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Ferrara M, Basaldella M, Vacca F, Woods SW, Walsh BC, Cannon TD, Srihari VH, Grassi L. The Italian adaptation of the Mini-SIPS, a tool for early detection of individuals at clinical high risk and first episode of psychosis: A preliminary study of implementation in an Italian FEP program. Early Interv Psychiatry 2024. [PMID: 38769052 DOI: 10.1111/eip.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/26/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
AIMS The study aims are to present the Italian adaptation of the Abbreviated Clinical Structured Interview for DSM-5 Attenuated Psychosis Syndrome (Mini-SIPS) and illustrate its implementation in a clinical setting. METHODS The Mini-SIPS was developed from the original extended version as a tool designed to identify, within the clinical high risk (CHR) framework, the DSM-5 Attenuated Psychosis Syndrome (APS) and to be implemented in clinical settings. The Mini-SIPS was translated in Italian by a Yale-certified SIPS trainer, then back-translated in English by a trained psychologist, then approved by the Mini-SIPS authors. Since September 2021, the adapted Italian version of the Mini-SIPS has been implemented at the First Episode Psychosis (FEP) Program in Ferrara, Italy. RESULTS The Italian version of Mini-SIPS was successfully administered to 15 individuals subsequently referred to the First Episode Psychosis service in Ferrara. Within this sample, the tool has proven to be both an effective and efficient tool for the identification of CHR and FEP, and a valid instrument to help with the differential diagnosis. It also performed as a valuable guide for retrieving information about psychiatric history, to date the onset of APS and/or full-blown psychosis, to track the progression from CHR to psychosis or to symptoms resolution and to describe patients' pathways to care. CONCLUSION The Mini-SIPS is an efficient and easy-to-use interview to identify the early stages of psychosis and established psychosis in clinical contexts. The Italian adaptation of this interview could be effectively implemented in other Italian FEP Programs as a screening and monitoring tool. Formal validation of the instrument is needed to assessed validity and reliability in the diagnosis of the CHR and FEP.
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Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Health Authority (AUSL), Ferrara, Italy
- Department of Psychiatry, Program for Specialized Treatment Early in Psychosis (STEP), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marta Basaldella
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Francesca Vacca
- Department of Mental Health and Pathological Addictions, Modena Health Authority (AUSL), Modena, Italy
| | - Scott W Woods
- Department of Psychology, Yale University, New Haven, USA
| | | | | | - Vinod H Srihari
- Department of Mental Health and Pathological Addictions, Modena Health Authority (AUSL), Modena, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Health Authority (AUSL), Ferrara, Italy
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2
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Lundin NB, Blouin AM, Cowan HR, Moe AM, Wastler HM, Breitborde NJK. Identification of Psychosis Risk and Diagnosis of First-Episode Psychosis: Advice for Clinicians. Psychol Res Behav Manag 2024; 17:1365-1383. [PMID: 38529082 PMCID: PMC10962362 DOI: 10.2147/prbm.s423865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.
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Affiliation(s)
- Nancy B Lundin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Alexandra M Blouin
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Henry R Cowan
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Aubrey M Moe
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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3
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Riccioni A, Siracusano M, Vasta M, Ribolsi M, Nastro FF, Gialloreti LE, Di Lorenzo G, Mazzone L. Clinical profile and conversion rate to full psychosis in a prospective cohort study of youth affected by autism spectrum disorder and attenuated psychosis syndrome: A preliminary report. Front Psychiatry 2022; 13:950888. [PMID: 36213900 PMCID: PMC9542639 DOI: 10.3389/fpsyt.2022.950888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Psychosis can occur at high rates in individuals with autism spectrum disorder (ASD). However, the detection of prodromal psychotic symptoms, including attenuated psychosis syndrome (APS), conditions at high risk of converting to full psychosis, has not been extensively investigated in ASD. We longitudinally evaluate a sample of young ASD individuals (age, mean ± SD: 13 ± 2.9) with (n = 13) or without (n = 18) concomitant APS through a standardized assessment of autistic (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2) and psychotic (Structured Interview for Psychosis-Risk Syndromes, SIPS) symptoms and cognitive and adaptive skills. Individuals with other neuropsychiatric disorders were excluded. We estimated the conversion rate to full psychosis (according to SIPS criteria) over time (39.6 ± 11.5 months) and explored the role of clinical variables at baseline in the transition to full psychosis. A conversion rate to full psychosis of 30.7% was found in ASD/APS. Conversion to full psychosis was not affected by the severity of the autistic and psychotic symptoms. At baseline, young individuals with ASD/APS who later converted to full psychosis showed lower cognitive performance (d = 2.05) and greater impairment of adaptive social functioning profile (d = 1.2) than those with ASD. The results of this preliminary report revealed that nearly a third of young individuals with ASD/APS convert to full psychosis over time. Conversion to full psychosis is affected by decreased cognitive and adaptive skills. Further investigations are needed to confirm the utility of APS detection and to better characterize the psychotic developmental trajectory in ASD, with consequent important implications on prognosis and therapeutic strategies.
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Affiliation(s)
- Assia Riccioni
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Fondazione PTV - Policlinico Tor Vergata, Rome, Italy.,Chair of Child Neurology and Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Siracusano
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Fondazione PTV - Policlinico Tor Vergata, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Michelangelo Vasta
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Fondazione PTV - Policlinico Tor Vergata, Rome, Italy.,Chair of Child Neurology and Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Federico Fiori Nastro
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione PTV - Policlinico Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Fondazione PTV - Policlinico Tor Vergata, Rome, Italy.,Chair of Child Neurology and Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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4
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, and Child Studies Center at Yale, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Hartford Healthcare Behavioral Health Network, Hartford, CT, USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University School of Medicine, Washington, WA, USA
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5
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Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Predictors of remission from the ultra-high risk state for psychosis. Early Interv Psychiatry 2021; 15:104-112. [PMID: 31910496 DOI: 10.1111/eip.12917] [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: 09/19/2019] [Revised: 11/06/2019] [Accepted: 12/14/2019] [Indexed: 02/07/2023]
Abstract
AIM A significant proportion of individuals at Ultra-High Risk (UHR) for psychosis do not transition to manifest psychosis. Many non-transitioning UHR individuals do, however, display poor long-term outcomes such as persistence of attenuated psychotic symptoms. Evidence is scarce on which variables may predict a better clinical and functional prognosis such as remission from the UHR state. METHODS A total of 146 UHR individuals were enrolled in a randomized clinical trial (RCT), with this being analyses secondary to the RCT. Participants were assessed on multiple domains of symptoms, functioning, neuro- and social cognition. Regression analyses elucidated on the predictive power of these measures to remission from the UHR status (ie, not meeting UHR criteria) at 12-month follow-up. RESULTS Of the 91 UHR individuals attending 12-month follow-up, 33 (36%) exhibited remission from the UHR state. Regression analyses revealed baseline functioning to be a significant predictor of risk remission, and this was maintained when controlling for the effect of antipsychotic medication, gender and estimated IQ. The individuals with remission from the UHR state showed lower attenuated psychotic- and depressive symptoms along with better functioning at 12-month follow-up. CONCLUSION Our findings indicate functioning to be a contributor to the symptomatic recovery of UHR individuals, but a large amount of the variance on risk remission is, however, explained by other factors. Additionally, our findings suggest that UHR individuals with better functioning at ascertainment may present with a better clinical and functional prognosis, which may inform on the need for monitoring and intervention in this subgroup.
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Affiliation(s)
- Louise B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Tina D Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
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6
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Worthington MA, Miklowitz DJ, O'Brien M, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Selection for psychosocial treatment for youth at clinical high risk for psychosis based on the North American Prodrome Longitudinal Study individualized risk calculator. Early Interv Psychiatry 2021; 15:96-103. [PMID: 31943807 PMCID: PMC7358123 DOI: 10.1111/eip.12914] [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: 04/08/2019] [Revised: 10/22/2019] [Accepted: 12/14/2019] [Indexed: 01/19/2023]
Abstract
AIM Recent findings suggest that family-focused therapy (FFT) is effective for individuals at clinical high-risk for psychosis (CHR-P). As outcomes of CHR-P individuals are quite varied, certain psychosocial interventions may be differentially effective in subgroups. The present study examined change in positive symptoms for CHR-P individuals at different levels of predicted risk for conversion to psychosis who received either FFT, a brief form of family education termed enhanced care (EC) or treatment as usual. METHODS Participants were drawn from the North American Prodromal Longitudinal Study (NAPLS2). A subset of NAPLS2 participants completed a randomized study involving FFT or EC. The present study includes participants from the FFT-CHR sub-study and non-randomized NAPLS2 participants. Predicted risk of conversion was calculated using the Individualized Risk Calculator for Psychosis. Robust linear regressions evaluated whether the association between predicted risk of conversion and positive symptom change differed across intervention groups. RESULTS A total of 94 participants from the FFT-CHR sub-study (FFT-CHR n = 50, EC n = 44) and 401 non-randomized NAPLS2 participants were included in this study. There was a treatment group by predicted risk of conversion interaction that predicted positive symptom improvement: higher risk individuals improved more with FFT-CHR than EC or the non-randomized NAPLS group, whereas lower-risk individuals did not differ in positive symptom improvement across treatment groups (FFT-CHR vs EC: P = .03, β = 20.27; FFT-CHR vs NAPLS2: P < .001, β = 28.40). CONCLUSIONS Intensive treatments such as FFT-CHR may be most appropriate for individuals at the highest levels of clinical risk for psychosis.
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Affiliation(s)
| | - David J Miklowitz
- Department of Psychiatry, UCLA Semel Institute, University of California, Los Angeles, California
| | - Mary O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, California
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, California
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, California
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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7
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Malhi GS, Bell E, Hamilton A, Morris G. Early intervention for risk syndromes: What are the real risks? Schizophr Res 2021; 227:4-9. [PMID: 32527679 DOI: 10.1016/j.schres.2020.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/04/2020] [Accepted: 04/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, New South Wales, Australia; Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, New South Wales, Australia; Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Amber Hamilton
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, New South Wales, Australia; Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Grace Morris
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, New South Wales, Australia; Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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8
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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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9
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McGorry PD, Nelson B, Wood SJ, Shah JL, Malla A, Yung A. Transcending false dichotomies and diagnostic silos to reduce disease burden in mental disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1095-1103. [PMID: 32683471 DOI: 10.1007/s00127-020-01913-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Patrick D McGorry
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,School of Psychology, University of Birmingham, Birmingham, UK
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Canada
| | - Alison Yung
- Orygen, 35 Poplar Rd (Locked Bag 10), Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,School of Health Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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10
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Trask CL, Cohn JR, Paxson AM, Hansen GS, Cicero DC. Form and content of attenuated psychotic symptoms in psychometrically assessed positive and negative schizotypy. Early Interv Psychiatry 2020; 14:321-329. [PMID: 31270947 DOI: 10.1111/eip.12856] [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: 07/26/2018] [Revised: 04/26/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
AIM Greater attention is being paid to early detection and identification of individuals who are at high risk of developing psychosis. One area of interest is the particular content types of psychotic-like experiences (PLEs), which can be thought of as attenuated, non-clinical positive symptoms (eg, feeling perplexed by reality). Previous research has examined content of PLEs in clinical high-risk samples. The current study aimed to build upon these findings by analysing content in a psychometrically determined high-risk sample. METHODS One hundred fifty-three undergraduates with scores greater than 1.96 SDs above the mean on a measure of schizotypy symptoms participated in a semi-structured interview for the assessment of prodromal syndromes. Each interview was transcribed verbatim and content of PLEs was rated according to the Content of Attenuated Positive Symptoms scale. RESULTS Frequencies of content items in the psychometric high-risk sample were similar to those found in a clinical high-risk sample. Multiple regression analyses revealed that certain content items were more predictive of decreased global functioning and increased positive symptom severity. CONCLUSIONS Content items that were associated with worse outcomes may be cause for greater concern if endorsed by individuals presenting for treatment. Future research should examine content of PLEs in a longitudinal design to determine whether particular items could predict subsequent conversion to a schizophrenia-spectrum disorder.
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Affiliation(s)
- Christi L Trask
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Jonathan R Cohn
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Aaliyah M Paxson
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Geoffrey S Hansen
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, Hawaii
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11
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Abstract
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what 'risk' entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry, and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA
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12
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Glenthøj LB, Bailey B, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Basic symptoms influence real-life functioning and symptoms in individuals at high risk for psychosis. Acta Psychiatr Scand 2020; 141:231-240. [PMID: 31621062 DOI: 10.1111/acps.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate potential clinical differences in high-risk profiles presenting with and without basic symptoms, and additionally investigate the association between basic symptoms and clinical symptoms, functioning, and cognition. METHODS High-risk individuals (n = 133) were stratified into individuals fulfilling ultra-high-risk (UHR) criteria (n = 59) and individuals fulfilling UHR+ basic symptoms criteria (BS) (n = 74). Group differences were assessed on clinical symptoms, real-life functioning, and cognition. Regression analyses were conducted to elucidate on the relationship between BS and clinical symptoms, functioning, neurocognition, and social cognition. RESULTS The group fulfilling both UHR+ BS criteria had significantly more symptoms and lower real-life functioning and quality of life but not more cognitive deficits. BS influenced on attenuated psychotic, depressive, and general symptoms, but only modestly on negative symptoms. No relationship between BS and neuro- and social cognition was established except for an association with emotion recognition processing speed. BS influenced real-life functioning, and this finding was sustained when controlling for the effect of negative symptoms. CONCLUSIONS Our findings indicate that BS contribute highly to the distress and symptom load of clinical high-risk individuals. Longitudinal findings are needed to establish the predictive validity of BS on high-risk individuals' clinical and functional prognosis.
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Affiliation(s)
- L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - B Bailey
- University of Basel Psychiatric Clinics, Basel, Switzerland
| | - T D Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - C Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - C Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Hellerup, Denmark
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Hellerup, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
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13
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Di Lorenzo G, Riccioni A, Ribolsi M, Siracusano M, Curatolo P, Mazzone L. Auditory Mismatch Negativity in Youth Affected by Autism Spectrum Disorder With and Without Attenuated Psychosis Syndrome. Front Psychiatry 2020; 11:555340. [PMID: 33329094 PMCID: PMC7732489 DOI: 10.3389/fpsyt.2020.555340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
The present study investigates the differences in auditory mismatch negativity (MMN) parameters given in a sample of young subjects with autism spectrum disorder (ASD, n = 37) with or without co-occurrent attenuated psychosis syndrome (APS). Our results show that ASD individuals present an MMN decreased amplitude and prolonged latency, without being influenced by concurrent APS. Additionally, when correlating the MMN indexes to clinical features, in the ASD + APS group, we found a negative correlation between the severity of autistic symptoms and the MMN latency in both frequency (f-MMN r = -0.810; p < 0.0001) and duration (d-MMN r = -0.650; p = 0.006) deviants. Thus, our results may provide a more informative characterization of the ASD sub-phenotype when associated with APS, highlighting the need for further longitudinal investigations.
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Affiliation(s)
- Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Assia Riccioni
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Psychiatry Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Martina Siracusano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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14
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Nelson B, McGorry P. The Prodrome of Psychotic Disorders: Identification, Prediction, and Preventive Treatment. Child Adolesc Psychiatr Clin N Am 2020; 29:57-69. [PMID: 31708053 DOI: 10.1016/j.chc.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Twenty-five years ago "at risk" for psychosis criteria were introduced to the field. Prediction studies have identified a range of risk factors involved in transition from "at risk" status to first episode psychotic illness, with recent interest in dynamic and multimodal prediction models. Treatment studies have indicated that risk of transition to psychotic disorder can at least be delayed in this clinical population. Although the strongest evidence to date is for cognitive behavioral therapy, the optimal type and sequence of treatment remains an active area of research.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia.
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia
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15
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Interaction of emotion and cognitive control along the psychosis continuum: A critical review. Int J Psychophysiol 2020; 147:156-175. [DOI: 10.1016/j.ijpsycho.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022]
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16
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Hazan H, Spelman T, Amminger GP, Hickie I, McGorry PD, Phillips LJ, Purcell R, Wood SJ, Yung AR, Nelson B. The prognostic significance of attenuated psychotic symptoms in help-seeking youth. Schizophr Res 2020; 215:277-283. [PMID: 31615738 DOI: 10.1016/j.schres.2019.10.016] [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] [Received: 07/25/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent findings suggest that attenuated psychotic symptoms (APS) might serve as a risk factor for general mental health impairment in help-seeking youth. The current study was designed to test this possibility by examining the prognostic significance of APS in a large cohort of help-seeking youth not selected for psychosis risk. METHOD 465 youth aged 12-25 referred to general youth mental health services were grouped as either APS + or APS- based on whether or not they met 'ultra high risk' for psychosis APS risk criteria as assessed using the Comprehensive Assessment of At Risk Mental States (CAARMS). They completed clinical assessments at baseline and at 12-month follow-up, measuring a range of psychopathology (depression, anxiety, eating disorders, general psychological distress, substance abuse) and psychosocial functioning. RESULTS APS + had significantly poorer outcomes at 12-months on a range of clinical variables, even after adjusting for baseline scores and amount of treatment received. However, the APS + group showed greater improvement in functioning at follow-up compared to APS-. CONCLUSION Attenuated psychotic symptoms are a prognostic indicator of persistent transdiagnostic mental health problems and reduced response to treatment in help-seeking youth over the short term. Hence, it is critical to screen and assess attenuated psychotic symptoms at the primary and secondary mental health services level, especially given that these subclinical symptoms are rarely voluntarily reported.
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Affiliation(s)
- H Hazan
- Psychology Department, University of Otago, New Zealand
| | - T Spelman
- Burnet Institute, Melbourne, Australia
| | - G P Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - I Hickie
- Brain and Mind Research Institute, The University of Sydney, Australia
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - L J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - R Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom
| | - A R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Institute of Brain, Behaviour and Mental Health, University of Manchester, United Kingdom
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
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17
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Abstract
The development of effective intervention and prevention strategies among individuals with psychosis risk syndromes may help to reduce symptomatology and conversion to a psychotic disorder. Although strides have been made in this area, more work is needed, particularly given the setbacks that remain (such as heterogeneity among this group). There has been a shift with the introduction of clinical staging models toward expanding current intervention and prevention efforts to a more developmental and transdiagnostic approach. With this, this article seeks to review treatments both recently and currently discussed in the staging literature, introduce advances in psychosis risk syndrome treatments that may be beneficial to consider in clinical staging heuristics, and pinpoint other promising options.
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Affiliation(s)
- Tina Gupta
- Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
| | - Vijay A Mittal
- Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.,Department of Psychiatry, Northwestern University, 420 E. Superior Street, Chicago, IL, 60611, USA.,Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208, USA.,Department of Medical Social Sciences, Northwestern University, 420 E. Superior Street, Chicago, IL, 60611, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, 633 N. St. Claire Street, Chicago, IL, 60611, USA
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18
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Trask CL, Kameoka VA, Schiffman J, Cicero DC. Perceptions of attenuated psychosis in a diverse sample of undergraduates. Early Interv Psychiatry 2019; 13:922-927. [PMID: 29968280 DOI: 10.1111/eip.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/03/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Abstract
AIM Prior to the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, experts in the field of psychosis research considered including a psychosis high-risk syndrome-attenuated psychosis syndrome-as a formal diagnosis. Opponents argued that such a diagnosis may increase the risk of stigmatization of individuals whose symptoms often remit. Although previous research has examined provider perceptions of attenuated psychosis syndrome, little work has focused on lay perceptions. METHODS A total of 455 college students read three vignettes, each depicting a character with a different level of psychotic disorder (attenuated psychosis syndrome, schizophrenia or no psychosis). Following each vignette, participants responded to questions assessing: (1) identification of the character as mentally ill, (2) stigmatizing attitudes and (3) beliefs regarding the helpfulness of potential treatments. RESULTS Compared to a character with no psychosis, participants identified the attenuated psychosis syndrome character as more likely to be experiencing mental illness, but endorsed only slightly more stigmatizing attitudes. Participants tended to rate psychological types of treatment as more helpful than other types for an attenuated psychosis syndrome character. CONCLUSIONS Non-expert undergraduates appear to view attenuated psychosis symptoms as indicative of mental illness, though not as severe as schizophrenia symptoms. The minimal level of stigma endorsement indicates that college students may not be especially likely to spontaneously stigmatize peers with attenuated psychosis syndrome.
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Affiliation(s)
- Christi L Trask
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Velma A Kameoka
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore, Maryland
| | - David C Cicero
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, Hawai'i
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19
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Long X, Liu F, Huang N, Liu N, Zhang J, Chen J, Qi A, Guan X, Lu Z. Brain regional homogeneity and function connectivity in attenuated psychosis syndrome -based on a resting state fMRI study. BMC Psychiatry 2018; 18:383. [PMID: 30526563 PMCID: PMC6286581 DOI: 10.1186/s12888-018-1954-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By combining regional homogeneity (ReHo) and functional connectivity (FC) analyses, this study aimed to explore brain functional alterations in Attenuated Psychosis Syndrome (APS), which could provide complementary information for the neurophysiological indicators for schizophrenia (SZ) associated brain dysfunction. METHODS Twenty-one APS subjects and twenty healthy controls were enrolled in the data acquisition of demographics and clinical characteristics as well as structural and resting-state functional magnetic resonance imaging (rs-fMRI). ReHo analysis was conducted to determine the peak coordinate of the abnormal regional brain activity. Then, identified brain regions were considered as seed regions and were used to calculate FC between reginal brain voxels and whole brain voxels. Finally, potential correlations between imaging indices and clinical data were also explored. RESULTS Four APS and two HC subjects were excluded because the largest dynamic translation or rotation had exceeded 2 mm / 2°. Compared with healthy controls (HCs), APS subjects exhibited higher ReHo values in the right middle temporal gyrus (MTG) and lower ReHo values in the left middle frontal gyrus (MFG), left superior frontal gyrus (SFG), left postcentral gyrus (PoCG), and left superior frontal gyrus, medial (SFGmed). Considered these areas as seed regions, the APS subjects showed abnormal enhancement in functional brain connections, predominantly in the frontal and temporal lobes. CONCLUSIONS We concluded that the APS subjects had spatially regional dysfunction and remoted synchronous dysfunction in the frontal and temporal lobes of the brain, and changes in ReHo and FC patterns may reveal the mechanism of brain dysfunctions and may serve as an imaging biomarker for the diagnosis and evaluation of SZ.
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Affiliation(s)
- Xiangyun Long
- 0000000123704535grid.24516.34Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065 China
| | - Fei Liu
- 0000000123704535grid.24516.34Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065 China
| | - Nan Huang
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030 China
| | - Na Liu
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030 China
| | - Jie Zhang
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030 China
| | - Jing Chen
- 0000 0004 0368 8293grid.16821.3cDepartment of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030 China
| | - Ansi Qi
- 0000000123704535grid.24516.34Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065 China
| | - Xiaofeng Guan
- 0000000123704535grid.24516.34Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065 China
| | - Zheng Lu
- Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, 389 Xin Cun Road, Shanghai, 200065, China. .,Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China.
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20
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Kirsch DJ, Doerfler LA, Domakonda M. Chart Review Study of Prescription of Antipsychotic Medication in College Students Referred for Psychopharmacologic Evaluation. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2018.1453759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Daniel J. Kirsch
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Leonard A. Doerfler
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Assumption College, Worcester, Massachusetts, USA
| | - Mirjana Domakonda
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
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21
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Abstract
This paper aims to understand the DSM-5 through situating it within the context of the historical development of the DSM series. When one looks at the sets of diagnostic criteria, the DSM-5 is strikingly similar to the DSM-IV. I argue that at this level the DSM has become 'locked-in' and difficult to change. At the same time, at the structural, or conceptual, level there have been radical changes, for example in the definition of 'mental disorder', in the role of theory and of values, and in the abandonment of the multiaxial approach to diagnosis. The way that the DSM-5 was constructed means that the overall conceptual framework of the classification only barely constrains the sets of diagnostic criteria it contains.
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22
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Du Y, Fryer SL, Lin D, Sui J, Yu Q, Chen J, Stuart B, Loewy RL, Calhoun VD, Mathalon DH. Identifying functional network changing patterns in individuals at clinical high-risk for psychosis and patients with early illness schizophrenia: A group ICA study. Neuroimage Clin 2017; 17:335-346. [PMID: 29159045 PMCID: PMC5681342 DOI: 10.1016/j.nicl.2017.10.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/13/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Although individuals at clinical high risk (CHR) for psychosis exhibit a psychosis-risk syndrome involving attenuated forms of the positive symptoms typical of schizophrenia (SZ), it remains unclear whether their resting-state brain intrinsic functional networks (INs) show attenuated or qualitatively distinct patterns of functional dysconnectivity relative to SZ patients. Based on resting-state functional magnetic imaging data from 70 healthy controls (HCs), 53 CHR individuals (among which 41 subjects were antipsychotic medication-naive), and 58 early illness SZ (ESZ) patients (among which 53 patients took antipsychotic medication) within five years of illness onset, we estimated subject-specific INs using a novel group information guided independent component analysis (GIG-ICA) and investigated group differences in INs. We found that when compared to HCs, both CHR and ESZ groups showed significant differences, primarily in default mode, salience, auditory-related, visuospatial, sensory-motor, and parietal INs. Our findings suggest that widespread INs were diversely impacted. More than 25% of voxels in the identified significant discriminative regions (obtained using all 19 possible changing patterns excepting the no-difference pattern) from six of the 15 interrogated INs exhibited monotonically decreasing Z-scores (in INs) from the HC to CHR to ESZ, and the related regions included the left lingual gyrus of two vision-related networks, the right postcentral cortex of the visuospatial network, the left thalamus region of the salience network, the left calcarine region of the fronto-occipital network and fronto-parieto-occipital network. Compared to HCs and CHR individuals, ESZ patients showed both increasing and decreasing connectivity, mainly hypo-connectivity involving 15% of the altered voxels from four INs. The left supplementary motor area from the sensory-motor network and the right inferior occipital gyrus in the vision-related network showed a common abnormality in CHR and ESZ groups. Some brain regions also showed a CHR-unique alteration (primarily the CHR-increasing connectivity). In summary, CHR individuals generally showed intermediate connectivity between HCs and ESZ patients across multiple INs, suggesting that some dysconnectivity patterns evident in ESZ predate psychosis in attenuated form during the psychosis risk stage. Hence, these connectivity measures may serve as possible biomarkers to predict schizophrenia progression.
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Affiliation(s)
- Yuhui Du
- The Mind Research Network, Albuquerque, NM, USA; Shanxi University, School of Computer & Information Technology, Taiyuan, China.
| | - Susanna L Fryer
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; The Mental Health Service, San Francisco VA Healthcare System, San Francisco, CA, USA
| | | | - Jing Sui
- The Mind Research Network, Albuquerque, NM, USA; Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Qingbao Yu
- The Mind Research Network, Albuquerque, NM, USA
| | - Jiayu Chen
- The Mind Research Network, Albuquerque, NM, USA
| | - Barbara Stuart
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Rachel L Loewy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM, USA; Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; The Mental Health Service, San Francisco VA Healthcare System, San Francisco, CA, USA.
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23
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Abstract
There is a debate concerning risks and benefits of early intervention in psychosis, especially concerning diagnosis disclosure. The present study reports preliminary findings on self-reported locus of control and psychological distress after the disclosure of diagnosis in an early recognition center. We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health. Persons with ARMS seem to particularly benefit from disclosure of diagnosis as part of early intervention.
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24
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Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychol Med 2017; 47:1867-1879. [PMID: 28196549 DOI: 10.1017/s0033291717000344] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined. METHOD This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results. RESULTS The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: 'sense of difference', 'characterizing difference negatively', 'negative reactions (anticipated and experienced)', 'strategies', 'lack of knowledge and understanding', and 'service-related factors'. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups. CONCLUSIONS Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.
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Affiliation(s)
- P C Gronholm
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - G Thornicroft
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - K R Laurens
- Department of Forensic and Neurodevelopmental Science,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S Evans-Lacko
- Health Service and Population Research Department,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
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25
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Fekih-Romdhane F, Chennoufi L, Cheour M. La schizophrénie dans le DSM-5. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2015.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Crocq MA. Le syndrome psychotique atténué dans le DSM-5. Encephale 2016; 42 Suppl 3:S3-S6. [DOI: 10.1016/s0013-7006(16)30215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Kambeitz-Ilankovic L, Meisenzahl EM, Cabral C, von Saldern S, Kambeitz J, Falkai P, Möller HJ, Reiser M, Koutsouleris N. Prediction of outcome in the psychosis prodrome using neuroanatomical pattern classification. Schizophr Res 2016; 173:159-165. [PMID: 25819936 DOI: 10.1016/j.schres.2015.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 01/11/2023]
Abstract
To date, research into the biomarker-aided early recognition of psychosis has focused on predicting the transition likelihood of clinically defined individuals with different at-risk mental states (ARMS) based on structural (and functional) brain changes. However, it is currently unknown whether neuroimaging patterns could be identified to facilitate the individualized prediction of symptomatic and functional recovery. Therefore, we investigated whether cortical surface alterations analyzed by means of multivariate pattern recognition methods could enable the single-subject identification of functional outcomes in twenty-seven ARMS individuals. Subjects were dichotomized into 'good' vs. 'poor' outcome groups on average 4years after the baseline MRI scan using a Global Assessment of Functioning (GAF) threshold of 70. Cortical surface-based pattern classification predicted good (N=14) vs. poor outcome status (N=13) at follow-up with an accuracy of 82% as determined by nested leave-one-cross-validation. Neuroanatomical prediction involved cortical area reductions in superior temporal, inferior frontal and inferior parietal areas and was not confounded by functional impairment at baseline, or antipsychotic medication and transition status over the follow-up period. The prediction model's decision scores were correlated with positive and general symptom scores in the ARMS group at follow-up, whereas negative symptoms were not linked to predicted poorer functional outcome. These findings suggest that poorer functional outcomes are associated with non-resolving attenuated psychosis and could be predicted at the single-subject level using multivariate neuroanatomical risk stratification methods. However, the generalizability and specificity of the suggested prediction model should be thoroughly investigated in future large-scale and cross-diagnostic MRI studies.
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Affiliation(s)
| | - Eva M Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Carlos Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Sebastian von Saldern
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
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Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis. Eur Child Adolesc Psychiatry 2016; 25:7-16. [PMID: 25711287 DOI: 10.1007/s00787-015-0692-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.
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Fusar-Poli P, Rocchetti M, Sardella A, Avila A, Brandizzi M, Caverzasi E, Politi P, Ruhrmann S, McGuire P. Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis. Br J Psychiatry 2015; 207:198-206. [PMID: 26329563 DOI: 10.1192/bjp.bp.114.157115] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment. AIMS To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes. METHOD Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654). RESULTS People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did. CONCLUSIONS Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
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Affiliation(s)
- Paolo Fusar-Poli
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Matteo Rocchetti
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alberto Sardella
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alessia Avila
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Martina Brandizzi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Edgardo Caverzasi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Pierluigi Politi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Stephan Ruhrmann
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
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Rapado-Castro M, McGorry PD, Yung A, Calvo A, Nelson B. Sources of clinical distress in young people at ultra high risk of psychosis. Schizophr Res 2015; 165:15-21. [PMID: 25890793 DOI: 10.1016/j.schres.2015.03.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/25/2015] [Accepted: 03/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic. METHOD Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psychosis was explored. RESULTS Of the total sample, 89.04% fulfilled the APS UHR criteria. APS symptoms were reported to be distressing for 58.5% of this subsample, but social and functioning difficulties (78.1%) and depressive symptoms (58.9%) were the highest sources of distress leading UHR patients to seek help. Intensity of distress associated with APS, anxiety symptoms and substance use was associated with transition to psychosis. CONCLUSIONS APS were reported to be distressing for approximately half of UHR patients. The intensity of distress associated to these symptoms may be associated with increased risk for subsequent transition to full threshold psychotic disorder.
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Affiliation(s)
- Marta Rapado-Castro
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia
| | - Alison Yung
- Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, England, United Kingdom
| | - Ana Calvo
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia.
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Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG. Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophr Bull 2014; 40:1499-508. [PMID: 24353096 PMCID: PMC4193691 DOI: 10.1093/schbul/sbt171] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population. METHOD Analyses involved 1229 participants (age 16-40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. "Symptom," "onset/worsening," "frequency," and "distress/disability" criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique. RESULTS The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome. CONCLUSIONS At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
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Katsura M, Ohmuro N, Obara C, Kikuchi T, Ito F, Miyakoshi T, Matsuoka H, Matsumoto K. A naturalistic longitudinal study of at-risk mental state with a 2.4 year follow-up at a specialized clinic setting in Japan. Schizophr Res 2014; 158:32-8. [PMID: 25034763 DOI: 10.1016/j.schres.2014.06.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 05/07/2014] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The notion of at-risk mental state (ARMS) is valuable for identifying individuals in a putative prodromal state of psychosis and for reducing conversion risk by pharmacological and psychological interventions. However, further systematic study is required because 1) diagnostic reliability in various clinical settings is not yet established; 2) predictive ability is insufficient; 3) optimal interventions in diversified populations are elusive; and 4) little evidence from non-Western regions exists. METHODS A naturalistic longitudinal study was conducted at a specialized clinic for early psychosis at a university hospital in Sendai, Japan. Individuals with ARMS (n=106) were recruited and followed up with case-by-case treatment. RESULTS Two-thirds of the participants were psychiatrist referrals, and 83 were followed up for at-least 1 year (mean follow-up=2.4 years). Fourteen developed psychosis and the estimated (by Kaplan-Meier) cumulative transition rate was 11.1% at 12, 15.4% at 24, and 17.5% at 30 months. At the end-point, about 30% of the 83 followed-up participants including 11 converters received antipsychotic medication. Compared to non-converters, converters showed more severe attenuated psychotic symptoms, including ego-boundary disturbance, formal thought disorder, and emotional disturbance. CONCLUSIONS The present study replicated previous major Western longitudinal studies, in terms of clinical characteristics, psychosis transition rate, and antipsychotic prescription rate. Our results emphasize the importance of phenomenological assessment of ARMS and intensive care in a clinical setting.
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Affiliation(s)
- Masahiro Katsura
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan.
| | - Noriyuki Ohmuro
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Chika Obara
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuo Kikuchi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fumiaki Ito
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Psychiatry, Tohoku Pharmaceutical University Hospital, Sendai, Japan
| | | | - Hiroo Matsuoka
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan; Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazunori Matsumoto
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan; Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
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Woods SW, Walsh BC, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Perkins DO, Seidman LJ, Tarbox SI, Tsuang MT, Walker EF, McGlashan TH. Current status specifiers for patients at clinical high risk for psychosis. Schizophr Res 2014; 158:69-75. [PMID: 25012147 PMCID: PMC4152558 DOI: 10.1016/j.schres.2014.06.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Longitudinal studies of the clinical high risk (CHR) syndrome for psychosis have emphasized the conversion vs non-conversion distinction and thus far have not focused intensively on classification among non-converters. The present study proposes a system for classifying CHR outcomes over time when using the Structured Interview for Psychosis-risk Syndromes and evaluates its validity. METHOD The system for classifying CHR outcomes is referred to as "current status specifiers," with "current" meaning over the month prior to the present evaluation and "specifiers" indicating a set of labels and descriptions of the statuses. Specifiers for four current statuses are described: progression, persistence, partial remission, and full remission. Data from the North American Prodromal Longitudinal Study were employed to test convergent, discriminant, and predictive validity of the current status distinctions. RESULTS Validity analyses partly supported current status distinctions. Social and role functioning were more impaired in progressive and persistent than in remitted patients, suggesting a degree of convergent validity. Agreement between CHR current statuses and current statuses for a different diagnostic construct (DSM-IV Major Depression) was poor, suggesting discriminant validity. The proportion converting to psychosis within a year was significantly higher in cases meeting progression criteria than in those meeting persistence criteria and tended to be higher than in those meeting full remission criteria, consistent with a degree of predictive validity. DISCUSSION CHR syndrome current status specifiers could offer a potentially valid and useful description of current clinical status among non-converters. Study in additional samples is needed.
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Affiliation(s)
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Robert Heinssen
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda MD
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill NC
| | | | | | - Ming T. Tsuang
- Department of Psychiatry, UCSD, San Diego CA,Department of Psychiatry, Harvard Medical School, Boston MA
| | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta GA
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Abstract
Whereas improving validity and reliability of psychiatric diagnoses were key objectives in the development of DSM-5, enhancing clinical utility was the primary goal. With reference to psychotic disorders, changes addressed limitations in DSM-IV while incorporating new information about the nature of these disorders generated over the past twenty years. With regard to schizophrenia, variation in distinct psychopathological dimensions has been found to better account for the heterogeneity of schizophrenia than traditional subtypes. Resulting changes in DSM-5 will likely include elimination of the classic subtypes of schizophrenia and addition of unique psychopathological dimensions, along with elimination of the special treatment of Schneiderian "first-rank symptoms." In view of the poor reliability and limited validity of DSM-IV schizoaffective disorder, a clearer definition is provided in DSM-5. Considering the discrepant treatment of catatonia in DSM-IV, it is treated consistently across the DSM-5 manual. Minor changes are made in the definition of delusional disorder to reduce spurious comorbidity and unnecessary complexity. A new category of "attenuated psychosis syndrome" is included in the appendix as a condition for further study. In this article, major likely revisions in the DSM-5 (due to be published in May 2013) criteria for schizophrenia spectrum and other psychotic disorders are summarized and their implications for clinical practice are discussed.
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Affiliation(s)
- Rajiv Tandon
- University of Florida, P.O. Box 103424, Gainesville, FL 32610-3424
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Cicero DC, Martin EA, Becker TM, Docherty AR, Kerns JG. Correspondence between psychometric and clinical high risk for psychosis in an undergraduate population. Psychol Assess 2014; 26:901-15. [PMID: 24708081 DOI: 10.1037/a0036432] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the common use of either psychometric or clinical methods for identifying individuals at risk for psychosis, previous research has not examined the correspondence and extent of convergence of these 2 approaches. Undergraduates (n = 160), selected from a larger pool, completed 3 self-report schizotypy scales: the Magical Ideation Scale, the Perceptual Aberration Scale, and the Revised Social Anhedonia Scale. They were administered the Structured Interview for Prodromal Syndromes. First, high correlations were observed for self-report and interview-rated psychotic-like experiences (rs between .48 and .61, p < .001). Second, 77% of individuals who identified as having a risk for psychosis with the self-report measures reported at least 1 clinically meaningful psychotic-like experience on the Structured Interview for Prodromal Syndromes. Third, receiver operating characteristic curve analyses showed that the self-report scales can be used to identify which participants report clinically meaningful positive symptoms. These results suggest that mostly White undergraduate participants who identify as at risk with the psychometric schizotypy approach report clinically meaningful psychotic-like experiences in an interview format and that the schizotypy scales are moderately to strongly correlated with interview-rated psychotic-like experiences. The results of the current research provide a baseline for comparing research between these 2 approaches.
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Affiliation(s)
- David C Cicero
- Department of Psychology, University of Hawai'i at Manoa
| | - Elizabeth A Martin
- Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System
| | - Theresa M Becker
- Institute for Learning and Brain Sciences, University of Washington
| | - Anna R Docherty
- Department of Statistical Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri
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Thompson E, Kline E, Reeves G, Pitts SC, Bussell K, Schiffman J. Using parent and youth reports from the Behavior Assessment System for Children, Second Edition to identify individuals at clinical high-risk for psychosis. Schizophr Res 2014; 154:107-12. [PMID: 24630261 DOI: 10.1016/j.schres.2014.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
Brief self-report screening can help facilitate early identification of individuals at risk for or in early stages of psychosis. Existing screening tools focus on self-reported attenuated positive symptoms to detect potential risk; however, parent reports may also be helpful for assessing symptoms, especially in younger patients. Recent evidence has shown that the "atypicality" scale within the self-report form of the Behavior Assessment System for Children, Second Edition (BASC-2) may be useful for identifying high-risk youth within a more clinically comprehensive and potentially minimally stigmatizing format. The BASC-2 parent report form also includes the atypicality scale, but no research has investigated the relation of this scale to psychosis risk. The aim of the current study is to evaluate the association of parent along with youth reports of BASC-2 atypicality with attenuated positive symptoms as assessed by the Structured Interview for Psychosis-Risk Syndromes (SIPS), in a sample of help-seeking adolescents (n=63). Results indicate that both parent and youth reports of atypicality predict clinician-rated symptoms. Moreover, the combination of parent and youth report significantly improved prediction of SIPS scores over either single-informant scale. These findings suggest that parent report scales, as ascertained through part of a larger, commonly used measure, may help identify youth at risk for psychosis, particularly if used in conjunction with youth self-report.
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Affiliation(s)
- Elizabeth Thompson
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Emily Kline
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Gloria Reeves
- University of Maryland, Baltimore, Department of Psychiatry, United States
| | - Steven C Pitts
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Kristin Bussell
- University of Maryland, Baltimore, Department of Psychiatry, United States
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Fusar-Poli P, Carpenter W, Woods S, McGlashan T. Attenuated Psychosis Syndrome: Ready for DSM-5.1? Annu Rev Clin Psychol 2014; 10:155-92. [DOI: 10.1146/annurev-clinpsy-032813-153645] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P. Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London SE5 8AF, United Kingdom;
- OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London SE5 8AF, United Kingdom
| | - W.T. Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland 21228
- US Department of Veterans Affairs, VISN 5 Mental Illness Research and Clinical Center, Baltimore, Maryland 21201
| | - S.W. Woods
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut 06519
| | - T.H. McGlashan
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut 06519
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Perez VB, Woods SW, Roach BJ, Ford JM, McGlashan TH, Srihari VH, Mathalon DH. Automatic auditory processing deficits in schizophrenia and clinical high-risk patients: forecasting psychosis risk with mismatch negativity. Biol Psychiatry 2014; 75:459-69. [PMID: 24050720 PMCID: PMC4028131 DOI: 10.1016/j.biopsych.2013.07.038] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 07/02/2013] [Accepted: 07/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Only about one third of patients at high risk for psychosis based on current clinical criteria convert to a psychotic disorder within a 2.5-year follow-up period. Targeting clinical high-risk (CHR) individuals for preventive interventions could expose many to unnecessary treatments, underscoring the need to enhance predictive accuracy with nonclinical measures. Candidate measures include event-related potential components with established sensitivity to schizophrenia. Here, we examined the mismatch negativity (MMN) component of the event-related potential elicited automatically by auditory deviance in CHR and early illness schizophrenia (ESZ) patients. We also examined whether MMN predicted subsequent conversion to psychosis in CHR patients. METHODS Mismatch negativity to auditory deviants (duration, frequency, and duration + frequency double deviant) was assessed in 44 healthy control subjects, 19 ESZ, and 38 CHR patients. Within CHR patients, 15 converters to psychosis were compared with 16 nonconverters with at least 12 months of clinical follow-up. Hierarchical Cox regression examined the ability of MMN to predict time to psychosis onset in CHR patients. RESULTS Irrespective of deviant type, MMN was significantly reduced in ESZ and CHR patients relative to healthy control subjects and in CHR converters relative to nonconverters. Mismatch negativity did not significantly differentiate ESZ and CHR patients. The duration + frequency double deviant MMN, but not the single deviant MMNs, significantly predicted the time to psychosis onset in CHR patients. CONCLUSIONS Neurophysiological mechanisms underlying automatic processing of auditory deviance, as reflected by the duration + frequency double deviant MMN, are compromised before psychosis onset and can enhance the prediction of psychosis risk among CHR patients.
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Affiliation(s)
- Veronica B. Perez
- University of California, San Francisco,San Francisco Veterans Administration Medical Center
| | | | - Brian J. Roach
- University of California, San Francisco,San Francisco Veterans Administration Medical Center
| | - Judith M. Ford
- University of California, San Francisco,San Francisco Veterans Administration Medical Center
| | | | | | - Daniel H. Mathalon
- University of California, San Francisco,San Francisco Veterans Administration Medical Center
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Abstract
BACKGROUND Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT). METHOD A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed treatment for preventing psychosis in people who are not taking antipsychotic medication, when compared to usual or non-specific control treatment. Included studies had to meet basic quality criteria, such as concealed and random allocation to treatment groups. RESULTS Our search produced 1940 titles, out of which we found seven completed trials (six published). The relative risk (RR) of developing psychosis was reduced by more than 50% for those receiving CBT at every time point [RR at 6 months 0.47, 95% confidence interval (CI) 0.27-0.82, p = 0.008 (fixed-effects only: six randomized controlled trials (RCTs), n = 800); RR at 12 months 0.45, 95% CI 0.28-0.73, p = 0.001 (six RCTs, n = 800); RR at 18-24 months 0.41, 95% CI 0.23-0.72, p = 0.002 (four RCTs, n = 452)]. Heterogeneity was low in every analysis and the results were largely robust to the risk of an unpublished 12-month study having unfavourable results. CBT was also associated with reduced subthreshold symptoms at 12 months, but not at 6 or 18-24 months. No effects on functioning, symptom-related distress or quality of life were observed. CBT was not associated with increased rates of clinical depression or social anxiety (two studies). CONCLUSIONS CBT-informed treatment is associated with a reduced risk of transition to psychosis at 6, 12 and 18-24 months, and reduced symptoms at 12 months. Methodological limitations and recommendations for trial reporting are discussed.
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Affiliation(s)
- P Hutton
- Greater Manchester West Mental Health NHS Foundation Trust, UK
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40
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
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41
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Schultze-Lutter F, Renner F, Paruch J, Julkowski D, Klosterkötter J, Ruhrmann S. Self-reported psychotic-like experiences are a poor estimate of clinician-rated attenuated and frank delusions and hallucinations. Psychopathology 2014; 47:194-201. [PMID: 24192655 DOI: 10.1159/000355554] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 09/10/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND One reason for the decision to delay the introduction of an Attenuated Psychosis Syndrome in the main text of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders was the concern that attenuated psychotic symptoms (APS) might in fact be common features in adolescents and young adults from the general population of no psychopathological significance in themselves. This concern was based on reports of high prevalence rates of psychotic-like experiences (PLEs) in the general population and the assumption that PLEs are a good estimate of APS. Although the criterion validity of self-reported PLEs had already been studied with respect to clinician-rated psychotic symptoms and found insufficient, it had been argued that PLEs might in fact be more comparable with mild, subclinical expressions of psychotic symptoms and, therefore, with APS. The present paper is the first to specifically study this assumption. SAMPLING AND METHODS The sample consisted of 123 persons seeking help at a service for the early detection of psychosis, of whom 54 had an at-risk mental state or psychosis, 55 had a nonpsychotic mental disorder and 14 had no full-blown mental disorder. PLEs were assessed with the Peters Delusion Inventory and the revised Launay-Slade Hallucination Scale, and psychotic symptoms and APS were assessed with the Structured Interview for Prodromal Syndromes. RESULTS At a level of agreement between the presence of any PLE (in 98.4% of patients) and any APS (in 40.7%) just exceeding chance (κ = 0.022), the criterion validity of PLEs for APS was insufficient. Even if additional qualifiers (high agreement or distress, preoccupation and conviction) were considered, PLEs (in 52.8%) still tended to significantly overestimate APS, and agreement was only fair (κ = 0.340). Furthermore, the group effect on PLE prevalence was, at most, moderate (Cramer's V ≤ 0.382). CONCLUSIONS The prevalence of APS cannot be deduced from studies of PLEs. Thus, the high population prevalence rate of PLEs does not allow the conclusion that APS are common features of no pathological significance and would lack clinical validity as an Attenuated Psychosis Syndrome in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Rather, the population prevalence rate of APS has to be assumed to be largely unknown at present but is likely lower than indicated by epidemiological studies of PLEs. Therefore, dedicated studies are warranted, in which APS are assessed in a way that equates to their clinical evaluation.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
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O'Brien MP, Miklowitz DJ, Candan KA, Marshall C, Domingues I, Walsh BC, Zinberg JL, De Silva SD, Woodberry KA, Cannon TD. A randomized trial of family focused therapy with populations at clinical high risk for psychosis: effects on interactional behavior. J Consult Clin Psychol 2013; 82:90-101. [PMID: 24188511 DOI: 10.1037/a0034667] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigated whether family focused therapy (FFT-CHR), an 18-session intervention that consisted of psychoeducation and training in communication and problem solving, brought about greater improvements in family communication than enhanced care (EC), a 3-session psychoeducational intervention, among individuals at clinical high risk for developing psychosis. METHOD This study was conducted within a randomized controlled trial across 8 sites. We examined 10-min problem-solving discussions at baseline and 6-month reassessment among 66 adolescents and young adults and their parents. Trained coders who were blind to treatment and time of assessment achieved high levels of interrater reliability when evaluating family discussions on categories of calm-constructive and critical-conflictual behavior. RESULTS Individuals at high risk and their family members who participated in FFT-CHR demonstrated greater improvement from baseline to 6-month reassessment in constructive communication and decreases in conflictual behaviors during family interactions than those in EC. Participants in FFT-CHR showed greater increases from baseline to 6 months in active listening and calm communication and greater decreases in irritability and anger, complaints and criticism, and off-task comments compared to participants in EC. These changes occurred equally in high-risk participants and their family members. CONCLUSIONS A 6-month family skills training treatment can bring about significant improvement in family communication among individuals at high risk for psychosis and their parents. Future studies should examine the association between enhancements in family communication and reduced risk for the onset of psychosis among individuals at high risk.
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Affiliation(s)
- Mary P O'Brien
- Department of Psychiatry, University of California, Los Angeles, School of Medicine
| | - David J Miklowitz
- Department of Psychiatry, University of California, Los Angeles, School of Medicine
| | - Kristin A Candan
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System
| | - Catherine Marshall
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary
| | | | - Barbara C Walsh
- Department of Psychiatry, Yale University School of Medicine
| | - Jamie L Zinberg
- Department of Psychology, University of California, Los Angeles
| | - Sandra D De Silva
- Center for the Assessment and Prevention of Prodromal States, University of California, Los Angeles
| | | | - Tyrone D Cannon
- Department of Psychiatry and Department of Psychology, University of California, Los Angeles
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Hwang SSH, Kim Y, Chang JS, Yun DY, Kim YS, Jung HY. Examination of categorical approach to symptom assessment: cross-validation of foulds' Delusions-Symptoms-States Inventory with Korean non-patient and patient groups. BMC Psychiatry 2013; 13:251. [PMID: 24103322 PMCID: PMC3816604 DOI: 10.1186/1471-244x-13-251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/06/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Foulds' Delusions-Symptoms-State Inventory (DSSI) has been purported to be a reliable, systematic categorical measure to assess the patients with schizophrenia according to the degree of illness. However, further cross-validations using other clinical measures and diverse samples from other cultures have not been advanced recently. We aimed to examine the validity of the DSSI hierarchical class model using both Korean non-patient and patient (schizophrenia and depression) groups. METHOD The hypothesis of inclusive, non-reflexive relationships among the DSSI classes was tested. The power of DSSI to detect presence of symptoms was assessed via cross-validation with other clinical measures, and the differences between the clinical features among the DSSI classes were examined using the Minnesota Multiphasic Personality Inventory (MMPI). RESULTS The high rate of model conformity (91.1%) across the samples and cross-validation with other criterion measures provided further support for the validity of DSSI. CONCLUSIONS DSSI is a reliable self-report measure that can be applied to both patient and non-patients to assess the presence and severity of psychiatric illness. Future studies that include more diverse clinical groups are necessary to lend further support for its utility in clinical practice.
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Affiliation(s)
- Samuel Suk-Hyun Hwang
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
| | - Yeni Kim
- Department of Child Psychiatry, Seoul National Hospital, Seoul 143-711, Republic of Korea
| | - Jae Seung Chang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam 463-707, Gyeonggi, Republic of Korea
| | - Da Young Yun
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul 156-707, Republic of Korea
| | - Yong Sik Kim
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Hee Yeon Jung
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul 156-707, Republic of Korea,Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
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44
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Abstract
Despite advances in the treatment of schizophrenia over the past half-century, the illness is frequently associated with a poor outcome. This is principally related to the late identification and intervention in the course of the illness by which time patients have experienced a substantial amount of socio-occupational decline that can be difficult to reverse. The emphasis has therefore shifted to defining psychosis-risk syndromes and evaluating treatments that can prevent transition to psychosis in these ultra-high risk groups. To consider the appropriateness of adding psychosis risk syndrome to our diagnostic nomenclature, the psychotic disorders work group extensively reviewed all available data, consulted a range of experts, and carefully considered the variety of expert and public comments on the topic. It was clear that reliable methods were available to define a syndrome characterized by sub-threshold psychotic symptoms (in severity or duration) and which was associated with a very significant increase in the risk of development of a full-fledged psychotic disorder (schizophrenia spectrum, psychotic mood disorder, and other psychotic disorders) within the next year. At the same time, the majority of individuals with "attenuated psychotic symptoms" had one or more other current psychiatric comorbid conditions (usually mood or anxiety disorders, substance use disorder; Fusar-Poli 2012) and exhibited a range of psychiatric outcomes other than conversion to psychosis (significant proportions either fully recover or develop some other psychiatric disorder, with a minority developing a psychotic disorder). Although the reliability of the diagnosis is well established in academic and research settings, it was found to be less so in community and other clinical settings. Furthermore, the nosological relationship of attenuated psychosis syndrome (APS) to schizotypal personality disorder and other psychiatric conditions was unclear. Further study will hopefully resolve these questions. The work group decided to recommend the inclusion of attenuated psychosis syndrome as a category in the appendix (Section 3) of DSM-5 as a condition for further study.
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45
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Response to Letter to the Editor. Ir J Psychol Med 2013. [DOI: 10.1017/ipm.2013.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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46
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De Herdt A, Wampers M, Vancampfort D, De Hert M, Vanhees L, Demunter H, Van Bouwel L, Brunner E, Probst M. Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis. Schizophr Res 2013; 149:48-55. [PMID: 23830855 DOI: 10.1016/j.schres.2013.06.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 05/16/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals at clinical high risk (CHR) for psychosis have become a major focus for research designed to explore early predictors of transition to full psychosis. Characterizing differences in neurocognitive (NC) functioning between psychosis converters (CHR-C) and non-converters (CHR-NC) might contribute to the identification of specific NC predictors of psychosis onset. Therefore, the aim of the present meta-analysis was to compare the baseline NC performance between CHR-C and CHR-NC. METHOD PubMed (MEDLINE), Web of Science, Embase and reference lists were searched for studies reporting baseline cognitive data of CHR-C and CHR-NC. Included NC tests were classified within the MATRICS - Measurement and Treatment Research to Improve Cognition in Schizophrenia - cognitive domains. RESULTS Of 95 studies assessed for eligibility, 9 studies comprising 583 CHR subjects (N CHR-C=195, N CHR-NC=388) met all the inclusion criteria. CHR-C performed significantly worse compared to CHR-NC on 2 MATRICS domains namely working memory (ES=-0.29, 95% CI=-0.53 to -0.05) and visual learning (ES=-0.40, 95% CI=-0.68 to -0.13). For the remaining 4 domains (processing speed, attention/vigilance, verbal learning, reasoning/problem solving) no significant differences between CHR-C and CHR-NC were observed. CONCLUSION Based on the current meta-analytic data we might conclude that it is possible to differentiate between CHR-C and CHR-NC with respect to working memory and visual learning. The addition of visual learning and working memory tasks to psychosis regression models might contribute to the predictive power of these models.
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Affiliation(s)
- Amber De Herdt
- Department of Rehabilitation Science, KU Leuven, Belgium.
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47
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Woods SW, Walsh BC, Hawkins KA, Miller TJ, Saksa JR, D'Souza DC, Pearlson GD, Javitt DC, McGlashan TH, Krystal JH. Glycine treatment of the risk syndrome for psychosis: report of two pilot studies. Eur Neuropsychopharmacol 2013; 23:931-40. [PMID: 23089076 PMCID: PMC4028140 DOI: 10.1016/j.euroneuro.2012.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 11/30/2022]
Abstract
Patients meeting criteria for the risk syndrome for psychosis have treatment needs including positive and negative symptoms and cognitive impairment. These features could potentially respond to NMDA glycine-site agonists. The present objective was to determine which symptoms or domains of cognition promise to show the greatest response to glycine in risk syndrome patients. We conducted two short-term pilot studies of glycine used without adjunctive antipsychotic medication. In the first trial, 10 risk syndrome subjects received open-label glycine at doses titrated to 0.8 g/kg/d for 8 weeks, followed by discontinuation and 16 weeks of evaluation for durability of effects. In the second, 8 subjects were randomized to double-blind glycine vs. placebo for 12 weeks, followed by open-label glycine for another 12 weeks. Patients were evaluated every 1-2 weeks with the Scale Of Psychosis-risk Symptoms (SOPS) and before and after treatment with a neurocognitive battery. Within-group and between-group effect sizes were calculated. Effect sizes were large for positive (open-label within-group -1.10, double-blind between-group -1.11) and total (-1.39 and -1.15) symptoms and medium-to-large (-0.74 and -0.79) for negative symptoms. Medium or large effect sizes were also observed for several neurocognitive measures in the open-label study, although data were sparse. No safety concerns were identified. We conclude that glycine was associated with reduced symptoms with promising effect sizes in two pilot studies and a possibility of improvement in cognitive function. Further studies of agents that facilitate NMDA receptor function in risk syndrome patients are supported by these preliminary findings.
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Affiliation(s)
- Scott W Woods
- Yale University School of Medicine, New Haven, CT, USA.
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48
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Woods SW, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Mathalon DH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, McGlashan TH. Psychotropic medication use in youth at high risk for psychosis: comparison of baseline data from two research cohorts 1998-2005 and 2008-2011. Schizophr Res 2013; 148:99-104. [PMID: 23787224 PMCID: PMC3867209 DOI: 10.1016/j.schres.2013.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/08/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Antipsychotic medication use rates have generally been rising among youth with psychiatric disorders, but little is known about use rates of antipsychotics or other psychotropic medications in patients at high risk for psychosis. METHOD Baseline psychotropic medication use rates were compared in two research cohorts of patients at high risk for psychosis that enrolled between 1998-2005 (n=391) and 2008-2011 (n=346). Treatment durations and antipsychotic doses were described for cohort 2. RESULTS Median age was 17years in cohort 1 and 18years in cohort 2. The rate of prescription of any psychotropic at baseline was roughly 40% for each cohort. Antipsychotic prescription rates were 24% among sites that permitted baseline antipsychotic use in cohort 1 and 18% in the cohort 2; the decline did not quite reach statistical significance (p=0.064). In cohort 2 the mean±SD baseline chlorpromazine-equivalent dose was 121±108mg/d, and lifetime duration of antipsychotic treatment was 3.8±5.9months. DISCUSSION Although the rate of antipsychotic prescription among high-risk youth may have fallen slightly, the nearly one-in-five rate in the second cohort still constitutes a significant exposure. Mitigating factors were that doses and durations of treatment were low. As for other nonpsychotic conditions, it is incumbent on our field to develop alternative treatments for high-risk patients and to generate additional evidence for or against the efficacy of antipsychotics to help define their appropriate role if alternative treatments fail.
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Affiliation(s)
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles CA
| | | | | | | | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill NC
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston MA
| | | | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta GA
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Carpenter WT, Tandon R. Psychotic disorders in DSM-5: summary of changes. Asian J Psychiatr 2013; 6:266-8. [PMID: 23642992 DOI: 10.1016/j.ajp.2013.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/01/2013] [Indexed: 01/06/2023]
Abstract
Key issues related to the diagnosis of schizophrenia and other psychotic disorders addressed in DSM-5 were more precisely defining diagnostic boundaries between different psychotic disorders, reducing spurious comorbidity, improving coherence across the diagnostic manual, and enhancing validity without loss of reliability. New information about the nature of these disorders generated since DSM-IV was incorporated into their definition. Resulting changes in DSM-5 include elimination of the classic subtypes of schizophrenia, elimination of special treatment of Schneiderian 'first-rank symptoms', more precise delineation of schizoaffective disorder from schizophrenia and psychotic mood disorders, and clarification of the nosologic status of catatonia and its consistent treatment across the manual. Changes in section 3 of the manual include addition of a new category of "attenuated psychosis syndrome" as a condition for further study and addition of unique psychopathological dimensions (that represent treatment targets across disorders). The specific nature of these revisions in the DSM-5 criteria for schizophrenia and other psychotic disorders along with their rationale are summarized in this article.
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Affiliation(s)
- William T Carpenter
- Department of Psychiatry and Pharmacology, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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Abstract
AIM The purpose of this study was to undertake a first step in trying to understand the types of treatments young people at clinical high risk of psychosis are interested in pursuing. METHODS The sample consisted of 30 young people who were current participants in the ongoing North American Prodrome Longitudinal Study (NAPLS 2) and who met criteria for being at clinical high risk for psychosis. Participants were administered a questionnaire that asked them to identify the types of mental health problems they were currently getting help with or would like to get help with and the types of treatments they thought would be helpful and may be interested in receiving. RESULTS Results showed that when individuals first began participation in NAPLS, almost half had no expectations for treatment. They wanted help but they did not really know what kind of help to be asking for. Participants had a wide range of concerns for which they wanted help. Although a majority endorsed attenuated positive symptoms as a concern, many other issues such a family and social problems were often identified. For those who were already receiving help, the general opinion was that it was beneficial. CONCLUSIONS The findings suggest that this population sees many different interventions as being potentially helpful. Furthermore, they are open to participating in a variety of treatments, including psychotherapeutic and psychiatric interventions as well as more general treatments addressing a range of possible deficits or difficulties.
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Affiliation(s)
- Kali Brummitt
- Department of Psychology Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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