meier failure functions, Cox and zero-inflated negative binomial regressions. FINDINGS 600 CHR-P patients (80.43% Attenuated Psychotic Symptoms, APS; 18.06%, Brief and Limited Intermittent Psychotic Symptoms, BLIPS, 1.51% Genetic Risk and Deterioration Syndrome) were included (mean age 22.63 years, range 13-36; 55.33% males; 46.44% white, mean duration of untreated attenuated psychotic symptoms 676.32 days, 1105.40 SD). The cumulative risk to first psychosis was 0.365 (95%CI 0.302-0.437) at 11 years; first antipsychotic 0.777 (95%CI 0.702-0.844) at 9 years; first benzodiazepine 0.259 (95%CI 0.183-0.359) at 12 years; first other types of medications 0.630 (95%CI 0.538-0.772) at 9 years; first psychotherapy 0.814 (95%CI 0.764-0.859) at 9 years; first informal admission 0.378 (95%CI 0.249-0.546) at 12 years; first compulsory admission 0.251 (95%CI 0.175-0.352) at 12 years; those admitted spent on average 94.84 (SD=169.94) days in hospital; the cumulative risk of death for any reason was 0.036 (95%CI 0.012-0.103) at 9 years, with an SMR of 3.9 (95%CI 1.20-6.6). Compared to APS, BLIPS had a higher risk of developing psychosis, being admitted compulsorily into hospital, receiving antipsychotics and benzodiazepines and lower probability of receiving psychotherapy. Other prognostic factors of long-term outcomes included age, symptoms severity, duration of untreated attenuated psychotic symptoms, ethnicity and employment status. INTERPRETATION Duration of care provided by CHR-P services should be expanded to address long-term real-world outcomes. FUNDING This study was supported by the King's College London Confidence in Concept award from the Medical Research Council (MRC) (MC_PC_16048) to PF-P. GSP is supported by the Alicia Koplowitz Foundation. HB is supported by a National Institute for Health Research Maudsley Biomedical Research Centre studentship.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
- Department of Brain and Behavioral Sciences, University
of Pavia, Pavia, Italy
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Lorenzo Signorini
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- Institute of Psychiatry and Mental Health. Department
of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio
Marañón School of Medicine, Universidad Complutense, Instituto de Investigación
Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Philip McGuire
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
- Department of Psychosis Studies, Institute of
Psychiatry, Psychology & Neuroscience, King's College London, London,
UK
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Fusar-Poli P, Spencer T, De Micheli A, Curzi V, Nandha S, McGuire P. Outreach and support in South-London (OASIS) 2001-2020: Twenty years of early detection, prognosis and preventive care for young people at risk of psychosis. Eur Neuropsychopharmacol 2020; 39:111-122. [PMID: 32921544 PMCID: PMC7540251 DOI: 10.1016/j.euroneuro.2020.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
This study aims to describe twenty years of early detection, prognosis and preventive care in the Outreach and Support In South-London (OASIS) mental health service for individuals at Clinical High risk of psychosis (CHR-P). The study presents a comprehensive analysis of the 2001- 2020 activity of the OASIS team encompassing core domains: (i) service characteristics, (ii) detection, (iii) prognosis, (iv) treatment and (v) clinical research. The analyses employed descriptive statistics, population-level data, the epidemiological incidence of psychosis, Kaplan Meier failure functions and Greenwood 95% CIs and Electronic Health Records. OASIS is part of the South London and Maudsley (SLaM) NHS trust, the largest European mental health provider, serving a total urban population of 1,358,646 individuals (population aged 16-35: 454,525). Incidence of psychosis in OASIS's catchment area ranges from 58.3 to 71.9 cases per 100,000 person-years, and it is higher than the national average of 41.5 cases per 100,000 person-year. OASIS is a standalone, NHS-funded, multidisciplinary (team leader, consultant and junior psychiatrists, clinical psychologists, mental health professionals), transitional (for those aged 14-35 years) community mental health service with a yearly caseload of 140 CHR-P individuals. OASIS regularly delivers a comprehensive service promotion outreach to several local community organisations. Referrals to OASIS (2366) are made by numerous agencies; about one-third of the referrals eventually met CHR-P criteria. Overall, 600 CHR-P individuals (55.33% males, mean age 22.63 years, white ethnicity 46.44%) have been under the care of the OASIS service: 80.43% met attenuated psychotic symptoms, 18.06% brief and limited intermittent psychotic symptoms and 1.51% genetic risk and deterioration CHR-P criteria. All CHR-P individuals were offered cognitive behavioural therapy and psychosocial support; medications were used depending on individual needs. The cumulative risk of psychosis at ten years was 0.365 (95%CI 0.302-0.437). At six years follow-up, across two-third of individuals non-transitioning to psychosis, 79.24% still displayed some mental health problem, and only 20.75% achieved a complete clinical remission. Research conducted at OASIS encompassed clinical, prognostic, neurobiological and interventional studies and leveraged local, national and international infrastructures; over the past ten years, OASIS-related research attracted about £ 50 million of grant income, with 5,922 citations in the international databases. Future developments may include broadening OASIS to prevent other serious mental disorders beyond psychosis and fostering translational risk prediction and interventional research. With a twenty-years activity, OASIS' cutting-edge quality of preventive care, combined with translational research innovations, consolidated the service as a leading reference model for evidence-based prevention of psychosis worldwide.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Thomas Spencer
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Victoria Curzi
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sunil Nandha
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Wigman JTW, Pijnenborg GHM, Bruggeman R, Vos M, Wessels A, Oosterholt I, Nauta M, Stelwagen R, Otto L, Wester A, Wunderink L, Sportel E, Boonstra N. Onset and transition of and recovery from adverse development: Study methodology. Early Interv Psychiatry 2020; 14:568-576. [PMID: 31691504 PMCID: PMC7496076 DOI: 10.1111/eip.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/07/2019] [Accepted: 09/24/2019] [Indexed: 01/26/2023]
Abstract
AIM Early intervention programs for first-episode psychosis have led to the awareness that the period before onset of a first episode is important in light of early intervention. This has induced a focus on the so-called 'at risk mental state' (ARMS). Individuals with ARMS are at increased risk for later psychotic disorder, but also for other psychiatric disorders as well as poor psychosocial functioning. Thus, adequate detection and treatment of ARMS is essential. METHODS Since 2018, screening for and treatment of ARMS is recommended standard care in the Netherlands. Implementation is still ongoing. We initiated a naturalistic long-term cohort study of ARMS individuals, the onset and transition of and recovery from adverse development (OnTheROAD) study, with the aim to monitor course and outcome of symptoms and psychosocial functioning over time, as well as patterns of comorbidity and associations with factors of risk and resilience. To this end, participants complete a broad battery of instruments at baseline and yearly follow-up assessments up to 3 years. Outcome is defined in terms of symptom severity level, functioning and quality of life. In particular, we aim to investigate the impact of negative symptoms as part of the ARMS concept. Results from this study can aid in refining the existing ARMS criteria, understanding the developmental course of ARMS and investigating the hypothesized pluripotentiality in outcome of ARMS. New knowledge may inform the further development of specialized early interventions. RESULTS AND CONCLUSIONS In this article, we describe the rationale, outline and set-up of OnTheROAD.
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Affiliation(s)
- Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Gerdina H M Pijnenborg
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Maarten Vos
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anita Wessels
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mediant Mental Health Organization, Enschede, The Netherlands
| | - Inez Oosterholt
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Dimence Mental Health Organization, Deventer, The Netherlands
| | - Maaike Nauta
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Department of Psychology, University of Groningen, Groningen, The Netherlands.,Accare Youth Mental Health Organization, Groningen, The Netherlands
| | - Renee Stelwagen
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lana Otto
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Anniek Wester
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands
| | - Lex Wunderink
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
| | - Esther Sportel
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,GGZ (Mental Health Organization) Drenthe, Assen, The Netherlands
| | - Nynke Boonstra
- University of Groningen, University Medical Center Groningen, Rob Giel Research Centre (RGOc), University of Groningen, Groningen, The Netherlands.,Mental Health Organization Friesland, Leeuwarden, The Netherlands
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35
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Petros N, Cullen AE, Fusar-Poli P, Mechelli A, McGuire P. Towards standardising the assessment of good outcome in people at clinical high risk for psychosis: A collaborative approach. Schizophr Res 2020; 223:361-362. [PMID: 32713747 DOI: 10.1016/j.schres.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), South London and Maudsley NHS Foundation Trust, UK
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36
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Monsonet M, Kwapil TR, Barrantes-Vidal N. Deconstructing the relationships between self-esteem and paranoia in early psychosis: an experience sampling study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:503-523. [PMID: 32862467 PMCID: PMC7693052 DOI: 10.1111/bjc.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/21/2020] [Indexed: 12/27/2022]
Abstract
Background No studies have examined the association between self‐esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self‐esteem relate to daily‐life paranoia across at‐risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self‐esteem and paranoia were examined. Design This study used a multilevel, cross‐sectional design. Methods One‐hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self‐esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self‐esteem were also collected. Results Global momentary and trait self‐esteem, and their positive and negative dimensions, were related to daily‐life paranoia in both ARMS and FEP groups. Conversely, implicit self‐esteem was not associated with daily‐life paranoia in either group. Anxiety negatively moderated the association between positive self‐esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self‐esteem and higher paranoia. Conclusions Different types, measures and dimensions of self‐esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily‐life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions. Practitioner points Different measures (trait and momentary) and dimensions (positive and negative) of explicit self‐esteem are distinctly related to paranoia across risk and first‐episode stages of psychosis. Explicit, but not implicit, self‐esteem is associated with real‐life paranoia in incipient psychosis. Anxiety boosted the association of poor self‐esteem and paranoia ideation in daily‐life. Social closeness, but feeling cared for by others in particular, interacts with self‐esteem tempering the expression of paranoia in real life.
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Affiliation(s)
- Manel Monsonet
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas R Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, USA
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
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37
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Mennigen E, Bearden CE. Psychosis Risk and Development: What Do We Know From Population-Based Studies? Biol Psychiatry 2020; 88:315-325. [PMID: 32061373 PMCID: PMC7305046 DOI: 10.1016/j.biopsych.2019.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/23/2022]
Abstract
Recent years have seen an advent in population-based studies in children, adolescents, and adults that examine the prevalence, etiology, and developmental trajectories of diverse subclinical psychopathological symptoms that pose a risk for the later development of severe mental illnesses. It is increasingly recognized that most categorically defined psychiatric disorders occur on a spectrum or continuum, show high heterogeneity and symptom overlap, and share genetic and environmental risk factors. We discuss neurodevelopmental underpinnings of psychosis spectrum symptoms and review brain morphometric and functional alterations as well as genetic liability for psychosis in individuals experiencing psychotic symptoms (PSs) in the general population. With regard to brain structure and function, findings of qualitatively similar alterations in individuals experiencing subthreshold PSs and individuals with overt psychotic disorders support the notion of a psychosis continuum. However, genetic and epidemiological studies have emphasized the overlap of PSs and other psychiatric illnesses. In particular, PSs during adolescence appear to be a nonspecific precursor of different psychopathological outcomes. Given the evidence presented in this review, we argue that findings from population-based studies are appropriate to guide policy-making to further emphasize public health efforts. Broadly accessible mental health programs are promising to make a difference in the field of adolescent mental health. However, the specific efficacy of these programs warrants further study, and caution is advised to not overpathologize potentially transient occurrence of mental health problems.
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Affiliation(s)
- Eva Mennigen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California; Department of Psychology, University of California, Los Angeles, Los Angeles, California.
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38
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Leopold K, Bauer M, Bechdolf A, Correll CU, Holtmann M, Juckel G, Lambert M, Meyer TD, Pfeiffer S, Kittel-Schneider S, Reif A, Stamm TJ, Rottmann-Wolf M, Mathiebe J, Kellmann EL, Ritter P, Krüger-Özgürdal S, Karow A, Sondergeld LM, Roessner V, Sauer C, Pfennig A. Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study. Bipolar Disord 2020; 22:517-529. [PMID: 32112496 DOI: 10.1111/bdi.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at-risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive-behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. METHOD In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. RESULTS Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between-group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop-outs. CONCLUSIONS Results suggest that young patients at-risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University Cologne, Köln, Germany
| | - Christoph U Correll
- Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Center for Psychiatric Neuroscience Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Psychiatry, Recognition and Prevention (RAP) Program, The Zucker Hillside Hospital, Long Island, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, LWL-University Hospital Hamm, Ruhr-University, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, Houston, TX, USA
| | - Steffi Pfeiffer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany
| | - Thomas J Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Maren Rottmann-Wolf
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Josephine Mathiebe
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Eva L Kellmann
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL- University Hospital Bochum, Ruhr-University, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Medical School Brandenburg, Neuruppin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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A Sequential Emotion Approach for Diagnosing Mental Disorder on Social Media. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mental disorder has been affecting numerous individuals; however, mental health care is in a passive state where only a minority of individuals actively seek professional help. Due to the rapid development of social networks, individuals accustomed to expressing their raw feelings on social media include patients who are suffering great pain from mental disorders. To distinguish individuals who merely feel sad and others who have mental disorders, the symptoms of mental disorder are taken into consideration. These symptoms constantly arise as a regular pattern like shifting of emotions or repeating of one representative emotion during a certain time. We proposed a Mental Disorder Identification Model (MDI-Model) to identify the four most commonly occurring mental disorders in the world: anxiety disorder, bipolar disorder, depressive disorder, and obsessive-compulsive disorder (OCD). The MDI-Model compares the sequential emotion pattern from users to identify mental disorders to detect those who are in a high risk. Tweets of diagnosed mental disorder users were analyzed to evaluate the accuracy of the MDI-Model, furthermore, the tweets of users from six different occupations were analyzed to verify the precision and predict the tendency of mental disorder among the different occupations. Results show that the MDI-Model can efficiently diagnose users with high precision in different mental statuses as severe, moderate, and mild stage, or tendency of mental disorder and mentally healthy status.
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Studerus E, Beck K, Fusar-Poli P, Riecher-Rössler A. Development and Validation of a Dynamic Risk Prediction Model to Forecast Psychosis Onset in Patients at Clinical High Risk. Schizophr Bull 2020; 46:252-260. [PMID: 31355885 PMCID: PMC7442327 DOI: 10.1093/schbul/sbz059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The prediction of outcomes in patients at Clinical High Risk for Psychosis (CHR-P) almost exclusively relies on static data obtained at a single snapshot in time (ie, baseline data). Although the CHR-P symptoms are intrinsically evolving over time, available prediction models cannot be dynamically updated to reflect these changes. Hence, the aim of this study was to develop and internally validate a dynamic risk prediction model (joint model) and to implement this model in a user-friendly online risk calculator. Furthermore, we aimed to explore the prognostic performance of extended dynamic risk prediction models and to compare static with dynamic prediction. One hundred ninety-six CHR-P patients were recruited as part of the "Basel Früherkennung von Psychosen" (FePsy) study. Psychopathology and transition to psychosis was assessed at regular intervals for up to 5 years using the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Various specifications of joint models were compared with regard to their cross-validated prognostic performance. We developed and internally validated a joint model that predicts psychosis onset from BPRS-E disorganization and years of education at baseline and BPRS-E positive symptoms during the follow-up with good prognostic performance. The model was implemented as online risk calculator (http://www.fepsy.ch/DPRP/). The use of extended joint models slightly increased the prognostic accuracy compared to basic joint models, and dynamic models showed a higher prognostic accuracy than static models. Our results confirm that extended joint modeling could improve the prediction of psychosis in CHR-P patients. We implemented the first online risk calculator that can dynamically update psychosis risk prediction.
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Affiliation(s)
- Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland,To whom correspondence should be addressed; tel: +41-61-325-59-95, e-mail:
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - 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, UK,OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,National Institute of Health Research—Mental Health—Translational Research Collaboration—Early Psychosis Workstream, London, UK
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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Onozato M, Uta A, Magarida A, Fukuoka N, Ichiba H, Tsujino N, Funatogawa T, Tagata H, Nemoto T, Mizuno M, Fukushima T. Alterations in methionine to homocysteine ratio in individuals with first-episode psychosis and those with at-risk mental state. Clin Biochem 2019; 77:48-53. [PMID: 31843665 DOI: 10.1016/j.clinbiochem.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Disturbance of the methionine (Met) cycle, which produces Met from homocysteine (Hcy), is suggested to be involved in several diseases, including psychiatric disorders. This study was aimed to investigate both levels of Met and Hcy in serum from individuals with first-episode psychosis (FEP) and individuals with at-risk mental state (ARMS). METHOD We measured serum Met and Hcy levels in individuals with FEP (n = 13) and ARMS (n = 30) using HPLC with fluorescence detection and LC-ESI-MS/MS. Met and Hcy levels in healthy controls (n = 41) were also measured. Differences between the 3 groups were analyzed by one-way analysis of variance (ANOVA) with Bonferroni correction. RESULTS Serum Met levels were decreased (p = 0.038) and Hcy levels were increased (p = 0.017) in the FEP group. Hcy levels were also significantly increased compared to the ARMS group (p = 0.016), while Met levels were not significantly different between the FEP and ARMS groups. A significant decrease in the Met to Hcy ratio (Met/Hcy) was observed in the FEP group compared to both the control (p = 4.58 × 10-4) and ARMS (p = 8.07 × 10-3) groups. Furthermore, Met/Hcy ratio was correlated with Positive and Negative Syndrome Scale, especially positive scores (p = 5.90 × 10-5). CONCLUSION Taken together, these data indicate that a decrease in the serum Met/Hcy ratio may be a risk factor for developing psychosis during the transition from ARMS to FEP, and may prove to be a useful marker of the phase between ARMS and FEP.
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Affiliation(s)
- Mayu Onozato
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Arisa Uta
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Ayaka Magarida
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Naomi Fukuoka
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Hideaki Ichiba
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Naohisa Tsujino
- Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi Ward, Yokohama, Kanagawa 230-0012, Japan
| | - Tomoyuki Funatogawa
- Department of Neuropsychiatry, Toho University School of Medicine, 6-11-1, Omorinishi, Otaku, Tokyo 143-8541, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine, 6-11-1, Omorinishi, Otaku, Tokyo 143-8541, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, 6-11-1, Omorinishi, Otaku, Tokyo 143-8541, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, 6-11-1, Omorinishi, Otaku, Tokyo 143-8541, Japan
| | - Takeshi Fukushima
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan.
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Fusar-Poli P, Davies C, Solmi M, Brondino N, De Micheli A, Kotlicka-Antczak M, Shin JI, Radua J. Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence). Front Psychiatry 2019; 10:764. [PMID: 31920732 PMCID: PMC6917652 DOI: 10.3389/fpsyt.2019.00764] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned. Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis. Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk. Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs. Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Neuroscience Department, Psychiatry Unit, Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
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Hüfner K, Brugger H, Caramazza F, Stawinoga AE, Brodmann-Maeder M, Gatterer H, Turner R, Tomazin I, Fusar-Poli P, Sperner-Unterweger B. Development of a Self-Administered Questionnaire to Detect Psychosis at High Altitude: The HAPSY Questionnaire. High Alt Med Biol 2019; 20:352-360. [DOI: 10.1089/ham.2019.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Katharina Hüfner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Clinic for Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Fabio Caramazza
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Clinic for Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | | | - Monika Brodmann-Maeder
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Iztok Tomazin
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - 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
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Clinic for Psychiatry II, Innsbruck Medical University, Innsbruck, Austria
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Campion J, Taylor MJ, McDaid D, Park AL, Shiers D. Applying economic models to estimate local economic benefits of improved coverage of early intervention for psychosis. Early Interv Psychiatry 2019; 13:1424-1430. [PMID: 30740880 DOI: 10.1111/eip.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
AIM Early Intervention Psychosis Services (EIPS) for people experiencing First Episode Psychosis (FEP) offer important clinical and non-clinical benefits over standard care. Similarly, intervention for Clinical High Risk for Psychosis state (CHR-P) can prevent psychosis, ameliorate symptoms and have non-clinical benefits. This study aimed to estimate associated local economic benefits of FEP and CHR-P services compared with standard care. METHODS Across four south London boroughs, proportion of annual number of new cases of FEP and CHR-P seen by early intervention services was estimated. Economic modelling conducted for England's mental health strategy was applied to estimate local economic impacts of current and improved service provision. RESULTS Across four London boroughs during 2011/2012, proportion of 15-34 year olds with FEP seen by EIPS was 100.2% assuming 80/100 000 annual incidence whereas proportion with CHR-P seen by CHR-P services was 4.1% assuming 200/100 000 annual incidence. Application of economic modelling suggests that provision of EIPS to reach all new FEP cases each year would free up resources of £13.1m over 10 years including £2.0m to National Health Service (NHS) after the first year. Scaling up to reach all new CHR-P cases each year would free up resources of £19.7m over 10 years with an estimated 10-year cost of implementation gap for each 1 year cohort of £18.9m. An earlier related briefing resulted in increased funding for EIPS and new CHR-P services despite overall cuts to mental health services. CONCLUSIONS Estimation of local economic impacts of FEP and CHR-P services was associated with improved investment in such services.
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Affiliation(s)
- Jonathan Campion
- Psychosis Clinical Academic Group and Public Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Brain Sciences, University College London, London, UK
| | - Matthew J Taylor
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations. Epidemiol Psychiatr Sci 2019; 29:e67. [PMID: 31739812 PMCID: PMC8061208 DOI: 10.1017/s2045796019000635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). METHODS Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. RESULTS One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. CONCLUSIONS BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.
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Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
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Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
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48
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Beck K, Studerus E, Andreou C, Egloff L, Leanza L, Simon AE, Borgwardt S, Riecher-Rössler A. Clinical and functional ultra-long-term outcome of patients with a clinical high risk (CHR) for psychosis. Eur Psychiatry 2019; 62:30-37. [PMID: 31514058 DOI: 10.1016/j.eurpsy.2019.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Few studies have followed up patients with a clinical high risk (CHR) for psychosis for more than 2-3 years. We aimed to investigate the rates and baseline predictors for remission from CHR and transition to psychosis over a follow-up period of up to 16 years. Additionally, we examined the clinical and functional long-term outcome of CHR patients who did not transition. METHODS We analyzed the long-term course of CHR patients that had been included in the longitudinal studies "Früherkennung von Psychosen" (FePsy) or "Bruderholz" (BHS). Those patients who had not transitioned to psychosis during the initial follow-up periods (2/5 years), were invited for additional follow-ups. RESULTS Originally, 255 CHR patients had been included. Of these, 47 had transitioned to psychosis during the initial follow-ups. Thus, 208 were contacted for the long-term follow-up, of which 72 (34.6%) participated. From the original sample of 255, 26%, 31%, 35%, and 38% were estimated to have transitioned after 3, 5, 10, and 16 years, respectively, and 51% had remitted from their high risk status at the latest follow-up. Better psychosocial functioning at baseline was associated with a higher rate of remission. Of the 72 CHR patients re-assessed at long-term follow-up, 60 had not transitioned, but only 28% of those were fully recovered clinically and functionally. CONCLUSIONS Our study shows the need for follow-ups and clinical attention longer than the usual 2-3 years as there are several CHR patients with later transitions and only a minority of CHR those without transition fully recovers.
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Affiliation(s)
- Katharina Beck
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Department of Psychology, Division of Developmental and Personality Psychology, Basel, Switzerland
| | - Christina Andreou
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Laura Egloff
- University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland; Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Letizia Leanza
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Andor E Simon
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel Psychiatric Hospital, Basel, Switzerland
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Beck K, Andreou C, Studerus E, Heitz U, Ittig S, Leanza L, Riecher-Rössler A. Clinical and functional long-term outcome of patients at clinical high risk (CHR) for psychosis without transition to psychosis: A systematic review. Schizophr Res 2019; 210:39-47. [PMID: 30651204 DOI: 10.1016/j.schres.2018.12.047] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/09/2018] [Accepted: 12/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on patients at clinical high risk (CHR) for psychosis has so far mainly focused on those with transition to frank psychosis (CHR-T patients). However, the majority of CHR patients do not transition (CHR-NT patients) and relatively little information is available on their clinical and functional outcome. METHODS We conducted a systematic review on clinical and functional long-term outcome of CHR-NT patients. Studies were included if they had an average follow-up period of at least 24 months and reported on long-term outcome of CHR-NT patients in one or more of the following domains: (non-)remission from CHR, prevalence of clinical symptoms and/or clinical diagnoses (axis I and II), and psychosocial functioning. RESULTS Ten publications from seven different single or multicenter studies with average follow-up durations of 2-7.5 years could be included. At the last follow-up assessment 28-71% of CHR-NT patients were not remitted from their CHR and 22-82% still had at least one clinical diagnosis. Approximately half of CHR-NT patients presented with poor psychosocial outcome at 2-year and 6-year follow-up. CONCLUSIONS The results suggest that, in the long-term, the majority of CHR-NT patients are not in full clinical remission and seem to suffer from one or more clinical disorders and psychosocial impairments. Since relatively few studies could be identified, further research is required to better understand the trajectories and clinical needs of CHR-NT patients.
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Affiliation(s)
- Katharina Beck
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Christina Andreou
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Sarah Ittig
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Letizia Leanza
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland.
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Peralta D, Studerus E, Andreou C, Beck K, Ittig S, Leanza L, Egloff L, Riecher-Rössler A. Exploring the predictive power of the unspecific risk category of the Basel Screening Instrument for Psychosis. Early Interv Psychiatry 2019; 13:969-976. [PMID: 30019850 DOI: 10.1111/eip.12719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 01/21/2023]
Abstract
AIM Ultrahigh risk (UHR) criteria, consisting of brief limited intermittent psychotic symptoms (BLIPS), attenuated psychotic symptoms (APS) and genetic risk and deterioration (GRD) syndrome are the most widely used criteria for assessing the clinical high-risk state for psychosis (CHR-P). The Basel Screening Instrument for Psychosis (BSIP) includes a further risk category, the unspecific risk category (URC). However, little is known about the predictive power of this risk category compared to other risk categories. METHODS Two hundred CHR-P patients were detected as part of the Früherkennung von Psychosen (FePsy) study using the BSIP. Transition to psychosis was assessed in regular intervals for up to 7 years. RESULTS Patients meeting only the URC criterion (n = 40) had a significantly lower risk of transition to psychosis than the UHR group (including BLIPS, APS and GRD) (HR 0.19 [0.05; 0.80] (P = 0.024). Furthermore, the URC only risk group had a lower transition risk than the APS without BLIPS group (P = 0.015) and a trendwise lower risk than the BLIPS group (P = 0.066). However, despite the lower transition risk in the URC only group, there were still two patients (5%) in this group with a later transition to psychosis. CONCLUSIONS The URC includes patients who have a lower risk of transition than those included by the UHR categories and thereby increases the sensitivity of the BSIP. This offers the possibility of a stratified intervention, with these subjects receiving low intensity follow-up and treatment.
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Affiliation(s)
- David Peralta
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Inpatient Unit, Zamudio Psychiatric Hospital, Mental Health Network of Biscay (Osakidetza), Bilbao, Spain
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Katharina Beck
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Letizia Leanza
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Laura Egloff
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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