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Tsai CL, Chu CM, Lane HY, Chen SL, Tu CH, Ma WF. The Comparison of Lifestyles, Mental Risks, and Physical Indices among Individuals with Ultra-High Risk of Psychosis, Patients with Schizophrenia, and the General Public. Behav Sci (Basel) 2024; 14:395. [PMID: 38785886 PMCID: PMC11118771 DOI: 10.3390/bs14050395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Early interventions may effectively reduce the risk of mental disorders in individuals with ultra-high risk. Specifying the health needs of individuals with ultra-high risk is crucial before the implementation of successful early intervention. This study aimed to explore the differences in lifestyles, mental risks, and physical indices among individuals with ultra-high risk, patients with schizophrenia, and healthy subjects. (2) Methods: A cross-section design applying seven questionnaires with physical examinations for 144 participants aged 13-45 years old was conducted in this study. The questionnaires included one about personal data, four on mental risks, and two for lifestyles. (3) Results: The individuals with ultra-high risk scored similarly in many dimensions as the patients with schizophrenia, but they displayed lower positive symptoms, lower negative symptoms, lower prodromal symptoms, higher interpersonal deficits, lower nutrition intake, and higher levels of exercise than the patients with schizophrenia. Female individuals with ultra-high risk had lower self-esteem, higher positive symptoms, lower nutrition intake, and higher exercise levels than male ones. (4) Conclusions: The study pinpointed specific health needs with interpersonal deficits, nutrition intake, and physical activity for the individuals with ultra-high risk. Future interventions targeted on improving social function, dietary pattern, and exercise will be beneficial.
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Affiliation(s)
- Ching-Lun Tsai
- Department of Research and Development, BIOZOE Co., Ltd., Taichung 404, Taiwan;
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan;
- Big Data Research Center, Fu-Jen Catholic University, New Taipei City 242, Taiwan
- Department of Public Health, School of Public Health, China Medical University, Taichung 404, Taiwan
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan;
- Department of Psychiatry, China Medical University Hospital, Taichung 404, Taiwan
- Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung 413, Taiwan
| | - Shiah-Lian Chen
- Department of Nursing, National Taichung University of Science and Technology, Taichung 403, Taiwan;
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 404, Taiwan;
| | - Wei-Fen Ma
- School of Nursing, China Medical University, Taichung 404, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung 404, Taiwan
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2
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Wiesepape CN, Smith EA, Hillis-Mascia JD, Queller Soza SE, Morris MM, James AV, Stokes A. Metacognition as a Transdiagnostic Determinant of Recovery in Schizotypy and Schizophrenia Spectrum Disorders. Behav Sci (Basel) 2024; 14:336. [PMID: 38667132 PMCID: PMC11047686 DOI: 10.3390/bs14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one's community, has been proposed to be an important transdiagnostic construct across schizophrenia spectrum disorders and a range of both clinical and non-clinical manifestations of schizotypy. In this paper, we review evidence that deficits in metacognition are present in individuals with relatively high levels of schizotypy and that these deficits are related to symptomology, function, and quality of life. We address the idea that decrements in metacognition may also contribute to the progression from schizotypy to more severe manifestations, while the amelioration of these deficits may enhance aspects of recovery, including the ability to form an integrated sense of self, others, and the wider world. We also review the following two recovery-oriented psychotherapies that target metacognition to promote recovery in individuals with clinical manifestations of schizotypy: Evolutionary Systems Therapy for Schizotypy (ESTS) and Metacognitive Reflection and Insight Therapy (MERIT).
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Affiliation(s)
- Courtney N Wiesepape
- Austin VA Clinic, Veterans Affairs Central Texas Health Care, Austin, TX 78744, USA
| | - Elizabeth A Smith
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
| | | | | | - Madyson M Morris
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | | | - Alexis Stokes
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
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3
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Åmlid HO, Carlsson J, Bjørnestad J, Joa I, Hegelstad WTV. We need to talk: a qualitative inquiry into pathways to care for young men at ultra-high risk for psychosis. Front Psychol 2024; 15:1282432. [PMID: 38410399 PMCID: PMC10894910 DOI: 10.3389/fpsyg.2024.1282432] [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: 08/24/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction It is known from the literature that men are slower to seek help and staying engaged in mental health care compared to women. Seeing that in psychosis, men more often than women have insidious onsets but also a more malign illness course, it is important to find ways to improve timely help-seeking. The aim of this study was to explore barriers and facilitators for help-seeking in young male persons struggling with early signs of psychosis. Methods Qualitative interviews with nine young men who suffer from a first episode of psychosis or psychosis risk symptoms. Results Male stereotypical ideals, significant others, and knowledge of symptoms and where to get help as well characteristics of symptom trajectories appeared to be important determinants of help-seeking behavior. Discussion Interviews indicated that help-seeking in the participants was delayed first, because of reluctancy to disclose distress and second, because significant others were unable to accurately recognize symptoms. Information, awareness, and easy access to care remain important in early detection and intervention in psychosis and psychosis risk. However, more emphasis should be placed on de-stigmatizing mental health problems in men and aiming information specifically at them.
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Affiliation(s)
- Håkon Olav Åmlid
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Jan Carlsson
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Jone Bjørnestad
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Inge Joa
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Institute of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Wenche ten Velden Hegelstad
- TIPS – Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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4
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Peyrot WJ, Panagiotaropoulou G, Olde Loohuis LM, Adams MJ, Awasthi S, Ge T, McIntosh AM, Mitchell BL, Mullins N, O'Connell KS, Penninx BWJH, Posthuma D, Ripke S, Ruderfer DM, Uffelmann E, Vilhjalmsson BJ, Zhu Z, Smoller JW, Price AL. Distinguishing different psychiatric disorders using DDx-PRS. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.02.24302228. [PMID: 38352307 PMCID: PMC10862992 DOI: 10.1101/2024.02.02.24302228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Despite great progress on methods for case-control polygenic prediction (e.g. schizophrenia vs. control), there remains an unmet need for a method that genetically distinguishes clinically related disorders (e.g. schizophrenia (SCZ) vs. bipolar disorder (BIP) vs. depression (MDD) vs. control); such a method could have important clinical value, especially at disorder onset when differential diagnosis can be challenging. Here, we introduce a method, Differential Diagnosis-Polygenic Risk Score (DDx-PRS), that jointly estimates posterior probabilities of each possible diagnostic category (e.g. SCZ=50%, BIP=25%, MDD=15%, control=10%) by modeling variance/covariance structure across disorders, leveraging case-control polygenic risk scores (PRS) for each disorder (computed using existing methods) and prior clinical probabilities for each diagnostic category. DDx-PRS uses only summary-level training data and does not use tuning data, facilitating implementation in clinical settings. In simulations, DDx-PRS was well-calibrated (whereas a simpler approach that analyzes each disorder marginally was poorly calibrated), and effective in distinguishing each diagnostic category vs. the rest. We then applied DDx-PRS to Psychiatric Genomics Consortium SCZ/BIP/MDD/control data, including summary-level training data from 3 case-control GWAS ( N =41,917-173,140 cases; total N =1,048,683) and held-out test data from different cohorts with equal numbers of each diagnostic category (total N =11,460). DDx-PRS was well-calibrated and well-powered relative to these training sample sizes, attaining AUCs of 0.66 for SCZ vs. rest, 0.64 for BIP vs. rest, 0.59 for MDD vs. rest, and 0.68 for control vs. rest. DDx-PRS produced comparable results to methods that leverage tuning data, confirming that DDx-PRS is an effective method. True diagnosis probabilities in top deciles of predicted diagnosis probabilities were considerably larger than prior baseline probabilities, particularly in projections to larger training sample sizes, implying considerable potential for clinical utility under certain circumstances. In conclusion, DDx-PRS is an effective method for distinguishing clinically related disorders.
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Landreth K, Burgess M, Watson L, Lorusso JM, Grayson B, Harte MK, Neill JC. Handling prevents and reverses cognitive deficits induced by sub-chronic phencyclidine in a model for schizophrenia in rats. Physiol Behav 2023; 263:114117. [PMID: 36781093 DOI: 10.1016/j.physbeh.2023.114117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
Treatments for schizophrenia are not effective in ameliorating cognitive deficits. Therefore, novel therapies are needed to treat cognitive impairments associated with schizophrenia (CIAS), which are modelled in rats through administration of sub-chronic phencyclidine (scPCP). We have previously shown that enrichment via voluntary exercise prevents and reverses impairments in novel object recognition (NOR) in this model. The present study aimed to investigate if handling could prevent delay-induced NOR deficits and prevent and reverse scPCP-induced NOR deficits. Two cohorts of adult female Lister Hooded rats were used. In experiment one, handling (five minutes/day, five days/week for two weeks), took place before scPCP administration (2 mg/kg, i.p. twice-daily for seven days). NOR tests were conducted at two, four, and seven weeks post-handling with a one-minute inter-trial interval (ITI) and at five weeks post-dosing with a six-hour ITI. In experiment two, rats were handled after scPCP administration and tested immediately in the one-minute ITI NOR task and again at two weeks post-handling. In both handling regimens, the scPCP control groups failed to discriminate novelty, conversely the scPCP handled groups significantly discriminated in this task. In the 6 h ITI test, vehicle control and scPCP control failed to discriminate novelty; however, the vehicle handled and scPCP handled groups did significantly discriminate. Handling rats prevented and reversed scPCP-induced deficits and prevented delay-induced NOR deficits. These findings add to evidence that environmental enrichment is a viable treatment for cognitive deficits in rodent tests and models of relevance to schizophrenia, with potential to translate into effective treatments for CIAS.
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Affiliation(s)
- K Landreth
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - M Burgess
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - L Watson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J M Lorusso
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - B Grayson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
| | - M K Harte
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J C Neill
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom; Medical Psychedelics Working Group, Drug Science, United Kingdom
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Brown E, Gao CX, Staveley H, Williams G, Farrelly S, Rickwood D, Telford N, Papanastasiou C, McGorry P, Thompson A. The clinical and functional outcomes of a large naturalistic cohort of young people accessing national early psychosis services. Aust N Z J Psychiatry 2022; 56:1265-1276. [PMID: 34845922 DOI: 10.1177/00048674211061285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Services for individuals with a first episode of psychosis or at ultra-high risk of psychosis have become a treatment model of choice in mental health care. The longitudinal changes in clinical and functional outcomes as a result of real-world treatment remain under-reported. METHODS We analysed data from first episode of psychosis and ultra-high risk services delivered across Australian primary youth mental health care services known as headspace between 19 June 2017 and 30 September 2019. Outcome measures were completed and entered into a minimum dataset every 90 days a participant was receiving treatment and included psychiatric symptomatology (Brief Psychiatric Rating Scale and psychological distress, K10) and psychosocial functioning (Social and Occupational Functioning Assessment Scale and My Life Tracker). Linear mixed-effects models were used to evaluate changes in outcome over time. RESULTS Outcome data from a total of 1252 young people were evaluated (643 first episode of psychosis, 609 ultra-high risk). Of those who entered ultra-high risk services, 11.8% transitioned to first episode of psychosis services. Overall, substantial improvement in clinical (Brief Psychiatric Rating Scale, K10) and functional (Social and Occupational Functioning Assessment Scale, My Life Tracker) outcomes were seen across groups and outcomes. Ultra-high risk patients showed a greater reduction in distress symptoms, while first episode of psychosis patients experienced a greater reduction in positive psychosis symptoms. Although clinical outcomes showed a plateau effect after approximately 3 months of care, improvement in functional outcomes (Social and Occupational Functioning Assessment Scale, My Life Tracker) continued later in treatment. CONCLUSION These findings support the use of real-time, real-world and low-cost administrative data to rigorously evaluate symptomatic and functional outcomes in early psychosis treatment settings. Findings that functional outcomes improve past the remittance of clinical outcomes also support the functional recovery focus of early psychosis services and remaining high levels of distress suggest the need for ultra-high risk services to extend beyond 6 months of care.
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Affiliation(s)
- Ellie Brown
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Heather Staveley
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Georgia Williams
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Simone Farrelly
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Debra Rickwood
- Headspace National, Melbourne, VIC, Australia.,University of Canberra, Canberra, ACT, Australia
| | - Nic Telford
- Headspace National, Melbourne, VIC, Australia
| | | | - Pat McGorry
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, Parkville, VIC, Australia
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7
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Hartmann JA, Nelson B, Amminger GP, Spark J, Yuen HP, Kerr MJ, Polari A, Wallis N, Blasioli J, Dixon L, Carter C, Loewy R, Niendam TA, Shumway M, McGorry PD. Baseline data of a sequential multiple assignment randomized trial (STEP study). Early Interv Psychiatry 2022; 16:1130-1142. [PMID: 35098659 PMCID: PMC9795376 DOI: 10.1111/eip.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 12/30/2022]
Abstract
AIM Research has shown that preventative intervention in individuals at ultra-high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive-behavioural case management and (3) antidepressant medication with an embedded fast-fail option of (4) omega-3 fatty acids or low-dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. METHODS STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. RESULTS Of 1343, help-seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty-five percent of the enrolled sample had a non-psychotic DSM-5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. DISCUSSION The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Barnaby Nelson
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - G. Paul Amminger
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Jessica Spark
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Melissa J. Kerr
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Andrea Polari
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Nicky Wallis
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Julie Blasioli
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York
| | - Cameron Carter
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Rachel Loewy
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Patrick D. McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne
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Sabe M, Sentissi O. Psychotic symptoms prior or concomitant to diagnosis of multiple sclerosis: a systematic review of case reports and case series. Int J Psychiatry Clin Pract 2022; 26:287-293. [PMID: 34487465 DOI: 10.1080/13651501.2021.1973506] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to examine the clinical features of psychotic symptoms preceding or concomitant to multiple sclerosis (MS) diagnosis. METHOD From the 1st to 10th of January 2020 a systematic review was conducted through an electronic search of different databases. Results were limited to English, French, German, Italian and Spanish language articles. RESULTS We identified 599 titles, and included 32 cases from case-report and case series. One case report from our department was added. The mean age of first psychiatric symptoms was 25.8 ± 10.2 years, the mean age of MS diagnosis was 31.2 ± 10.7 years and the mean delay until MS diagnosis was 2.7 ± 3 years. Most reported symptoms were delusions (81%), auditory hallucinations (59%) and visual hallucinations (50%). Upon the MS diagnosis, immunosuppressive therapy was significantly more effective for psychotic symptoms than antipsychotics (OR = 9.0; 95%CI: 2.15-37; p = 0.002). Diffuse periventricular lesions were found in 95.6% of cases, with mostly temporal or frontal predominant lesions. In cases affected by predominant temporal lesions, 83% of cases presented visual hallucinations (p < 0.05). CONCLUSION Poor response or resistance to antipsychotics treatment should alert clinicians on the need to consider a differential diagnosis. Considering the impact of delay in MS diagnosis further research regarding this subject is warranted.KEY POINTSInsight into the occurrence of psychotic symptoms in multiple sclerosis (MS) is mainly limited to case reports and case series.Delay in MS management between initial psychotic symptoms and the MS diagnosis is 2.73 ± 3 years and 0.8 ± 1.2 years for patients presenting a first episode of psychosis.The resistance and poor response to antipsychotics found in most cases (75%) were associated with an excellent improvement (95%) of both psychiatric and neurologic symptoms with corticosteroids.Prospective studies are needed to investigate the spectrum of psychosis in MS.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
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9
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Lazaridou FB, Schubert SJ, Ringeisen T, Kaminski J, Heinz A, Kluge U. Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01468-8. [PMID: 36001139 PMCID: PMC9400567 DOI: 10.1007/s00406-022-01468-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.
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Affiliation(s)
- Felicia Boma Lazaridou
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany. .,National Discrimination and Racism Monitor, German Institute for Integration and Migration Research - DeZIM, Berlin, Germany. .,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany.
| | | | | | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany ,Department of Psychiatry and Psychotherapy, Charité University Medicine, Alexianer St. Hedwig-Hospital, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany
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10
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Zhang X, Lee J, Goh WWB. An Investigation of How Normalisation and Local Modelling Techniques Confound Machine Learning Performance In a Mental Health Study. Heliyon 2022; 8:e09502. [PMID: 35663731 PMCID: PMC9156999 DOI: 10.1016/j.heliyon.2022.e09502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/12/2022] [Accepted: 05/16/2022] [Indexed: 01/12/2023] Open
Abstract
Machine learning (ML) is increasingly deployed on biomedical studies for biomarker development (feature selection) and diagnostic/prognostic technologies (classification). While different ML techniques produce different feature sets and classification performances, less understood is how upstream data processing methods (e.g., normalisation) impact downstream analyses. Using a clinical mental health dataset, we investigated the impact of different normalisation techniques on classification model performance. Gene Fuzzy Scoring (GFS), an in-house developed normalisation technique, is compared against widely used normalisation methods such as global quantile normalisation, class-specific quantile normalisation and surrogate variable analysis. We report that choice of normalisation technique has strong influence on feature selection. with GFS outperforming other techniques. Although GFS parameters are tuneable, good classification model performance (ROC-AUC > 0.90) is observed regardless of the GFS parameter settings. We also contrasted our results against local modelling, which is meant to improve the resolution and meaningfulness of classification models built on heterogeneous data. Local models, when derived from non-biologically meaningful subpopulations, perform worse than global models. A deep dive however, revealed that the factors driving cluster formation has little to do with the phenotype-of-interest. This finding is critical, as local models are often seen as a superior means of clinical data modelling. We advise against such naivete. Additionally, we have developed a combinatorial reasoning approach using both global and local paradigms: This helped reveal potential data quality issues or underlying factors causing data heterogeneity that are often overlooked. It also assists to explain the model as well as provides directions for further improvement.
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Affiliation(s)
- Xinxin Zhang
- School of Biological Sciences, Nanyang Technological University, 637551, Singapore
| | - Jimmy Lee
- North Region & Department of Psychosis, Institute of Mental Health, 539747, Singapore
- Corresponding author.
| | - Wilson Wen Bin Goh
- School of Biological Sciences, Nanyang Technological University, 637551, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 636921, Singapore
- Centre for Biomedical Informatics, Nanyang Technological University, 636921, Singapore
- Corresponding author.
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Raballo A, Poletti M. Overlooking the transition elephant in the ultra-high-risk room: are we missing functional equivalents of transition to psychosis? Psychol Med 2022; 52:184-187. [PMID: 31779736 DOI: 10.1017/s0033291719003337] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the wake of the almost quarter of a century since the conceptualization of ultra-high-risk (UHR) states for psychosis, empirical evidences in the field are constantly scrutinized and re-assessed through meta-analytic lens. Briefly, such scrutiny converges on three major evidences: pretest risk enrichment, risk hierarchy within UHR states, and declining transition rates. While the former two are intuitive, the dilution effect remains elusive and might be rather symptomatic of unsolved issues in the field. Those include the heterogeneously reported antipsychotic (AP) exposure in UHR samples and the almost univocal focus on purely psychometric transition to psychosis. Both issues lead to the neglect of functional equivalents of transition, i.e. that of a mental state at immediate need for AP medication, and might have a cascading confounding effect on the predictive value of contemporary risk calculators centered on criterial transition as a unique outcome.
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Affiliation(s)
- Andrea Raballo
- Department of Medicine, Division of Psychiatry, University of Perugia, Perugia, Italy
- Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Michele Poletti
- Department of Mental Health, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Bemrose HV, Akande IO, Cullen AE. Self-esteem in individuals at ultra-high risk for psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2021; 15:775-786. [PMID: 32860493 DOI: 10.1111/eip.13034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
AIM Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population. METHODS We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Random-effects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences. RESULTS Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = -1.33 [-1.73 to -0.94] P < .001).However, there was evidence of substantial heterogeneity (I2 = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = -0.26, P = .02). CONCLUSIONS UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.
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Affiliation(s)
- Holly V Bemrose
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isaac O Akande
- Outreach and Support in South London (OASIS), South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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13
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Janssen H, Maat A, Slot MIE, Scheepers F. Efficacy of psychological interventions in young individuals at ultra-high risk for psychosis: A naturalistic study. Early Interv Psychiatry 2021; 15:1019-1027. [PMID: 32945145 DOI: 10.1111/eip.13048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
AIM Early detection and intervention in individuals at risk for developing psychosis have become a priority for many clinical services around the world. Limited naturalistic evidence is available on whether detection and intervention for ultra-high risk (UHR) is effective by means of reducing psychosis risk and improving functioning. METHODS We compared functioning scores over 5.9 (±7.7) months of time between UHR individuals (n = 61) and help-seeking adolescents without a specific UHR profile (general adolescent help-seeking population [HSP]; n = 82) aged 12 to 25 years receiving psychological interventions at a specialized UHR service in the Netherlands. Attenuated psychotic symptoms (APS) were evaluated over time within the UHR group. In addition, the impact of duration of treatment, <7 sessions, 8 to 21 sessions and >20 sessions, as well as treatment type, that is, cognitive behavioural therapy (CBT) and CBT + add on treatment, were evaluated. RESULTS Both UHR and HSP showed an increase in functioning over time (P < .001), with no difference between these groups. The UHR group showed a reduction of APS over time (P < .001). More than 20 treatment sessions was more effective than 1 to 6 treatment sessions (P < .01, partial eta squared = .08) and CBT was equally effective as CBT-add on in improving functioning. CONCLUSIONS The findings of this study suggest that psychological treatment is just as effective in improving functioning in UHR as in HSP. Moreover, it decreases APS in UHR. Improvement in functioning is not affected by treatment type, but positively affected by the duration of treatment.
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Affiliation(s)
- Hella Janssen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Arija Maat
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margot I E Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floortje Scheepers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Svancer P, Spaniel F. Brain ventricular volume changes in schizophrenia. A narrative review. Neurosci Lett 2021; 759:136065. [PMID: 34146640 DOI: 10.1016/j.neulet.2021.136065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Brain ventricles are among the most studied structures in psychotic illness. In our mini-review we present available evidence on brain ventricle changes during the course of schizophrenia, from high-risk subjects and the first episode of schizophrenia to patients with chronic schizophrenia. We present current findings on the relationship between ventricle changes and level of psychopathology. The potential pathophysiological background of ventricle changes is also discussed. Understanding the dynamics of brain ventricle changes could resolve long-standing questions on the proportion of neurodegenerative and neurodevelopmental processes in the pathophysiology of schizophrenia.
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Affiliation(s)
- Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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15
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 170] [Impact Index Per Article: 56.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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16
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Silverstein SM, Thompson JL, Gold JM, Schiffman J, Waltz JA, Williams TF, Zinbarg RE, Mittal VA, Ellman LM, Strauss GP, Walker EF, Woods SW, Levin JA, Kafadar E, Kenney J, Smith D, Powers AR, Corlett PR. Increased face detection responses on the mooney faces test in people at clinical high risk for psychosis. NPJ SCHIZOPHRENIA 2021; 7:26. [PMID: 34001909 PMCID: PMC8129098 DOI: 10.1038/s41537-021-00156-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023]
Abstract
Identifying state-sensitive measures of perceptual and cognitive processes implicated in psychosis may allow for objective, earlier, and better monitoring of changes in mental status that are predictive of an impending psychotic episode, relative to traditional self-report-based clinical measures. To determine whether a measure of visual perception that has demonstrated sensitivity to the clinical state of schizophrenia in multiple prior studies is sensitive to features of the at-risk mental state, we examined differences between young people identified as being at clinical high risk for psychosis (CHR; n = 37) and non-psychiatric matched controls (n = 29) on the Mooney Faces Test (MFT). On each trial of the MFT, participants report whether they perceive a face in a degraded face image. The CHR group reported perceiving a greater number of faces in both upright and inverted MFT stimuli. Consistent with prior work, males reported more faces on the MFT than females in both conditions. However, the finding of greater reported face perception among CHR subjects was robustly observed in the female CHR group relative to the female control group. Among male CHR participants, greater reported face perception was related to increased perceptual abnormalities. These preliminary results are consistent with a small but growing literature suggesting that heightened perceptual sensitivity may characterize individuals at increased clinical risk for psychosis. Further studies are needed to determine the contributions of specific perceptual, cognitive, and motivational mechanisms to the findings.
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Affiliation(s)
- Steven M. Silverstein
- grid.412750.50000 0004 1936 9166University of Rochester Medical Center, New York, NY USA
| | - Judy L. Thompson
- grid.412750.50000 0004 1936 9166University of Rochester Medical Center, New York, NY USA
| | - James M. Gold
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Jason Schiffman
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA ,grid.266093.80000 0001 0668 7243Present Address: University of California, Irvine, CA USA
| | - James A. Waltz
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| | - Trevor F. Williams
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Richard E. Zinbarg
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Vijay A. Mittal
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Lauren M. Ellman
- grid.264727.20000 0001 2248 3398Temple University, Philadelphia, PA USA
| | | | - Elaine F. Walker
- grid.189967.80000 0001 0941 6502Emory University, Atlanta, GA USA
| | - Scott W. Woods
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Jason A. Levin
- grid.213876.90000 0004 1936 738XUniversity of Georgia, Athens, GA USA
| | - Eren Kafadar
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Joshua Kenney
- grid.47100.320000000419368710Yale University, New Haven, CT USA
| | - Dillon Smith
- grid.16750.350000 0001 2097 5006Princeton University, Princeton, NJ USA
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17
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Beasley RE, Kivisto AJ, Leonhardt BL, Waldron JS. Childhood Maltreatment and Psychosis: A Comparative Validity Study of Maltreatment Indices. CHILD MALTREATMENT 2021; 26:228-237. [PMID: 32462923 DOI: 10.1177/1077559520927475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Childhood maltreatment is a robust risk factor for psychosis, but it remains unclear whether different measurement methods provide equivalent validity in predicting psychotic symptoms. This study compared the predictive validity of two common indices of maltreatment at age 12-children's self-report and Child Protective Services (CPS) reports-on the development of psychotic symptoms at age 18 using data from a large, multisite longitudinal study (N = 629). Consistent with prior research, agreement was low between indices, with the prevalence of self-reported maltreatment being 2-3 times higher. A quarter of the sample endorsed at least one psychotic symptom at age 18, most commonly delusions. While CPS-indicated maltreatment was generally not associated with later psychotic symptoms, all forms of self-reported maltreatment were. Sexual abuse demonstrated a particularly strong relationship with psychosis, especially hallucinations. These results suggest that self-reports may provide stronger predictive validity than CPS indications of maltreatment in the assessment of psychosis risk, indicating that a child's interpretation of trauma matters more than the traumatic event itself in this regard.
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Affiliation(s)
- Rhianna E Beasley
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
- The Institute of Living, Hartford, CT, USA
| | - Aaron J Kivisto
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Prevention and Recovery Center, Sandra Eskenazi Mental Health Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jordan S Waldron
- 216442School of Psychological Sciences, University of Indianapolis, IN, USA
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18
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Esposito CM, Enrico P, Sciortino D, Caletti E, Marchetti GB, Cesaretti C, Oldani L, Fiorentini A, Brambilla P. Case Report: The Association Between Chromosomal Anomalies and Cluster A Personality Disorders: The Case of Two Siblings With 16p11.2 Deletion and a Review of the Literature. Front Psychiatry 2021; 12:689359. [PMID: 34168584 PMCID: PMC8217436 DOI: 10.3389/fpsyt.2021.689359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Although several studies have shown the correlation between chromosomal rearrangements and the risk of developing psychotic disorders, such as schizophrenia, little attention has been given to identifying the genetic basis of pre-disposing personality so far. In this regard, a limited but significant number of studies seem to indicate an association between chromosomal anomalies and cluster A personality disorders (CAPD). Starting from the clinical description of two brothers affected by familial 16p11 deletion syndrome (OMIM #611913), both sharing cluster A and C personality traits, the aim of the present study is to critically review the literature regarding the correlation between chromosomal rearrangements and CAPD. A bibliographic search on PubMed has been conducted, and eight studies were finally included in our review. Most of the studies highlight the presence of schizotypal personality disorder in the 22q11.2 deletion syndrome, whose evolutionary course toward psychotic pictures is well-known. One study also identified a paranoid personality disorder in a patient with a deletion on chromosome 7q21.3. No studies have so far identified the presence of paranoid personality disorder in 16p11 deletion, as in the case of the two siblings we report, while its association with psychosis and autism is already known. Although further epidemiologic studies on broader populations are indicated, our observations might pave the way for the definition of new diagnostic subgroups of CAPD and psychotic disorders, in order to implement the clinical management of such complex conditions.
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Affiliation(s)
| | - Paolo Enrico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Domenico Sciortino
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisabetta Caletti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Bruna Marchetti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cesaretti
- Medical Genetics Unit, Woman-Child-Newborn Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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19
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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20
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Fusar-Poli P, De Micheli A, Signorini L, Baldwin H, Salazar de Pablo G, McGuire P. Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care. EClinicalMedicine 2020; 28:100578. [PMID: 33294806 PMCID: PMC7700893 DOI: 10.1016/j.eclinm.2020.100578] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Most services for individuals at Clinical High Risk for Psychosis (CHR-P) provide short-term clinical care. This study determines the real-world and long-term clinical outcomes beyond transition to psychosis in a large cohort of CHR-P individuals. METHOD Retrospective RECORD-compliant real-world Electronic Health Records (EHR) cohort study in secondary mental health care (the South London and the Maudsley -SLaM- NHS Foundation Trust). All CHR-P patients accessing the CHR-P service at SLaM in the period 2001-2018 were included. Main outcomes were long-term cumulative risk of first: (i) developing an ICD-10 psychotic disorder (primary outcome), receiving a treatment with (iia) antipsychotic medication, (iib) benzodiazepines, (iic) other psychotropic medications, (iid) psychotherapy, receiving an (iiia) informal or (iiib) compulsory admission into a mental health hospital, and the time to these events; (iiic) number of days spent in hospital and (iv) cumulative risk of death for any reason and age/gender Standardised Mortality Ratio (SMR). Data were extracted from the EHR and analysed with Kaplan Meier failure functions, Cox and zero-inflated negative binomial regressions. FINDINGS 600 CHR-P patients (80.43% Attenuated Psychotic Symptoms, APS; 18.06%, Brief and Limited Intermittent Psychotic Symptoms, BLIPS, 1.51% Genetic Risk and Deterioration Syndrome) were included (mean age 22.63 years, range 13-36; 55.33% males; 46.44% white, mean duration of untreated attenuated psychotic symptoms 676.32 days, 1105.40 SD). The cumulative risk to first psychosis was 0.365 (95%CI 0.302-0.437) at 11 years; first antipsychotic 0.777 (95%CI 0.702-0.844) at 9 years; first benzodiazepine 0.259 (95%CI 0.183-0.359) at 12 years; first other types of medications 0.630 (95%CI 0.538-0.772) at 9 years; first psychotherapy 0.814 (95%CI 0.764-0.859) at 9 years; first informal admission 0.378 (95%CI 0.249-0.546) at 12 years; first compulsory admission 0.251 (95%CI 0.175-0.352) at 12 years; those admitted spent on average 94.84 (SD=169.94) days in hospital; the cumulative risk of death for any reason was 0.036 (95%CI 0.012-0.103) at 9 years, with an SMR of 3.9 (95%CI 1.20-6.6). Compared to APS, BLIPS had a higher risk of developing psychosis, being admitted compulsorily into hospital, receiving antipsychotics and benzodiazepines and lower probability of receiving psychotherapy. Other prognostic factors of long-term outcomes included age, symptoms severity, duration of untreated attenuated psychotic symptoms, ethnicity and employment status. INTERPRETATION Duration of care provided by CHR-P services should be expanded to address long-term real-world outcomes. FUNDING This study was supported by the King's College London Confidence in Concept award from the Medical Research Council (MRC) (MC_PC_16048) to PF-P. GSP is supported by the Alicia Koplowitz Foundation. HB is supported by a National Institute for Health Research Maudsley Biomedical Research Centre studentship.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
- Department of Brain and Behavioral Sciences, University
of Pavia, Pavia, Italy
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Lorenzo Signorini
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection
(EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, King's College London, 5th Floor, PO63, 16 De Crespigny Park,
SE5 8AF London, UK
- Institute of Psychiatry and Mental Health. Department
of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio
Marañón School of Medicine, Universidad Complutense, Instituto de Investigación
Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Philip McGuire
- OASIS service, South London and Maudsley NHS Foundation
Trust, London, UK
- Maudsley Biomedical Research Centre, National Institute
for Health Research, South London and Maudsley NHS Foundation Trust, London,
UK
- Department of Psychosis Studies, Institute of
Psychiatry, Psychology & Neuroscience, King's College London, London,
UK
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21
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Forget B, Icick R, Robert J, Correia C, Prevost MS, Gielen M, Corringer PJ, Bellivier F, Vorspan F, Besson M, Maskos U. Alterations in nicotinic receptor alpha5 subunit gene differentially impact early and later stages of cocaine addiction: a translational study in transgenic rats and patients. Prog Neurobiol 2020; 197:101898. [PMID: 32841724 DOI: 10.1016/j.pneurobio.2020.101898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022]
Abstract
Cocaine addiction is a chronic and relapsing disorder with an important genetic component. Human candidate gene association studies showed that the single nucleotide polymorphism (SNP) rs16969968 in the α5 subunit (α5SNP) of nicotinic acetylcholine receptors (nAChRs), previously associated with increased tobacco dependence, was linked to a lower prevalence of cocaine use disorder (CUD). Three additional SNPs in the α5 subunit, previously shown to modify α5 mRNA levels, were also associated with CUD, suggesting an important role of the subunit in this pathology. To investigate the link between this subunit and CUD, we submitted rats knockout for the α5 subunit gene (α5KO), or carrying the α5SNP, to cocaine self-administration (SA) and showed that the acquisition of cocaine-SA was impaired in α5SNP rats while α5KO rats exhibited enhanced cocaine-induced relapse associated with altered neuronal activity in the nucleus accumbens. In addition, we observed in a human cohort of patients with CUD that the α5SNP was associated with a slower transition from first cocaine use to CUD. We also identified a novel SNP in the β4 nAChR subunit, part of the same gene cluster in the human genome and potentially altering CHRNA5 expression, associated with shorter time to relapse to cocaine use in patients. In conclusion, the α5SNP is protective against CUD by influencing early stages of cocaine exposure while CHRNA5 expression levels may represent a biomarker for the risk to relapse to cocaine use. Drugs modulating α5 containing nAChR activity may thus represent a novel therapeutic strategy against CUD.
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Affiliation(s)
- Benoît Forget
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France.
| | - Romain Icick
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France; Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Assistance-Publique Hôpitaux de Paris, 75010, Paris, France; INSERM UMR_S1144, 4 avenue de l'Observatoire, 75006, Paris, France; Université Sorbonne - Paris - Cité, Paris, France
| | - Jonathan Robert
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Caroline Correia
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Marie S Prevost
- Unité Récepteurs-Canaux, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France
| | - Marc Gielen
- Université Sorbonne - Paris - Cité, Paris, France; Unité Récepteurs-Canaux, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France
| | - Pierre-Jean Corringer
- Unité Récepteurs-Canaux, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Assistance-Publique Hôpitaux de Paris, 75010, Paris, France; Université Sorbonne - Paris - Cité, Paris, France; Unité Récepteurs-Canaux, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France
| | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Assistance-Publique Hôpitaux de Paris, 75010, Paris, France; INSERM UMR_S1144, 4 avenue de l'Observatoire, 75006, Paris, France; Université Sorbonne - Paris - Cité, Paris, France
| | - Morgane Besson
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France.
| | - Uwe Maskos
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France.
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22
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Guloksuz S, Pries LK, Ten Have M, de Graaf R, van Dorsselaer S, Klingenberg B, Bak M, Lin BD, van Eijk KR, Delespaul P, van Amelsvoort T, Luykx JJ, Rutten BPF, van Os J. Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS-2 cohort. World Psychiatry 2020; 19:199-205. [PMID: 32394548 PMCID: PMC7215054 DOI: 10.1002/wps.20755] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The validity and clinical utility of the concept of "clinical high risk" (CHR) for psychosis have so far been investigated only in risk-enriched samples in clinical settings. In this population-based prospective study, we aimed - for the first time - to assess the incidence rate of clinical psychosis and es-timate the population attributable fraction (PAF) of that incidence for preceding psychosis risk states and DSM-IV diagnoses of non-psychotic mental disorders (mood disorders, anxiety disorders, alcohol use disorders, and drug use disorders). All analyses were adjusted for age, gender and education. The incidence rate of clinical psychosis was 63.0 per 100,000 person-years. The mutually-adjusted Cox proportional hazards model indicated that preceding diagnoses of mood disorders (hazard ratio, HR=10.67, 95% CI: 3.12-36.49), psychosis high-risk state (HR=7.86, 95% CI: 2.76-22.42) and drug use disorders (HR=5.33, 95% CI: 1.61-17.64) were associated with an increased risk for clinical psychosis incidence. Of the clinical psychosis incidence in the population, 85.5% (95% CI: 64.6-94.1) was attributable to prior psychopathology, with mood disorders (PAF=66.2, 95% CI: 33.4-82.9), psychosis high-risk state (PAF=36.9, 95% CI: 11.3-55.1), and drug use disorders (PAF=18.7, 95% CI: -0.9 to 34.6) as the most important factors. Although the psychosis high-risk state displayed a high relative risk for clinical psychosis outcome even after adjusting for other psychopathology, the PAF was comparatively low, given the low prevalence of psychosis high-risk states in the population. These findings provide empirical evidence for the "prevention paradox" of targeted CHR early intervention. A comprehensive prevention strategy with a focus on broader psychopathology may be more effective than the current psychosis-focused approach for achieving population-based improvements in prevention of psychotic disorders.
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Affiliation(s)
- Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Boris Klingenberg
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bochao D Lin
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kristel R van Eijk
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jurjen J Luykx
- Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- GGNet Mental Health, Apeldoorn, The Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK
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23
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Boldrini T, Solmi M. Introduction to the Special Section on clinical high risk for mental illness: transdiagnostic framework, detection strategies, assessment, treatment and outcome. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:462. [PMID: 32913832 PMCID: PMC7451291 DOI: 10.4081/ripppo.2020.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Historically, the idea of preventing severe mental disorders by intervening in their prodromal stages was first introduced by the psychoanalyst Harry Stack Sullivan. Sullivan (1994) claimed that schizophrenia was the result of maladaptive relationships and experiences, rather than hereditary or biological factors and, as such, could be prevented. (...)
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Affiliation(s)
- Tommaso Boldrini
- Department of Developmental and Socialization Psychology, University of Padua, Padua
| | - Marco Solmi
- Neurosciences Department, University of Padua; Neuroscience Center, University Hospital of Padua, Psychiatry Unit, Padua, Italy
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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24
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Pontillo M, Tata MC, Averna R, Gargiullo P, Guerrera S, Vicari S. Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:455. [PMID: 32913830 PMCID: PMC7451377 DOI: 10.4081/ripppo.2020.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (i.e., different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed.
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Affiliation(s)
- Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Roberto Averna
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome.,Institute of Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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25
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Allswede DM, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan T, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Characterizing Covariant Trajectories of Individuals at Clinical High Risk for Psychosis Across Symptomatic and Functional Domains. Am J Psychiatry 2020; 177:164-171. [PMID: 31509005 PMCID: PMC7002249 DOI: 10.1176/appi.ajp.2019.18111290] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to characterize differences in outcomes among help-seeking individuals at clinical high risk for psychosis by identifying covariant longitudinal patterns of symptoms and functioning. METHODS Group-based multitrajectory modeling was applied to longitudinal ratings of four symptom domains (positive, negative, disorganized, general) and general functioning among clinical high-risk individuals in an initial discovery sample (N=422). An independent sample (N=133) was used to test replicability. RESULTS Three trajectory groups were identified among clinical high-risk individuals in the discovery sample: group 1 (30%) exhibited substantial improvement across all domains, with half reaching positive outcomes for both functioning and positive symptoms; group 2 (49%) exhibited moderate impairments across domains, with approximately one-quarter meeting criteria for positive outcomes; the remaining participants (group 3; 22%) exhibited consistent levels of severe impairment across domains and did not experience positive outcomes. These trajectory groups and remission patterns were replicated in an independent sample. CONCLUSIONS Replicable subgroups of help-seeking clinical high-risk cases can be ascertained based on distinctive profiles of change over time in symptoms and functioning. Within each of the three identified subgroups, similar patterns of change (i.e., rapid, moderate, or no improvement) were observed across the four symptom domains and functioning. This consistency of change over time across domains within each subgroup is a novel observation supporting the syndrome consistency of clinical high-risk symptoms and signs. The observed trajectory subgroups are suggestive of different degrees of need for clinical interventions, ranging from minimal or supportive for about one-third of cases to increasingly intensive among the remainder.
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Affiliation(s)
- Dana M. Allswede
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Jean Addington
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Carrie E. Bearden
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Kristin S. Cadenhead
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Barbara A. Cornblatt
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Daniel H. Mathalon
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Thomas McGlashan
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Diana O. Perkins
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Larry J. Seidman
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Ming T. Tsuang
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Elaine F. Walker
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Scott W. Woods
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
| | - Tyrone D. Cannon
- Department of Psychology (Allswede, Cannon) and Department of Psychiatry (McGlashan, Woods, Cannon), Yale University, New Haven, Conn.; Department of Psychiatry, University of Calgary, Calgary, Canada (Addington); Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles (Bearden); Department of Psychiatry (Cadenhead, Tsuang) and Center for Behavioral Genomics (Tsuang), University of California, San Diego, La Jolla; Department of
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26
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Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.
Key learning aims
(1)
To understand CBT evidence and procedures for young individuals with ARMS.
(2)
To reflect on the current limitations in the literature on CBT for ARMS.
(3)
To understand the importance and clinical implications of assessing worry in ARMS.
(4)
To focus on changes in worry as an outcome after CBT for ARMS.
(5)
To reflect on future research directions on the role of worry in CBT for ARMS.
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