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Teigset CM, Mohn C, Mohn-Haugen CR, Larøi F, Rund BR. Psychological and social difficulties in young non-help-seeking adolescents at risk for psychosis: insights from a large cohort study. Front Psychol 2024; 15:1430805. [PMID: 39355295 PMCID: PMC11443346 DOI: 10.3389/fpsyg.2024.1430805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/28/2024] [Indexed: 10/03/2024] Open
Abstract
Background This study used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa), and explored the psychological and social challenges of 14-year-olds who report psychotic symptoms. Research on help-seeking youths indicates comorbid symptoms of depression, anxiety, and social deterioration, but less is known about non-help-seeking individuals who may not use healthcare services, possibly skewing comorbidity profiles. Also, findings suggest that adolescents manifesting psychotic symptoms refrain from pursuing help. This gap underscores the necessity of studying non-help-seeking adolescents to better understand their needs and the risks they face without intervention. Methods We analyzed responses from adolescents who completed the 14-year questionnaire in MoBa (N = 127), identifying those as at risk by their high scores on psychosis-risk items, within the top 0.4% (N = 58). Comparative analyses were conducted against matched controls to assess differences in psychological and social functioning (N = 69). Results Results indicated that the at-risk adolescents experience significantly more depression and anxiety and have lower self-esteem and poorer social functioning than controls. Social functioning parameters, including leisure activities, social competence, quality of parental relationship, and sense of school belonging, were significantly worse than those observed in controls. The results indicate a pronounced vulnerability among non-help-seeking adolescents at-risk, similar to issues seen in help-seeking youths. Conclusion These findings highlight the importance of early identification and intervention strategies that reach beyond traditional clinical settings, suggesting the efficacy of population or community-based screenings to prevent long-term adverse outcomes. The study proposes a broader understanding of psychosis risk, stressing the importance of inclusive approaches to support at-risk adolescents effectively.
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Affiliation(s)
| | - Christine Mohn
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Frank Larøi
- Department of Psychology, University of Oslo, Oslo, Norway
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Rodríguez-Pascual M, Álvarez-Subiela X, Tor J, Pardo M, de la Serna E, Sugranyes G, Puig O, Baeza I, Dolz M. Major depressive disorder and attenuated negative symptoms in a child and adolescent sample with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry 2022; 31:1431-1440. [PMID: 33893893 DOI: 10.1007/s00787-021-01793-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
Some 70-80% of subjects with psychotic risk syndrome (PRS) have lifetime comorbidity, with depressive disorders being the most common. A high proportion of patients with PRS present nonspecific symptoms which can be confounding factors for diagnosis. Depressive and negative symptoms may be difficult to distinguish and it is important to differentiate them. The aim of this study is to assess the presence of depressive disorder in a child and adolescent sample of PRS and to examine the presence of negative symptoms and detect possible confounding characteristics between them and depressive symptoms. This is a naturalistic multi-site study with subjects who met PRS criteria. A sample of 89 PRS adolescent patients was included. Major depressive disorder (MDD) is the most prevalent comorbid disorder (34.83%). The sample was divided into patients who met criteria for MDD (PRS-MDD, n = 31) and those who did not have this disorder (PRS-ND, n = 44). We obtained significant differences in the attenuated negative symptoms (ANS) between PRS-MDD and PRS-ND (68.18 vs. 90.32%, respectively, p = 0.021). Subjects with MDD presented a higher score in ANS and Hamilton Depression Rating Scale (HDRS). Moreover, we obtained a correlation between negative symptomatology and HDRS score with a higher score on HDRS in subjects with higher negative symptom scores (r = 0.533, p < 0.001). More research is needed to fine tune differentiation between depressive and negative symptoms and learn more about the possible impact of MDD on PRS children and adolescents.
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Affiliation(s)
- Marta Rodríguez-Pascual
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain.
| | - Xavier Álvarez-Subiela
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Jordina Tor
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Marta Pardo
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Gisela Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
- Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - Montserrat Dolz
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, 08950, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
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Hou J, Schmitt S, Zhao X, Wang J, Chen J, Mao Z, Qi A, Lu Z, Kircher T, Yang Y, Shi J. Neural Correlates of Facial Emotion Recognition in Non-help-seeking University Students With Ultra-High Risk for Psychosis. Front Psychol 2022; 13:812208. [PMID: 35756282 PMCID: PMC9226575 DOI: 10.3389/fpsyg.2022.812208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the introduction of the neurodevelopmental perspective of schizophrenia research on individuals at ultra-high risk for psychosis (UHR) has gained increasing interest, aiming at early detection and intervention. Results from fMRI studies investigating behavioral and brain functional changes in UHR during facial emotion recognition, an essential component of social cognition, showed heterogenous results, probably due clinical diversity across these investigations. This fMRI study investigated emotion recognition in a sub-group of the UHR spectrum, namely non-help-seeking, drug-naïve UHR with high cognitive functioning to reveal the neurofunctional underpinnings of their social functioning in comparison to healthy controls. Methods Two large cohorts of students from an elite University (n 1 = 4,040, n 2 = 4,364) were screened firstly with the Prodromal Questionnaires and by surpassing predefined cut-offs then interviewed with the semi-structured Interview for Psychosis-Risk Syndromes to verify their UHR status. Twenty-one identified non-help-seeking UHR and 23 non-UHR control subjects were scanned with functional magnetic resonance imaging while classifying emotions (i.e., neutral, happy, disgust and fear) in a facial emotion recognition task. Results Behaviorally, no group differences were found concerning accuracy, reaction times, sensitivity or specificity, except that non-help-seeking UHR showed higher specificity when recognizing neutral facial expressions. In comparison to healthy non-UHR controls, non-help-seeking UHR showed generally higher activation in the superior temporal and left Heschl's gyrus as well as in the somatosensory, insular and midcingulate cortex than the control subjects during the entire recognition task regardless of the emotion categories. In an exploratory analysis, in the non-help-seeking UHR group, functional activity in the left superior temporal gyrus was significantly correlated with deficits in the ability to experience emotions at uncorrected statistical thresholds. Conclusions Compared to healthy controls, non-help-seeking UHR show no behavioral deficits during facial emotion recognition, but functional hyperactivities in brain regions associated with this cognitive process. Our study may inspire future early intervention and provide loci for treatment using neural stimulation.
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Affiliation(s)
- Jiaojiao Hou
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
- Hannover Medical School, Clinics for Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Xudong Zhao
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Wang
- Tongji University School of Medicine, Shanghai, China
| | - Jianxing Chen
- Tongji University School of Medicine, Shanghai, China
| | - Ziyu Mao
- Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ansi Qi
- Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Lu
- Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Yunbo Yang
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Jingyu Shi
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Division of Medical Humanities and Behavioral Sciences, Tongji University School of Medicine, Shanghai, China
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West ML, Parrish EM, Friedman-Yakoobian M. Treatment outcomes for young people at clinical high risk for psychosis: Data from a specialized clinic. Early Interv Psychiatry 2022; 16:500-508. [PMID: 34309198 DOI: 10.1111/eip.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
AIM Treatment for youth exhibiting signs of clinical high risk for psychosis (CHR-P) has been emphasized in recent years, but there is need for a greater understanding of the course of symptoms and functioning across treatment. The aim of this study is to describe 10 years of naturalistic treatment outcomes in a real-world, specialized CHR-P outpatient clinic, the Center for Early Detection, Assessment, and Response to Risk (CEDAR) Clinic. METHODS The CEDAR Clinic routinely collects client outcomes data for the purposes of program development, monitoring treatment effectiveness, and characterizing the clinic population. Clients are assessed at baseline, every 6 months (for up to 2 years depending on duration of treatment), and at the end of treatment. A series of mixed-effects models were performed to analyse change over time in outcomes (symptoms and functioning) between baseline and follow-up time points. RESULTS Over time, clients' (N = 123) positive (F = 11.8, p < .001) and negative (F = 4.91, p = .002) symptoms declined relative to their baseline. Social functioning improved over time (F = 2.50, p = .049), as did depression (F = 8.60, p < .001) and hopelessness (F = 4.21, p = .004). Clients' total CEDAR treatment hours ranged across type of treatment service, but the amount of treatment clients received was not associated with any clinical outcomes. CONCLUSIONS Over the course of treatment at this real-world, specialized CHR-P program, clients exhibited significant improvement in clinical outcomes and did not significantly decline in any measured outcomes. We discuss this study in the context of current understanding and guidelines for specialized coordinated specialty care treatment for CHR-P.
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Affiliation(s)
- Michelle L West
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Emma M Parrish
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Michelle Friedman-Yakoobian
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Mental Health, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Brookline Center for Community Mental Health, Brookline, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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5
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Basic self-disturbance trajectories in clinical high risk for psychosis: a one-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2022; 272:1007-1019. [PMID: 34783878 PMCID: PMC9388413 DOI: 10.1007/s00406-021-01349-6] [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: 02/20/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15-30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline (n = 5) and in SSDs at follow-up (n = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.
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6
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Thompson EC, Andorko ND, Rouhakhtar PR, Millman ZB, Sagun K, Han SC, Chibani D, Reeves GM, Herman B, Schiffman J. Psychosis-Spectrum Screening and Assessment Within a College Counseling Center: A Pilot Study Exploring Feasibility and Clinical Need. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2022; 36:201-222. [PMID: 35694629 PMCID: PMC9175646 DOI: 10.1080/87568225.2020.1797604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence supports the use of brief psychosis-spectrum screening tools for identifying individuals at an increased risk of developing a psychotic disorder. Screening has not been well studied in general mental health settings that serve young adults in the age range associated with highest risk for psychosis. This study explored the feasibility of psychosis-risk screening and assessment among help-seeking students at a university counseling center. The PRIME Screen-Revised was administered to students at clinic intake. Participants who screened positively were offered a follow-up assessment using the Structured Interview for Psychosis-risk Syndromes (SIPS). At intake, 510 students completed the PRIME Screen-Revised, with 132 (25.9%) screening positive. Comprehensive psychosis-spectrum evaluations were completed with 38 participants, and 22 met criteria for a psychosis-spectrum disorder, representing 57.9% of this subsample. Findings suggest that psychosis-risk screening in a college clinic is a promising approach to identifying those at high risk for or in the early stages of psychosis.
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Affiliation(s)
- Elizabeth C. Thompson
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Nicole D. Andorko
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | | | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Kristin Sagun
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Susan C. Han
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Doha Chibani
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Gloria M. Reeves
- Child and Adolescent Psychiatry, University of Maryland Medical Center, Baltimore, MD, 21201
| | - Bruce Herman
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
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Iorio M, Casini E, Damiani S, Fusar-Poli P, Borgatti R, Mensi MM. Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target. Front Psychiatry 2022; 13:861201. [PMID: 35492727 PMCID: PMC9051044 DOI: 10.3389/fpsyt.2022.861201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of a positive family relationship has been suggested as a protective factor from parental stress and from the development of full-blown psychosis. However, to date, there is limited research on family functioning in adolescents with psychosis and at clinical high risk for psychosis (CHR-P). This study is aimed at comparing family functioning and perceived stress in parents of adolescents with either CHR-P, early onset psychosis (EOP), or other psychiatric disorders (no CHR-P). As a secondary aim, it will correlate family functioning with parental perceived stress in order to find critical targets of intervention. We conducted a Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD)-compliant, real-world, cross-sectional study. One-hundred and eleven adolescents aged 12-17 who access the institute of hospitalization and care with scientific character (IRCCS) Mondino Foundation Neuropsychiatric services (Pavia, Italy) between 2017 and 2020 and their parents (n = 222) were included. Sociodemographic characteristics of adolescents and their parents were collected. Family functioning was evaluated through the Family Adaptability and Cohesion Evaluation Scale-IV (FACES-IV) and the level of stress through the Perceived Stress Scale (PSS). Twenty adolescents had EOP, 38 had CHR-P, and 59 had no CHR-P. In total, 2.6% of CHR-P adolescents were adopted, 76.3% had separated-divorced parents, and 34.2% of parents had a depressive disorder. Among the FACES-IV sub-scale, maternal rigidity was progressively increased from no-CHR-P to CHR-P to EOP group, with statistical differences between EOP and the other two groups (p = 0.01). CHR-P mothers and fathers showed a high level of PSS values, without group difference. Lastly, PSS values correlated positively with the Rigidity, Disengagement, and Chaos scale of FACES-IV and negatively with the Communication scale (p < 0.05). Our results suggest that family functioning has a central role and could represent a worthwhile target of intervention for adolescents at CHR-P, leading the way to new preventive approaches.
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Affiliation(s)
- Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Erica Casini
- Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
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8
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Stress in pregnancy: Clinical and adaptive behavior of offspring following Superstorm Sandy. Dev Psychopathol 2021; 34:1249-1259. [PMID: 34596500 DOI: 10.1017/s0954579421000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The current study investigated 304 children from a longitudinal project (the Stress in Pregnancy (SIP) Study) who were exposed and unexposed to Superstorm Sandy ("Sandy") in utero. They were prospectively followed from 2 to 6 years of age and their clinical and adaptive behaviors were assessed annually. Using a hierarchical linear model, the study found that in utero Sandy exposure was associated with greater clinical (anxiety, depression, and somatization) and lower adaptive behaviors (social skills and functional communication) at age 2 years. However, the trajectories were notably different between the two groups. Anxiety increased more rapidly among the exposed than unexposed group at ages 2-4, and depression increased only among the exposed. In contrast, social skills and functional communication were lower in exposed compared to unexposed children at age 2, but quickly increased and exceeded the capacities of unexposed children by age 3. The findings confirm that prenatal Sandy exposure is not only associated with an increase in anxiety, depression, and somatization in offspring, but also with greater adaptive skills as the children got older. Our study demonstrates that while children who have experienced stress in utero demonstrate elevated suboptimal clinical behaviors related to affective disorders, they nevertheless have the potential to learn adaptive skills.
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9
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Sanfelici R, Antonucci LA, Dwyer DB, Koutsouleris N. Reply to: Individualized Diagnostic and Prognostic Models for Psychosis Risk Syndromes: Do Not Underestimate Antipsychotic Exposure. Biol Psychiatry 2021; 90:e37-e38. [PMID: 34001369 DOI: 10.1016/j.biopsych.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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10
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Mittal VA, Ellman LM, Strauss GP, Walker EF, Corlett PR, Schiffman J, Woods SW, Powers AR, Silverstein SM, Waltz JA, Zinbarg R, Chen S, Williams T, Kenney J, Gold JM. Computerized Assessment of Psychosis Risk. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6:e210011. [PMID: 34307899 PMCID: PMC8302046 DOI: 10.20900/jpbs.20210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early detection and intervention with young people at clinical high risk (CHR) for psychosis is critical for prevention efforts focused on altering the trajectory of psychosis. Early CHR research largely focused on validating clinical interviews for detecting at-risk individuals; however, this approach has limitations related to: (1) specificity (i.e., only 20% of CHR individuals convert to psychosis) and (2) the expertise and training needed to administer these interviews is limited. The purpose of our study is to develop the computerized assessment of psychosis risk (CAPR) battery, consisting of behavioral tasks that require minimal training to administer, can be administered online, and are tied to the neurobiological systems and computational mechanisms implicated in psychosis. The aims of our study are as follows: (1A) to develop a psychosis-risk calculator through the application of machine learning (ML) methods to the measures from the CAPR battery, (1B) evaluate group differences on the risk calculator score and test the hypothesis that the risk calculator score of the CHR group will differ from help-seeking and healthy controls, (1C) evaluate how baseline CAPR battery performance relates to symptomatic outcome two years later (i.e., conversion and symptomatic worsening). These aims will be explored in 500 CHR participants, 500 help-seeking individuals, and 500 healthy controls across the study sites. This project will provide a next-generation CHR battery, tied to illness mechanisms and powered by cutting-edge computational methods that can be used to facilitate the earliest possible detection of psychosis risk.
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Affiliation(s)
- Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | | | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA 92697, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Steven M. Silverstein
- Center for Visual Science, Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
- The Family Institute at Northwestern University, Evanston, IL 60208, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Trevor Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Joshua Kenney
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
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11
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Catalan A, Salazar de Pablo G, Vaquerizo Serrano J, Mosillo P, Baldwin H, Fernández-Rivas A, Moreno C, Arango C, Correll CU, Bonoldi I, Fusar-Poli P. Annual Research Review: Prevention of psychosis in adolescents - systematic review and meta-analysis of advances in detection, prognosis and intervention. J Child Psychol Psychiatry 2021; 62:657-673. [PMID: 32924144 DOI: 10.1111/jcpp.13322] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/20/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. METHODS We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. RESULTS Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. PROGNOSIS Risk for psychosis was 10.4% (95%CI: 5.8%-18.1%) at 6 months, 20% (95%CI: 15%-26%) at 12 months, 23% (95%CI: 18%-29%) at 24 months and 23.3% (95%CI: 17.3%-30.7%) at ≥36 months. INTERVENTIONS There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. CONCLUSIONS It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.
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Affiliation(s)
- Ana Catalan
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain.,Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Julio Vaquerizo Serrano
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Pierluca Mosillo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aranzazu Fernández-Rivas
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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12
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Thompson EC, DeLuca JS, Petti E, Rakhshan Rouhakhtar P, Schiffman J. Preliminary support for using the Atypicality Scale from the Behavior Assessment System for Children, Second Edition, to screen for psychosis-spectrum disorders within a college counselling centre. Early Interv Psychiatry 2021; 15:406-411. [PMID: 32436366 PMCID: PMC7679286 DOI: 10.1111/eip.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
AIM Evidence supports the use of brief psychosis-spectrum screeners for identifying individuals at risk for psychosis. Screening has not been well-studied in help-seeking college samples. This study investigated the use of the Behavior Assessment System for Children, Second Edition (BASC-2) Atypicality Scale as a psychosis-spectrum screening tool within a university counselling centre. METHODS Atypicality scores from the BASC-2 were compared to interview-based assessment, the Structured Interview for Psychosis-risk Syndromes (SIPS), to explore associations across the measures and evaluate the scale's ability to identify individuals who meet criteria for a psychosis-spectrum diagnosis. RESULTS Forty-three participants completed the BASC-2 and SIPS, and 23 were SIPS-positive. Compared to the SIPS-negative group, the SIPS-positive group had significantly higher Atypicality scores. Exploratory results indicated that Atypicality scores identified SIPS-positive individuals with an overall accuracy of 72% (78% sensitivity, 65% specificity). CONCLUSION The Atypicality Scale may be an appropriate first-line psychosis-spectrum screening tool in college counselling centres.
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Affiliation(s)
- Elizabeth C Thompson
- Department of Psychology, University of Maryland, Catonsville, Maryland, USA
- Brown's Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Child and Adolescent Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Joseph S DeLuca
- Department of Psychology, University of Maryland, Catonsville, Maryland, USA
| | - Emily Petti
- Department of Psychology, University of Maryland, Catonsville, Maryland, USA
| | | | - Jason Schiffman
- Department of Psychology, University of Maryland, Catonsville, Maryland, USA
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13
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Rinne GR, O'Brien MP, Miklowitz DJ, Addington JM, Cannon TD. Depression, family interaction and family intervention in adolescents at clinical-high risk for psychosis. Early Interv Psychiatry 2021; 15:360-366. [PMID: 32232954 PMCID: PMC8175016 DOI: 10.1111/eip.12954] [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: 09/25/2019] [Revised: 01/21/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIM The relationship between family behaviour and depression in adolescents at clinical high risk (CHR) for psychosis remains understudied despite high rates of depression in this population. This study examines the relationship between family problem-solving behaviours and depression in CHR adolescents and the impact of family interventions targeting subthreshold symptoms of psychosis on reducing symptoms of depression over 2-years. METHODS Participants were a subset of the North American Prodrome Longitudinal Study who were randomized to 6-months of family focused therapy for individuals at CHR or family psychoeducational treatment. We evaluated the relationship between communication during family conflict discussion and adolescents' symptoms of depression before treatment. At follow-up assessments the family treatment groups were compared on depression. Finally, we compared those in family treatment with matched controls. RESULTS Adolescents' constructive communication was associated with less severe symptoms of depression before treatment. Symptoms of depression improved for adolescents in both family treatment groups. However, there were no significant group by treatment interactions. When adolescents who participated in either type of family intervention were compared to CHR adolescent controls, symptoms of depression improved for adolescents in treatment and control groups, but there were no significant time by treatment interactions. CONCLUSIONS The communication skills of CHR adolescents are related to both depression and their parents' communication skills pre-treatment. However, reductions in depression over the course of the treatment trial cannot be attributed to family treatment. It is imperative to incorporate interventions that directly target depression into future family treatment studies.
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Affiliation(s)
- Gabrielle R Rinne
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Mary P O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - David J Miklowitz
- Semel Institute, University of California, Los Angeles, California, USA
| | - Jean M Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA.,Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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14
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Gupta T, Mittal VA. Transcranial direct current stimulation and emotion processing deficits in psychosis and depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:69-84. [PMID: 32488523 PMCID: PMC7704557 DOI: 10.1007/s00406-020-01146-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/23/2020] [Indexed: 01/11/2023]
Abstract
Emotional processing deficits (EPDs) are commonly observed among individuals diagnosed with (1) psychotic disorders (2) and depression. Given that EPDs can impact overall functioning and quality of life, the need to identify effective interventions is critical. To date, our current understanding of treatments for these impairments is limited. However, there is increasing interest in investigating the efficacy of transcranial direct current stimulation (tDCS). This neuromodulation technique releases a weak electrical current through the brain. Given research suggesting promise for using tDCS to improve symptoms and cognition across psychopathology, this approach may be useful for improving EPDs and related symptoms in psychosis and depression. In the current review, we provide an overview of the literature determining the effects of tDCS for EPDs and related symptoms in these groups. Furthermore, we highlight methodological advances and pinpoint potential future directions.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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15
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Wiedmann M, Kuitunen-Paul S, Basedow LA, Roessner V, Golub Y. Attenuated Psychotic Symptoms in Adolescents With Chronic Cannabis and MDMA Use. Front Psychiatry 2021; 12:696133. [PMID: 35126190 PMCID: PMC8814345 DOI: 10.3389/fpsyt.2021.696133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/13/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Both substance use, on the one hand, and the first signs of psychosis, on the other, commonly begin in adolescence. Adolescents with substance use disorder (SUD) frequently show recreational use of cannabis and 3,4-methylenedioxymethamphetamine (MDMA). When attenuated psychotic symptoms (APS) occur during the course of SUD, they are commonly attributed to the cannabis use, neglecting the role of other substances abused, such as MDMA in the risk of psychosis. METHODS We analyzed retrospective self-reports on APS (Prodromal Questionnaire, PQ-16) and amount of cannabis and MDMA use in n = 46 adolescent psychiatry outpatients with SUD. N = 17 (35%) individuals reported MDMA consume additional to cannabis. Furthermore, we examined the associations of APS with cannabis and MDMA use in stepwise hierarchical regressions while controlling for trauma history, birth complications and gender. RESULTS APS were not related to cannabis (B = 0.04, p = 0.842), but to MDMA use (B = 4.88, p = 0.001) and trauma history (B = 0.72, p = 0.001). Gender (B = -0.22, p = 0.767) and birth complications (B = -0.68, p = 0.178) were not associated with APS. DISCUSSION Our results indicate that MDMA use additional to cannabis use is associated with APS among adolescent SUD patients. Contrary to our expectations, we did not see an association of cannabis use and APS. We speculate that cannabis increases the risk for psychosis after a longer period of use and in combination with other risk factors, such as trauma history. Clinicians should screen for APS among SUD patients using MDMA and cannabis in order to adapt treatment plans of SUDs. Future research should validate these findings in longitudinal studies including polysubstance use and trauma history.
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Affiliation(s)
- Melina Wiedmann
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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16
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Abstract
Schizophrenia and other psychotic disorders are serious psychiatric disorders that are associated with substantial societal, family, and individual costs/distress. Evidence suggests that early intervention can improve prognostic outcomes; therefore, it is essential to accurately identify those at risk for psychosis before full psychotic symptoms emerge. The purpose of our study is to develop a brief, valid screening questionnaire to identify individuals at risk for psychosis in non-clinical populations across 3 large, community catchment areas with diverse populations. This is a needed study, as the current screening tools for at-risk psychotic populations in the US have been validated only in clinical and/or treatment seeking samples, which are not likely to generalize beyond these specialized settings. The specific aims are as follows: (1) to determine norms and prevalence rates of attenuated positive psychotic symptoms across 3 diverse, community catchment areas and (2) to develop a screening questionnaire, inclusive of both symptom-based and risk factor-based questions. Our study will develop an essential screening tool that will identify which individuals have the greatest need of follow-up with structured interviews in both research and clinical settings. Our study has the potential for major contributions to the early detection and prevention of psychotic disorders.
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17
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DeLuca JS, Andorko ND, Chibani D, Jay SY, Rakhshan Rouhakhtar PJ, Petti E, Klaunig MJ, Thompson EC, Millman ZB, Connors KM, Akouri-Shan L, Fitzgerald J, Redman SL, Roemer C, Bridgwater MA, DeVylder JE, King CA, Pitts SC, Reinblatt SP, Wehring HJ, Bussell KL, Solomon N, Edwards SM, Reeves GM, Buchanan RW, Schiffman J. Telepsychotherapy with Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices during the COVID-19 Pandemic. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2020; 30:304-331. [PMID: 34305369 PMCID: PMC8297958 DOI: 10.1037/int0000211] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis-those at Clinical High Risk for psychosis (CHR)-given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the COVID-19 pandemic and its subsequent physical isolation measures, due to heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this paper, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic; best practices for treatment and adaptations for telepsychotherapy for individuals at CHR; and highlight real clinical issues that we are currently experiencing in a United States-based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.
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Affiliation(s)
- Joseph S. DeLuca
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Nicole D. Andorko
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Doha Chibani
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha Y. Jay
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | - Emily Petti
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Mallory J. Klaunig
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Elizabeth C. Thompson
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI
| | | | - Kathleen M. Connors
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - LeeAnn Akouri-Shan
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - John Fitzgerald
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha L. Redman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Caroline Roemer
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | | | - Cheryl A. King
- University of Michigan, Departments of Psychiatry and Psychology, Ann Arbor, MI
| | - Steven C. Pitts
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Shauna P. Reinblatt
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Natalee Solomon
- Maryland Department of Health, Behavioral Health Administration, Transition-Aged Youth and Young Adult Services, Baltimore, MD
| | - Sarah M. Edwards
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Gloria M. Reeves
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
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18
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Thompson E, Spirito A, Frazier E, Thompson A, Hunt J, Wolff J. Suicidal thoughts and behavior (STB) and psychosis-risk symptoms among psychiatrically hospitalized adolescents. Schizophr Res 2020; 218:240-246. [PMID: 31948902 PMCID: PMC7299764 DOI: 10.1016/j.schres.2019.12.037] [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: 07/04/2019] [Revised: 11/04/2019] [Accepted: 12/27/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Individuals in the early stages of psychosis have a markedly high risk for suicidal thoughts and behavior (STB). It is not well understood if STB among those with psychosis-risk symptoms is accounted for by co-occurring psychopathology (e.g., depression), unique experiences specific to psychosis-spectrum symptomatology (e.g., hallucinations, delusions), or combined effects of different factors. This cross-sectional study explored the link between psychosis-spectrum symptoms, co-occurring disorders, and STB. METHODS This record review included 569 adolescents (mean age = 14.83) admitted to a psychiatric inpatient hospital due to exhibiting behavior indicating they were an imminent threat to themselves or others. Upon intake to the hospital, participants completed a diagnostic interview and self-report measures of suicidal ideation, suicide attempt history, and psychosis-spectrum symptoms. The primary analysis used linear regression to predict suicidal ideation from psychosis-spectrum symptom scores, controlling for known characteristics associated with STB including specific psychiatric disorders (i.e. depressive, anxiety, post-traumatic stress, and psychotic disorders), biological sex, and race. RESULTS Psychosis-spectrum symptoms predicted suicidal ideation above and beyond the significant effects of a depressive disorder diagnosis and sex, as well as the non-significant effects of anxiety, PTSD, full-threshold psychosis, and race. Item-level correlations demonstrated that several psychosis-spectrum symptoms were significantly associated with ideation and lifetime suicide attempts. CONCLUSIONS Results indicate that within this sample of psychiatrically hospitalized youth, psychosis-risk symptoms were uniquely linked to STB. These findings suggest that attention to psychosis-spectrum symptoms, including several specific psychosis-risk experiences, may be clinically important for better assessment and treatment of suicidal youth.
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Affiliation(s)
- Elizabeth Thompson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America; Child and Adolescent Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West Suite 204, Providence, RI 02903, United States of America.
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America.
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America.
| | - Alysha Thompson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America.
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America.
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, United States of America; Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States of America; Child and Adolescent Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West Suite 204, Providence, RI 02903, United States of America.
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19
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Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
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Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
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20
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Dolz M, Tor J, De la Serna E, Pardo M, Muñoz-Samons D, Rodríguez-Pascual M, Puig O, Sugranyes G, Usall J, Sánchez-Gistau V, Baeza I. Characterization of children and adolescents with psychosis risk syndrome: The Children and Adolescents Psychosis Risk Syndrome (CAPRIS) study. Early Interv Psychiatry 2019; 13:1062-1072. [PMID: 30478873 DOI: 10.1111/eip.12728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/20/2018] [Accepted: 07/29/2018] [Indexed: 01/18/2023]
Abstract
AIM Despite the interest in psychosis risk syndrome (PRS) in children and adolescents, information on the syndrome in this population is scarce. METHODS Prospective naturalistic multi-site study in which 10- to 17-year-old help-seeking subjects who met PRS criteria (positive or negative attenuated symptoms; brief limited intermittent psychotic symptoms; genetic risk or schizotypal personality disorder plus impairment in functioning) were included, along with 45 age and sex-matched healthy controls (HC). All subjects were clinically and functionally assessed. RESULTS Ninety-one PRS subjects (PRSS) with a mean age of 15.5 ± 1.4 met inclusion criteria (IC). Compared with HC, PRSS presented worse global and academic functioning in the previous year, had experienced more psychiatric and psychological problems, and presented gestational ages outside the normal range. More than 80% of PRSS met ≥2 IC, with 65.9% having one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision diagnosis, and 61.7% of those having ≥2 diagnoses. Some 49.5% of PRSS had a first- or second-degree family history (FH) of psychosis. Patients with first- and second-degree FH do not differ in their clinical expression. CONCLUSIONS Children and adolescents with PRS are a patient group with a pattern of neurodevelopmental impairment and clinical complexity similar to patients with schizophrenia spectrum disorders, highlighting the importance of assessing these variables in child and adolescent samples. PRSS with first- and second-degree relatives with FH do not present differences in their clinical presentation, suggesting that including these two groups of patients in the genetic risk criteria would enrich knowledge of these criteria.
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Affiliation(s)
- Montserrat Dolz
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Jordina Tor
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Elena De la Serna
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Marta Pardo
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Marta Rodríguez-Pascual
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Judith Usall
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | - Vanessa Sánchez-Gistau
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Early Intervention Service, Pere Mata Institut Universitary Hospital, IISPV (Institut d'Investigació Sanitaria Pere Vigili), Rovira Virgili University and CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Reus, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
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21
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Tsuji T, Phalen P, Rouhakhtar PR, Millman Z, Bussell K, Thompson E, Demro C, Roemer C, Reeves G, Schiffman J. Using the K-SADS psychosis screen to identify people with early psychosis or psychosis risk syndromes. Clin Child Psychol Psychiatry 2019; 24:809-820. [PMID: 31094226 PMCID: PMC7263389 DOI: 10.1177/1359104519846582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current methods to identify people with psychosis risk involve administration of specialized tools such as the Structured Interview for Psychosis-Risk Syndromes (SIPS), but these methods have not been widely adopted. Validation of a more multipurpose assessment tool-such as the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)-may increase the scope of identification efforts. METHODS We assessed the correspondence between SIPS-determined clinical high risk/early psychosis (CHR/early psychosis) status and K-SADS psychosis screen (child and parent reports and their combination) in a sample of 147 help-seeking individuals aged 12-25. Detailed classification results are reported. RESULTS Both the child and parent interviews on the K-SADS psychosis screen were strongly predictive of CHR/early psychosis status, although parent reports contributed no significant additional information beyond child reports. Across informants, the presence of either subthreshold hallucinations or subthreshold delusions was highly suggestive of CHR/early psychosis status as determined by SIPS interview (78% (child) and 74% (parent) accuracy). CONCLUSIONS Subthreshold scores on the two-item K-SADS psychosis screen may be good indicators of the presence or absence of early signs of psychosis. The option of using a non-specialized assessment such as the K-SADS as a staged approach to assess for CHR/early psychosis status could increase rates of early psychosis screening and treatment.
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Affiliation(s)
| | - Peter Phalen
- School of Medicine, University of Maryland, USA
- VA Capitol Health Care Network (VISN 5), USA
| | | | | | - Kristin Bussell
- School of Medicine, University of Maryland, USA
- School of Nursing, University of Maryland, USA
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22
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Parrish EM, Kim NS, Woodberry KA, Friedman-Yakoobian M. Clinical high risk for psychosis: The effects of labelling on public stigma in a undergraduate population. Early Interv Psychiatry 2019; 13:874-881. [PMID: 29927070 DOI: 10.1111/eip.12691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
AIM Schizophrenia is a highly stigmatized disorder. Identification of youth at high risk for psychosis has the potential for improved outcomes. However, identifying youth at risk could subject them to increased public stigma. Using an experimental vignette design, this study examined relative levels of public stigma elicited by the labels "schizophrenia," "clinical high risk (CHR)," "attenuated psychotic symptoms syndrome (APSS)," a label implying normative adolescent development ("a bad breakup"), and a no-label control condition. METHODS Ninety-six undergraduates (age: 18.8 + 1.1, range: 18-22) read a vignette describing an adolescent experiencing symptoms typical of CHR for psychosis. The vignette label (APSS, CHR, schizophrenia, a bad breakup or no label) was counterbalanced between participants. Participants answered questions assessing stigma toward the individual and their prior knowledge of and familiarity with psychosis. RESULTS Overall stigma did not differ across conditions. Only ratings of personal responsibility were higher for the breakup label than the schizophrenia label (P < .05). More prior knowledge about, and higher familiarity with, psychotic symptoms predicted lower overall stigma. CONCLUSION We did not find that schizophrenia, CHR or APSS labels elicited elevated stigma in this sample relative to the control labels. This may reflect relatively low levels of mental health stigma in the group studied, a new finding inconsistent with earlier work. Greater levels of knowledge about and familiarity with psychosis were associated with lower stigma. These findings reinforce the potential for mental health awareness campaigns to reduce stigma but also raise questions about factors contributing to lower rates of stigma.
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Affiliation(s)
- Emma M Parrish
- Department of Psychology, Northeastern University, Boston, Massachusetts.,Center for Early Detection Assessment and Response to Risk at Massachusetts Mental Health Center, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Commonwealth Research Center, Boston, Massachusetts
| | - Nancy S Kim
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Kristen A Woodberry
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Commonwealth Research Center, Boston, Massachusetts
| | - Michelle Friedman-Yakoobian
- Center for Early Detection Assessment and Response to Risk at Massachusetts Mental Health Center, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Commonwealth Research Center, Boston, Massachusetts
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23
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Okkenhaug A, Tanem T, Myklebust TÅ, Gjervan B, Johansen A. Self-reported premorbid health in 15 individuals who later developed schizophrenia compared with healthy controls: Prospective data from the Young-HUNT1 Survey (The HUNT Study). ACTA ACUST UNITED AC 2018. [DOI: 10.15714/scandpsychol.5.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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24
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Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:683-700. [PMID: 28914382 DOI: 10.1007/s00787-017-1046-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.
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25
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Perceived social stress and symptom severity among help-seeking adolescents with versus without clinical high-risk for psychosis. Schizophr Res 2018. [PMID: 28629890 DOI: 10.1016/j.schres.2017.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Research suggests that social stress exposure influences illness presentation and course among youth at clinical high-risk (CHR) for psychosis, though less is known about the extent to which self-reported perceptions of social stress relate to the severity of positive symptoms. Importantly, despite the notion that youth at CHR are especially susceptible to elevations in positive symptoms under conditions of stress, no study has examined this presumption relative to other psychiatric groups. Extending previous work demonstrating that perceived social stress was higher in a CHR group than in a clinical group of non-CHR, help-seeking controls, the current study aimed to: (1) examine whether perceived social stress is related to the severity of attenuated positive symptoms in the full sample (N=110); and (2) determine whether CHR status moderates the stress-symptom relation. Exploratory analyses examined relations of perceived social stress to negative, disorganized, and general symptoms. Greater perceptions of social stress were associated with more severe positive symptoms in the entire sample; however, although positive symptoms and perceived social stress were higher in the CHR group, the strength of this relation was statistically indistinguishable across groups. No differential effect of perceived social stress was observed for any symptom domain. Results provide some support for the diathesis-stress model of psychosis, while also suggesting that social stress and symptomatology are related independent of clinical vulnerability to psychosis. Future research would benefit from longitudinal studies of stress-symptom relations across CHR and help-seeking control groups.
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26
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Fonseca-Pedrero E, Ortuño-Sierra J, Chocarro E, Inchausti F, Debbané M, Bobes J. Psychosis risk screening: Validation of the youth psychosis at-risk questionnaire - brief in a community-derived sample of adolescents. Int J Methods Psychiatr Res 2017; 26:e1543. [PMID: 27790784 PMCID: PMC6877222 DOI: 10.1002/mpr.1543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/18/2016] [Accepted: 09/23/2016] [Indexed: 12/17/2022] Open
Abstract
There have been several attempts to identify individuals potentially at high risk for psychotic-spectrum disorders using brief screening measures. However, relatively few studies have tested the psychometric properties of the psychosis screening measures in representative samples of adolescents. The main purpose of the present study was to analyse the prevalence, factorial structure, measurement invariance across gender, and reliability of the Youth Psychosis At-Risk Questionnaire - Brief (YPARQ-B) in a community-derived sample of adolescents. Additionally, the relationship between YPARQ-B, depressive symptoms, psychopathology, stress manifestations, and prosocial skills was analysed. One thousand and twenty students from high schools participated in a cross-sectional survey. The YPARQ-B, the Reynolds Adolescent Depression Scale, the Strengths and Difficulties Questionnaire, and the Student Stress Inventory - Stress Manifestations were used. A total of 85.1% of the total sample self-reported at least one subclinical psychotic experience. We observed a total of 10.9% of adolescents with a cutoff score of ≥11 or 6.8% with a cutoff score of ≥13. The analysis of internal structure of the YPARQ-B yielded an essentially unidimensional structure. The YPARQ-B scores showed measurement invariance across gender. The internal consistency of the YPARQ-B total score was 0.94. Furthermore, self-reported subclinical psychotic experiences were associated with depressive symptoms, emotional and behavioural problems, poor prosocial skills, and stress manifestations. These results would appear to indicate that YPARQ-B is a brief and easy tool to assess self-reported subclinical psychotic experiences in adolescents from the general population. The assessment of these experiences in community settings, and its associations with psychopathology, may help us to enhance the possibility of an early identification of adolescents potentially at risk for psychosis and mental health problems.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain.,Prevention Program for Psychosis (P3), Oviedo, Spain.,Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
| | | | - Edurne Chocarro
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain
| | - Felix Inchausti
- Mental Health Services, Complejo Hospitalario of Navarre, Pamplona, Spain
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julio Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, University of Oviedo, Oviedo, Spain
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27
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Fusar-Poli P, Tantardini M, De Simone S, Ramella-Cravaro V, Oliver D, Kingdon J, Kotlicka-Antczak M, Valmaggia L, Lee J, Millan M, Galderisi S, Balottin U, Ricca V, McGuire P. Deconstructing Vulnerability for Psychosis: Meta-Analysis of Environmental Risk Factors for Psychosis in Subjects at Ultra High-Risk. Eur Psychiatry 2016; 40:65-75. [DOI: 10.1016/j.eurpsy.2016.09.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 01/13/2023] Open
Abstract
AbstractBackgroundSubjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined.MethodSystematic review of associations between genetic or environmental risk factors for psychosis that are widely established in the literature and UHR state, based on comparisons to controls.ResultsForty-four studies encompassing 170 independent datasets and 54 risk factors were included. There were no studies on association between genetic or epigenetic risk factors and the UHR state that met the inclusion criteria. UHR subjects were more likely to show obstetric complications, tobacco use, physical inactivity, childhood trauma/emotional abuse/physical neglect, high perceived stress, childhood and adolescent low functioning, affective comorbidities, male gender, single status, unemployment and low educational level as compared to controls.ConclusionsThe increased vulnerability of UHR subjects can be related to environmental risk factors like childhood trauma, adverse life events and affective dysfunction. The role of genetic and epigenetic risk factors awaits clarification.
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28
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Bentley E, Millman ZB, Thompson E, Demro C, Kline E, Pitts SC, DeVylder JE, Smith ME, Reeves G, Schiffman J. High-risk diagnosis, social stress, and parent-child relationships: A moderation model. Schizophr Res 2016; 174:65-70. [PMID: 27131911 DOI: 10.1016/j.schres.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/07/2016] [Accepted: 04/11/2016] [Indexed: 01/31/2023]
Abstract
Stress is related to symptom severity among youth at clinical high-risk (CHR) for psychosis, although this relation may be influenced by protective factors. We explored whether the association of CHR diagnosis with social stress is moderated by the quality of parent-child relationships in a sample of 96 (36 CHR; 60 help-seeking controls) adolescents and young adults receiving mental health services. We examined self-reported social stress and parent-child relationships as measured by the Behavior Assessment System for Children, Second Edition (BASC-2), and determined CHR status from the clinician-administered Structured Interview for Psychosis-Risk Syndrome (SIPS). The social stress subscale, part of the clinical domain of the BASC-2, assesses feelings of stress and tension in personal relationships and the relations with parents subscale, part of the adaptive domain of the BASC-2, assesses perceptions of importance in family and quality of parent-child relationship. There was a modest direct relation between risk diagnosis and social stress. Among those at CHR, however, there was a significant relation between parent-child relationships and social stress (b=-0.73, t[92]=-3.77, p<0.001, f(2)=0.15) that was not observed among non-CHR individuals, suggesting that a positive parent-child relationship may be a protective factor against social stress for those at risk for psychosis. Findings provide additional evidence to suggest that interventions that simultaneously target both social stress and parent-child relationships might be relevant for adolescents and young adults at clinical high-risk for psychosis.
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Affiliation(s)
- Eryn Bentley
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Zachary B Millman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Elizabeth Thompson
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Caroline Demro
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Emily Kline
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Steven C Pitts
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jordan E DeVylder
- Department of Social Work, University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Melissa Edmondson Smith
- Department of Social Work, University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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29
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Carpenter WT, Schiffman J. Diagnostic Concepts in the Context of Clinical High Risk/Attenuated Psychosis Syndrome. Schizophr Bull 2015; 41:1001-2. [PMID: 26163478 PMCID: PMC4535653 DOI: 10.1093/schbul/sbv095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
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30
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Kline E, Thompson E, Demro C, Bussell K, Reeves G, Schiffman J. Longitudinal validation of psychosis risk screening tools. Schizophr Res 2015; 165:116-22. [PMID: 25975827 DOI: 10.1016/j.schres.2015.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
The development of widely used interview tools has helped to standardize the criteria for a "clinical high risk" syndrome, thus enabling advances in efforts to develop interventions for this phase of illness. These assessments, however, are burdensome to administer and not likely to be adopted for widespread use. Scalable early intervention depends on the availability of brief, low-cost assessment tools that can serve to screen populations of interest or triage treatment-seekers toward specialized care. The current study examines the sensitivity, specificity, and predictive strength of three self-report measures (Prime Screen-Revised, Prodromal Questionnaire-Brief, and Youth Psychosis at Risk Questionnaire-Brief) with regard to psychosis onset and symptom persistence over six months of follow-up within an indicated sample of 54 adolescents and young adults ages 12-22. Within this sample, all three measures demonstrated excellent sensitivity to emerging psychosis and strong agreement with clinician evaluations of attenuated psychosis symptoms. Additionally, all screeners obtained negative predictive values of 1.00 with regard to psychosis onset, indicating that an individual scoring below the recommended threshold score would be extremely unlikely to develop psychosis over the following six months. The longitudinal validation of psychosis risk screening tools constitutes an important step toward establishing a standard of care for early identification and monitoring in this vulnerable population.
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Affiliation(s)
- Emily Kline
- Massachusetts Mental Health Center, Public Psychiatry Division of Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA 02115, USA
| | - Elizabeth Thompson
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Caroline Demro
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Kristin Bussell
- University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD 21201, USA
| | - Gloria Reeves
- University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD 21201, USA
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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31
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Schiffman J, Carpenter WT. Attenuated psychosis syndrome: benefits of explicit recognition. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:48-51. [PMID: 25852257 PMCID: PMC4372762 DOI: 10.11919/j.issn.1002-0829.215015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/01/2022]
Abstract
Given the unique characteristics of people who meet criteria for attenuated psychosis syndrome (APS) and the growing literature on the clinical benefits of providing services to individuals who meet these criteria, the APS diagnosis serves an important, and previously missing, role in psychiatry. The promotion of the APS diagnosis should help reduce the over-diagnosis and over-treatment of individuals with prodromal psychotic conditions and it should also encourage expanded training about attenuated psychosis among clinicians who primarily provide services to youth (a primary group who are diagnosed with APS). Only some of the individuals with APS subsequently develop psychosis, but all have existing clinical needs – regardless of subsequent conversion. The formal recognition of APS in DSM-5 will facilitate the research needed to identify and meet those needs.
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Affiliation(s)
- Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, United States
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, and VA Capitol Health Care Network (VISN 5) MIRECC, Baltimore, Maryland, United States
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