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Tor J, Baeza I, Sintes-Estevez A, De la Serna E, Puig O, Muñoz-Samons D, Álvarez-Subiela J, Sugranyes G, Dolz M. Cognitive predictors of transition and remission of psychosis risk syndrome in a child and adolescent sample: longitudinal findings from the CAPRIS study. Eur Child Adolesc Psychiatry 2024; 33:89-104. [PMID: 36598585 DOI: 10.1007/s00787-022-02137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
Cognitive impairments are proposed as predictors in the differentiation between subjects with psychosis risk syndrome (PRS) who will develop a psychotic disorder (PRS-P) and those who will not (PRS-NP). More in-depth study of the PRS-NP group could contribute to defining the role of cognitive alterations in psychosis. This study aims to analyze cognition of children and adolescents with PRS in terms of their clinical outcome at 18-month follow-up (psychosis, remission, and non-remission) and of determinate predictors of transition to psychosis and remission of PRS. The method is two-site, naturalistic, longitudinal study design, with 98 help-seeking adolescents with PRS and 64 healthy controls (HC). PRS-P (n = 24) and PRS-NP (n = 74) participants were clinically and cognitively assessed at baseline, and when full-blown psychotic disorder had developed or at 18-month follow-up. PRS-P subjects showed lower scores at baseline in processing speed, visuospatial memory, attention, and executive function (cognitive flexibility/processing speed) compared to HC. PRS-NP subjects showed lower baseline scores in verbal working memory and verbal fluency compared to HC. This deficit is also observed in the PRS group of participants still presenting attenuated psychotic symptoms at 18-month follow-up, while PRS subjects in remission showed a similar cognitive profile to HC subjects. Baseline score on processing speed, measured with a coding task, appeared to be a predictive variable for the development of a psychotic disorder. Performance in verbal working memory was predictive of remission in the PRS-NP. Post hoc comparisons indicate the need for careful interpretation of cognitive markers as predictors of psychosis. Cognitive impairments are present in both PRS-P and PRS-NP. Those individuals who recover from PRS show baseline cognitive performance comparable to the HC group. Together with sociodemographic variables, this observation could help in the differentiation of a variety of PRS trajectories in children and adolescents.
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Affiliation(s)
- Jordina Tor
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain.
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, (2017SGR881), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain
- Health Sciences Division, Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain
| | - Anna Sintes-Estevez
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Elena De la Serna
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, (2017SGR881), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, (2017SGR881), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain
| | - Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Javier Álvarez-Subiela
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, (2017SGR881), Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (CERCA-IDIBAPS), Barcelona, Spain
| | - Montserrat Dolz
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950, Esplugues de Llobregat, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Shishkovskaia TI, Oleichik IV, Baranov PA. [Basic symptoms in young female patients with depression within the framework of schizophrenia and affective spectrum disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:94-100. [PMID: 39072573 DOI: 10.17116/jnevro202412406194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To investigate the structure and severity of basic symptoms in young female patients with endogenous depression. MATERIAL AND METHODS One hundred and nineteen female patients, aged from 16 to 26 years, were examined. Three groups were identified: patients meeting the criteria of high risk of psychosis (51 patients, mean age 18.55±3.84 years), patients not meeting the criteria of high risk of psychosis(48 patients, mean age 20.12±3.84 years), patients with postpsychotic depression (20 patients, mean age 21.8±4.5 years). The main method of the study was the application of COGDIS (Cognitive Distortions) and COPER (Cognitive-perceptual baseline symptoms) criteria. RESULTS The baseline symptoms criteria were met by 83.3% of depressed patients without psychosis risk symptoms (mean severity score 24.0±14.7), 96% of depressed patients with high psychosis risk symptoms (38.1±15.9 points), and 50% of patients with postpsychotic depression (15.3±12.9 points). COGDIS criteria were met by 62.5% of depressed patients without psychosis risk symptoms (16.2±10.1 points), 68.6% of depressed patients with high psychosis risk symptoms (22.3±9.6 points), and 25% of patients with postpsychotic depression (9.2±8.4 points). The COPER criteria were met by 77.5% of patients with depression without psychosis risk symptoms (16.2±10.3 points), 92.2% of patients with depression at high risk of psychosis (28.4±14.0 points), and 50% of patients with postpsychotic depression (8.9±9.7 points). CONCLUSIONS The group with post schizophrenic depression was characterized by lower basic symptom scale scores and percentage of eligible patients. Basic symptoms were common in a group of young female patients with depression who did not meet high-risk criteria. The score differentiates the high-risk group from the group of patients without risk symptoms.
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Affiliation(s)
| | | | - P A Baranov
- Mental Health Research Center, Moscow, Russia
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Aeberli T, Müller M, Theodoridou A, Hagenmuller F, Seifritz E, Walitza S, Rössler W, Kawohl W, Heekeren K. Mismatch negativity generation in subjects at risk for psychosis: source analysis is more sensitive than surface electrodes in risk prediction. Front Psychiatry 2023; 14:1130809. [PMID: 37539328 PMCID: PMC10394234 DOI: 10.3389/fpsyt.2023.1130809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background Deficits of mismatch negativity (MMN) in patients with schizophrenia have been demonstrated many times and there is growing evidence that alterations of MMN already exist in individuals at risk for psychosis. The present study examines differences in MMN between subjects fulfilling ultra-high risk (UHR) or only basic symptoms criteria and it addresses the question, if MMN source analysis can improve prediction of transition to psychosis. Methods The MMN to duration, frequency, and intensity deviants was recorded in 50 healthy controls and 161 individuals at risk for psychosis classified into three subgroups: only basic symptoms (n = 74), only ultra-high risk (n = 13) and persons who fulfill both risk criteria (n = 74). Based on a three-source model of MMN generation, we conducted an MMN source analysis and compared the amplitudes of surface electrodes and sources among the three groups. Results Significant differences in MMN generation among the four groups were revealed at surface electrodes Cz and C4 (p < 0.05) and at the frontal source (p < 0.001) for duration deviant stimuli. The 15 subjects from the risk groups who subsequently developed a manifest psychosis had a significantly lower MMN amplitude at frontal source (p = 0.019) without showing significant differences at surface electrodes. Low activity at frontal MMN source increased the risk of transition to manifest disease by the factor 3.12 in UHR subjects. Conclusion MMN activity differed significantly between subjects presenting only basic symptoms and subjects which additionally meet UHR criteria. The largest differences between groups as well as between individuals with and without transition were observed at the frontal source. The present results suggest that source analysis is more sensitive than surface electrodes in psychosis risk prediction by MMN.
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Affiliation(s)
- Tina Aeberli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Florence Hagenmuller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
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Farooq S, Sheikh S, Dikomitis L, Haq MMU, Khan AJ, Sanauddin N, Ali MW, Ali J, Khan MF, Chaudhry I, Husain N, Gul M, Irfan M, Andrews G, Kaistha P, Shah SMU, Azeemi I, Hamid S, Minhaz A, Mallen C, Lewis M. Traditional healers working with primary care and mental health for early intervention in psychosis in young persons: protocol for the feasibility cluster randomised controlled trial. BMJ Open 2023; 13:e072471. [PMID: 37451736 PMCID: PMC10351321 DOI: 10.1136/bmjopen-2023-072471] [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: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES In low/middle-income countries (LMICs), more than half of patients with first-episode psychosis initially seek treatment from traditional and religious healers as their first care. This contributes to an excessively long duration of untreated psychosis (DUP). There is a need for culturally appropriate interventions to involve traditional and spiritual healers to work collaboratively with primary care practitioners and psychiatrists through task-shifting for early detection, referral and treatment of first episode of psychosis. METHODS To prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention. Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons (THE HOPE) will be developed using ethnographic and qualitative methods with traditional healers and caregivers. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. Ninety-three union councils in district Peshawar, Pakistan will be randomised and allocated using a 1:1 ratio to either intervention arm (THE HOPE) or enhanced treatment as usual and stratified by urban/rural setting. Data on feasibility outcomes will be collected at baseline and follow-up. Patients, carers, clinicians and policymakers will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop-go criteria. ETHICS AND DISSEMINATION Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH210177), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/IG/001005) and National Bioethics Committee Pakistan (ref no. 4-87/NBC-840/22/621). The results of THE HOPE feasibility trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers. TRIAL REGISTRATION NUMBER ISRCTN75347421.
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Affiliation(s)
- Saeed Farooq
- School of Primary, Community and Social Care, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Saima Sheikh
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent, Canterbury, UK
| | | | - Abdul Jalil Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Noor Sanauddin
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Johar Ali
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | | | - Imran Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Ziauddin University Hospital, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Muhammad Gul
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry & Behavioral Sciences, Peshawar Medical College, Peshawar, Pakistan
- Riphah International University, Islamabad, Pakistan
| | - Gabrielle Andrews
- Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | | | - Ishfaq Azeemi
- Department of Sociology, University of Peshawar, Peshawar, Pakistan
| | - Shumaila Hamid
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Aaliya Minhaz
- Department of Chemistry, Shaheed Benazir Bhutto Women University, Peshawar, Pakistan
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Martyn Lewis
- School of Primary, Community and Social Care, Keele University, Keele, UK
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Lindgren M, Kuvaja H, Jokela M, Therman S. Predictive validity of psychosis risk models when applied to adolescent psychiatric patients. Psychol Med 2023; 53:547-558. [PMID: 34024309 DOI: 10.1017/s0033291721001938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several multivariate algorithms have been developed for predicting psychosis, as attempts to obtain better prognosis prediction than with current clinical high-risk (CHR) criteria. The models have typically been based on samples from specialized clinics. We evaluated the generalizability of 19 prediction models to clinical practice in an unselected adolescent psychiatric sample. METHODS In total, 153 adolescent psychiatric patients in the Helsinki Prodromal Study underwent an extensive baseline assessment including the SIPS interview and a neurocognitive battery, with 50 participants (33%) fulfilling CHR criteria. The adolescents were followed up for 7 years using comprehensive national registers. Assessed outcomes were (1) any psychotic disorder diagnosis (n = 18, 12%) and (2) first psychiatric hospitalization (n = 25, 16%) as an index of overall deterioration of functioning. RESULTS Most models improved the overall prediction accuracy over standard CHR criteria (area under the curve estimates ranging between 0.51 and 0.82), although the accuracy was worse than that in the samples used to develop the models, also when applied only to the CHR subsample. The best models for transition to psychosis included the severity of positive symptoms, especially delusions, and negative symptoms. Exploratory models revealed baseline negative symptoms, low functioning, delusions, and sleep problems in combination to be the best predictor of psychiatric hospitalization in the upcoming years. CONCLUSIONS Including the severity levels of both positive and negative symptomatology proved beneficial in predicting psychosis. Despite these advances, the applicability of extended psychosis-risk models to general psychiatric practice appears limited.
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Affiliation(s)
- Maija Lindgren
- Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heidi Kuvaja
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Sebastian Therman
- Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland
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6
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Fusar-Poli P, Salazar de Pablo G. Antipsychotics and Attenuated Psychosis Syndrome: Transdiagnostic assessment and discontinuation strategies. Schizophr Res 2022; 243:402-404. [PMID: 34217548 DOI: 10.1016/j.schres.2021.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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7
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Laursen MF, Correll CU, Licht RW, Rodrigo-Domingo M, Pagsberg AK, Ernst Nielsen R. Occurrence and accuracy of a register-based diagnosis of pediatric bipolar disorder: A nationwide cohort study. Aust N Z J Psychiatry 2021; 55:1101-1108. [PMID: 33951969 DOI: 10.1177/00048674211009622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the accuracy of a diagnosis of pediatric bipolar disorder in the Danish National Register compared to the patient charts. Second, we reported on the occurrence of a diagnosis of pediatric bipolar disorder during the study period. METHODS All persons appearing in the Danish nationwide registers between 1995 and 2014 with an incident ICD-10 diagnosis of single hypomanic/manic episode or a diagnosis of bipolar disorder (summarized as bipolar disorder [BD]) before turning 18 years were identified (n = 521) and a random sample (n = 131) hereof was selected for chart review. Each chart was reviewed by two independent Schedules for Clinical Assessment in Neuropsychiatry (SCAN) certified raters to assess whether symptoms documented in the chart were consistent with a formal diagnosis of BD according to the ICD-10 criteria or not. RESULTS The formal diagnostic criteria for BD according to the ICD-10 were fulfilled in 48 charts (45.3%, 95% CI: [36.1%, 54.8%]) out of 106 reviewable charts, age at index = 16.4 ± 1.6 (range = 9.1-18.3) years. Cohen's Kappa ranged from 94.4% to 100%. The estimate of a lifetime prevalence up till the current age for bipolar disorder for those of aged 5-18 years, was 0.019% in 2014. CONCLUSION Less than half of the register-based pediatric BD diagnoses were confirmed by chart review, which was lower than expected. The occurrence of a register diagnosis of pediatric BD was relatively low.
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Affiliation(s)
- Mathilde Frahm Laursen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, New York, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine, Hempstead, NY, USA.,Center for Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Rasmus W Licht
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maria Rodrigo-Domingo
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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8
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Wu J, Long X, Liu F, Qi A, Chen Q, Guan X, Zhang Q, Yao Y, Shi J, Xie S, Yan W, Hu M, Yuan X, Tang J, Wu S, Zhang T, Wang J, Lu Z. Screening of the college students at clinical high risk for psychosis in China: a multicenter epidemiological study. BMC Psychiatry 2021; 21:253. [PMID: 34001048 PMCID: PMC8127262 DOI: 10.1186/s12888-021-03229-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To investigate a 3-stage screening procedure and explore the clinical features of subjects at Clinical High Risk (CHR) for psychosis in a representative sample of Chinese college students. METHODS An epidemiological survey of the prevalence of the CHR syndrome in Chinese college students that was selected by stratified random sampling from Shanghai, Nanjing and Nanchang cities was done following a 3-stage procedure. Participants were initially screened with the Prodromal Questionnaire-brief version (PQ-B), and whose distress score of PQ-B exceeded 24 would be invited to a telephone assessment using the subscale for positive symptoms of the Scale of Prodromal Symptoms (SOPS)/Structured Interview for Prodromal Syndromes (SIPS). Lastly, participants who scored 3 or higher in any item of the subscale would be administered with the SIPS interview conducted by trained researchers to confirm the diagnosis of CHR syndrome. RESULTS Twenty-three thousand sixty-three college students completed the survey during September 2017 to October 2018. Seventy-two students were diagnosed as CHR subjects, and the detection rate in the total sample was 0.3%. The peak age range for the first diagnosis of CHR was 17 to 20 years. Thirteen and forty-six were set as the cutoff points of PQ-B total score and distress score to balance the greatest sensitivity and specificity. Binary logistic regression revealed that 8 items in PQ-B showed significant distinction for detecting CHR subjects. CONCLUSIONS The 3-stage screening method can be utilized in the detection of CHR subjects for psychosis in the general population, during which delusional ideas, perceptual abnormalities and suspiciousness deserve great attention.
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Affiliation(s)
- Jiaxin Wu
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China ,grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Xiangyun Long
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China ,grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Fei Liu
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Ansi Qi
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Qi Chen
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Xiaofeng Guan
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Qiong Zhang
- grid.24516.340000000123704535Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065 PR China
| | - Yuhong Yao
- grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Jingyu Shi
- grid.24516.340000000123704535Tongji University School of Medicine, Shanghai, 200092 PR China
| | - Shiping Xie
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029 PR China
| | - Wei Yan
- grid.89957.3a0000 0000 9255 8984Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029 PR China
| | - Maorong Hu
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Xin Yuan
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Jun Tang
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Siliang Wu
- grid.412604.50000 0004 1758 4073Department of Psychiatry, The First Affiliated Hospital of Nanchang University, Nanchang, 330006 PR China
| | - Tianhong Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030 PR China
| | - Jijun Wang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030 PR China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital of Tongji University, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, PR China. .,Tongji University School of Medicine, Shanghai, 200092, PR China.
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Catalan A, Salazar de Pablo G, Vaquerizo Serrano J, Mosillo P, Baldwin H, Fernández-Rivas A, Moreno C, Arango C, Correll CU, Bonoldi I, Fusar-Poli P. Annual Research Review: Prevention of psychosis in adolescents - systematic review and meta-analysis of advances in detection, prognosis and intervention. J Child Psychol Psychiatry 2021; 62:657-673. [PMID: 32924144 DOI: 10.1111/jcpp.13322] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/20/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. METHODS We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. RESULTS Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. PROGNOSIS Risk for psychosis was 10.4% (95%CI: 5.8%-18.1%) at 6 months, 20% (95%CI: 15%-26%) at 12 months, 23% (95%CI: 18%-29%) at 24 months and 23.3% (95%CI: 17.3%-30.7%) at ≥36 months. INTERVENTIONS There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. CONCLUSIONS It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.
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Affiliation(s)
- Ana Catalan
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain.,Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Julio Vaquerizo Serrano
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Pierluca Mosillo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aranzazu Fernández-Rivas
- Mental Health Department - Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Faculty of Medicine and Dentistry, University of the Basque Country - UPV/EHU, Biscay, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of Madrid, Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA.,Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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10
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Schultze-Lutter F, Schimmelmann BG, Flückiger R, Michel C. Effects of age and sex on clinical high-risk for psychosis in the community. World J Psychiatry 2020; 10:101-124. [PMID: 32477906 PMCID: PMC7243619 DOI: 10.5498/wjp.v10.i5.101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recent reports of both heightened prevalence rates and limited clinical relevance of clinical high-risk (CHR) criteria and their relevant symptoms in children and adolescents indicate an important role of neurodevelopment in the early detection of psychoses. Furthermore, sex effects in CHR symptoms have been reported, though studies were inconclusive. As sex also impacts on neurodevelopment, we expected that sex might have an additional contribution to age in the prevalence and clinical relevance of CHR symptoms and criteria.
AIM To investigate age and sex effects on CHR criteria and symptoms and their association with psychosocial impairment and mental disorder.
METHODS In this cross-sectional cohort study, n = 2916 8- to 40-year-olds, randomly drawn from the population register of the Swiss canton Bern, were assessed in semi-structured interviews by phone or face-to-face for CHR symptoms and criteria using the Structured Interview for Psychosis-Risk Syndromes and the Schizophrenia Proneness Instrument in its child and youth, and adult version, respectively. Furthermore, social and occupational functioning and DSM-IV axis I disorders were assessed. Simple and interaction effects of age and sex on CHR symptoms and criteria, and interaction effects of age, sex, and CHR symptoms and criteria on presentation of functional impairment and of non-psychotic disorder were investigated using logistic regression analyses.
RESULTS Altogether, 542 (18.6%) participants reported any CHR symptom; of these, 261 (9.0%) participants reported any one of the 11 criteria relevant cognitive and perceptual basic symptoms, and 381 (13.1%) any one of the five attenuated or transient psychotic symptoms (attenuated psychotic symptoms/brief intermittent psychotic symptoms). Fewer participants met any one of the CHR criteria (n = 82, 2.8%) or any one of the three recently recommended CHR criteria (n = 38, 1.3%). Both age and sex were significantly (P < 0.05) associated with CHR symptoms and criteria, mostly by younger age and female sex. Though slightly differing between symptom groups, age thresholds were detected around the turn from adolescence to adulthood; they were highest for cognitive basic symptoms and CHR criteria. With the exception of the infrequent speech disorganization attenuated psychotic symptom, the interaction of age with CHR symptoms and criteria predicted functional impairment; whereas, independent of each other, sex and CHR symptoms mostly predicted mental disorders.
CONCLUSION Age and sex differentially impact on CHR symptoms and criteria; these differences may support better understanding of causal pathways. Thus, future CHR studies should consider effects of sex and age.
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Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40692, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
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11
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Sullivan SA, Kounali D, Cannon M, David AS, Fletcher PC, Holmans P, Jones H, Jones PB, Linden DEJ, Lewis G, Owen MJ, O'Donovan M, Rammos A, Thompson A, Wolke D, Heron J, Zammit S. A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder. Am J Psychiatry 2020; 177:308-317. [PMID: 31906710 DOI: 10.1176/appi.ajp.2019.19060654] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors investigated the incidence, course, and outcome of psychotic experiences from childhood through early adulthood in the general population and examined prediction of psychotic disorder. METHODS This was a population-based cohort study using the semistructured Psychosis-Like Symptoms Interview at ages 12, 18, and 24 (N=7,900 with any data). Incidence rates were estimated using flexible parametric modeling, and positive predictive values (PPVs), sensitivity, specificity, and area under the curve were estimated for prediction. RESULTS The incidence rate of psychotic experiences increased between ages 13 and 24, peaking during late adolescence. Of 3,866 participants interviewed at age 24, 313 (8.1%, 95% CI=7.2, 9.0) had a definite psychotic experience since age 12. A total of 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%), by both self-report and interviewer-rated measures of psychotic experiences at age 18 (PPVs, 2.9% and 10.0%, respectively), was improved by incorporating information on frequency and distress (PPVs, 13.3% and 20.0%, respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder at ages 18-24 was 21.1% (95% CI=6.1, 45.6) (sensitivity, 14.3%, 95% CI=4.0, 32.7). CONCLUSIONS The study results show a peak in incidence of psychotic experiences during late adolescence as well as an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cutoff thresholds will likely have little impact on population levels of first-episode psychosis.
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Affiliation(s)
- Sarah A Sullivan
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Daphne Kounali
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Mary Cannon
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Anthony S David
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Paul C Fletcher
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Peter Holmans
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Hannah Jones
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Peter B Jones
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - David E J Linden
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Glyn Lewis
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Michael J Owen
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Michael O'Donovan
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Alexandros Rammos
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Andrew Thompson
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Dieter Wolke
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Jon Heron
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Stanley Zammit
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
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12
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Salazar de Pablo G, Catalan A, Fusar-Poli P. Clinical Validity of DSM-5 Attenuated Psychosis Syndrome: Advances in Diagnosis, Prognosis, and Treatment. JAMA Psychiatry 2020; 77:311-320. [PMID: 31746950 DOI: 10.1001/jamapsychiatry.2019.3561] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Since the release of the DSM-5 diagnosis of attenuated psychosis syndrome (DSM-5-APS) in 2013, several research studies have investigated its clinical validity. Although critical and narrative reviews have reviewed these progresses, no systematic review has comprehensively summarized the available evidence regarding the clinical validity of DSM-5-APS. OBJECTIVE To provide current evidence on the clinical validity of DSM-5-APS, focusing on recent advances in diagnosis, prognosis, and treatment. EVIDENCE REVIEW A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, conference proceedings, and trial registries from database inception to June 16, 2019, was conducted following PRISMA and MOOSE guidelines and PROSPERO protocol. Studies with original data investigating individuals diagnosed using DSM-5-APS or meeting comparable criteria were included. The results of the systematic review were summarized in tables and narratively synthesized against established evidence-based antecedent, concurrent, and prognostic validators. A quantitative meta-analysis was conducted to explore the cumulative risk of psychosis onset at 6, 12, 24, and 36 months in individuals diagnosed using DSM-5-APS criteria. FINDINGS The systematic review included 56 articles, which reported on 124 validators, including 15 antecedent, 55 concurrent, and 54 prognostic validators. The epidemiological prevalence of the general non-help-seeking young population meeting DSM-5-APS criteria was 0.3%; the prevalence of individuals meeting DSM-5-APS criteria was variable in clinical samples. The interrater reliability for DSM-5-APS criteria was comparable with that of other DSM-5 mental disorders and can be optimized by the use of specific psychometric instruments. DSM-5-APS criteria were associated with frequent depressive comorbid disorders, distress, suicidality, and functional impairment. The meta-analysis included 23 prospective cohort studies, including 2376 individuals. The meta-analytical risk of psychosis onset was 11% at 6 months, 15% at 12 months, 20% at 24 months, and 23% at 36 months. Research into predisposing and precipitating epidemiological factors, neurobiological correlates, and effective treatments for DSM-5-APS criteria has been limited. CONCLUSIONS AND RELEVANCE Over recent years, DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research into the clinical high-risk state for psychosis. Precipitating and predisposing factors, neurobiological correlates, and effective treatments are undetermined to date.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.,Mental Health Group, BioCruces Health Research Institute, Bizkaia, Spain.,Neuroscience Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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13
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Walger H, Antonucci LA, Pigoni A, Upthegrove R, Salokangas RKR, Lencer R, Chisholm K, Riecher-Rössler A, Haidl T, Meisenzahl E, Rosen M, Ruhrmann S, Kambeitz J, Kambeitz-Ilankovic L, Falkai P, Ruef A, Hietala J, Pantelis C, Wood SJ, Brambilla P, Bertolino A, Borgwardt S, Koutsouleris N, Schultze-Lutter F. Basic Symptoms Are Associated With Age in Patients With a Clinical High-Risk State for Psychosis: Results From the PRONIA Study. Front Psychiatry 2020; 11:552175. [PMID: 33312133 PMCID: PMC7707000 DOI: 10.3389/fpsyt.2020.552175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022] Open
Abstract
In community studies, both attenuated psychotic symptoms (APS) and basic symptoms (BS) were more frequent but less clinically relevant in children and adolescents compared to adults. In doing so, they displayed differential age thresholds that were around age 16 for APS, around age 18 for perceptive BS, and within the early twenties for cognitive BS. Only the age effect has previously been studied and replicated in clinical samples for APS. Thus, we examined the reported age effect on and age thresholds of 14 criteria-relevant BS in a patient sample at clinical-high risk of psychosis (N = 261, age 15-40 yrs.), recruited within the European multicenter PRONIA-study. BS and the BS criteria, "Cognitive Disturbances" (COGDIS) and "Cognitive-perceptive BS" (COPER), were assessed with the "Schizophrenia Proneness Instrument, Adult version" (SPI-A). Using logistic regressions, prevalence rates of perceptive and cognitive BS, and of COGDIS and COPER, as well as the impact of social and role functioning on the association between age and BS were studied in three age groups (15-18 years, 19-23 years, 24-40 years). Most patients (91.2%) reported any BS, 55.9% any perceptive and 87.4% any cognitive BS. Furthermore, 56.3% met COGDIS and 80.5% COPER. Not exhibiting the reported differential age thresholds, both perceptive and cognitive BS, and, at trend level only, COPER were less prevalent in the oldest age group (24-40 years); COGDIS was most frequent in the youngest group (15-18 years). Functional deficits did not better explain the association with age, particularly in perceptive BS and cognitive BS meeting the frequency requirement of BS criteria. Our findings broadly confirmed an age threshold in BS and, thus, the earlier assumed link between presence of BS and brain maturation processes. Yet, age thresholds of perceptive and cognitive BS did not differ. This lack of differential age thresholds might be due to more pronounced the brain abnormalities in this clinical sample compared to earlier community samples. These might have also shown in more frequently occurring and persistent BS that, however, also resulted from a sampling toward these, i.e., toward COGDIS. Future studies should address the neurobiological basis of CHR criteria in relation to age.
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Affiliation(s)
- Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Foundation Major Hospital Polyclinic, University of Milan, Milan, Italy.,MoMiLab Research Unit, Institutions, Markets, Technologies (IMT) School for Advanced Studies Lucca, Lucca, Italy
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.,Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Anita Riecher-Rössler
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Jarmo Hietala
- Department of Psychiatry, Medical Faculty, University of Turku, Turku, Finland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.,Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Foundation Major Hospital Polyclinic, University of Milan, Milan, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Frauke Schultze-Lutter
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
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14
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Salazar de Pablo G, Guinart D, Cornblatt BA, Auther AM, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Lo Cascio N, Brandizzi M, Arango C, Moreno C, Van Meter A, Fusar-Poli P, Correll CU. DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders. Front Psychiatry 2020; 11:568982. [PMID: 33192693 PMCID: PMC7609900 DOI: 10.3389/fpsyt.2020.568982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = -0.17 to -0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r 2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Andrea M Auther
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Ricardo E Carrión
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Maren Carbon
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | | | - Nella Lo Cascio
- Prevention and Early Intervention Service, Department of Mental Health, Rome, Italy
| | - Martina Brandizzi
- Local Health Agency Rome 1, Santo Spirito in Sassia Hospital, Department of Mental Health, Inpatient Psychiatric Unit, Rome, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Anna Van Meter
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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15
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Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Gebhardt E, Pupo S, Andrea R. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Eur Child Adolesc Psychiatry 2019; 28:957-971. [PMID: 30506419 DOI: 10.1007/s00787-018-1262-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2018] [Indexed: 12/25/2022]
Abstract
The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13-18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy.
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, AUSL di Bologna, Bologna, Italy
| | - Eva Gebhardt
- Cmed Polyspecialistic Diagnostic and Therapeutic Centre, Rome, Italy
| | - Simona Pupo
- Intensive Care Unit, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raballo Andrea
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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16
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Traber-Walker N, Gerstenberg M, Metzler S, Joris MR, Karr M, Studer N, Zulauf Logoz M, Roth A, Rössler W, Walitza S, Franscini M. Evaluation of the Combined Treatment Approach "Robin" (Standardized Manual and Smartphone App) for Adolescents at Clinical High Risk for Psychosis. Front Psychiatry 2019; 10:384. [PMID: 31244692 PMCID: PMC6562244 DOI: 10.3389/fpsyt.2019.00384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The prevention of schizophrenia and other psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and to treat the at-risk symptoms in the pre-psychotic period. Although at-risk symptoms such as attenuated hallucinations or delusions are common in adolescents and associated with a marked reduction in global functioning, the evidence base of effective interventions for adolescents at CHR state and even first-episode psychosis is limited. Thus, the present protocol describes a study design that combines therapy modules for CHR adolescents with a smartphone application supporting the young individuals between the therapy sessions. The treatment approach "Robin" is based on existing therapy strategies for adolescents with first episode of psychosis and the available recommendations for adults with at-risk symptoms. Methods: The evaluation aims firstly to compare the efficacy of Robin in 30 CHR adolescents aged 14-18 to an active control group (treatment as usual) from a previous study. Primary outcome measures will be at-risk symptomatology, comorbid diagnosis, functioning, self-efficacy, and quality of life. For the prospective intervention condition (16 weekly individual sessions + a minimum 4 family sessions), help-seeking adolescents with CHR for psychosis, aged 14-18, will be recruited over 3 years. At-risk and comorbid symptoms, functioning, self-efficacy, and quality of life are monitored at six time points (baseline, during the treatment period; immediately after intervention; and 6, 12, and 24 months later) and compared with the respective measures of the active control group. Discussion: To the best of our knowledge, this is the first controlled trial to test the efficacy of a specific early psychosis treatment in combination with a smartphone application for adolescents at CHR for developing psychosis. The results of the study are expected to add information that may substantially decrease the burden of CHR adolescents and increase their resilience. It may offer age-adapted and targeted strategies to guide clinicians in the treatment of these vulnerable individuals. Furthermore, research in the field of early intervention will be enriched by our findings. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03829527.
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Affiliation(s)
- Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sibylle Metzler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Maria Raquel Joris
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Markus Karr
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nadja Studer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Marina Zulauf Logoz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Alexander Roth
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
- Laboratory of Neuroscience, LIM27, Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
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17
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Theodoridou A, Hengartner MP, Heekeren K, Dvorsky D, Schultze-Lutter F, Gerstenberg M, Walitza S, Rössler W. Influence of demographic characteristics on attenuated positive psychotic symptoms in a young, help-seeking, at-risk population. Early Interv Psychiatry 2019; 13:53-56. [PMID: 28417595 DOI: 10.1111/eip.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 01/20/2017] [Accepted: 02/05/2017] [Indexed: 01/15/2023]
Abstract
AIM Presentation of attenuated positive psychotic symptoms (APS) was reported to be modestly influenced by age, sex and education in a psychosis-risk sample. We re-examined the influence of demographic variables on APS in an independent psychosis-risk sample. METHOD In a clinical high-risk-sample (N = 188; 13-35 years; 60.1% men), bivariate correlations were examined with Spearman correlations. All other associations were computed with generalized linear models. RESULTS Inter-correlations between positive symptoms were statistically significant for all but the smallest coefficient (range: r = 0.12-0.49). Age was negatively related to APS (range: OR = 0.53-0.78, all P < .01). Male sex was uniquely related to disorganized communication (OR = 1.46) and a high education-level related negatively to suspiciousness/persecutory ideas (OR = 0.64), perceptual abnormalities/hallucinations (OR = 0.57) and disorganized communication (OR = 0.54). The variance explained by age ranged from R 2 = 0.044 for unusual thought content to R 2 = 0.144 for perceptual abnormalities. CONCLUSION Our results highlighted the role of age and, thereby, neurodevelopment in psychosis-risk assessment.
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Affiliation(s)
- Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
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18
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Grivel MM, Leong W, Masucci MD, Altschuler RA, Arndt LY, Redman SL, Yang LH, Brucato G, Girgis RR. Impact of lifetime traumatic experiences on suicidality and likelihood of conversion in a cohort of individuals at clinical high-risk for psychosis. Schizophr Res 2018; 195:549-553. [PMID: 28935167 PMCID: PMC5857405 DOI: 10.1016/j.schres.2017.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
Recent research suggests that trauma history (TH) is a strong socio-environmental risk factor for the development of psychosis. While reported rates of childhood trauma are higher among individuals at clinical high-risk (CHR) for psychosis than in the general population, little research has explored the effects of trauma upon the severity of attenuated positive symptoms. We aimed to explore the specific relationships between TH and baseline symptom severity; likelihood of conversion to full-blown psychosis; suicidal ideation (SI); and suicidal behavior (SB) in a cohort of 200 help-seeking CHR individuals. Participants were evaluated every three months for up to two years using the Structured Interview for Psychosis-Risk Syndromes (SIPS). More trauma history was reported by females and Hispanic/Latino participants, while age and race did not significantly distinguish those with and without TH. Individuals with TH reported higher rates of SI and SB than those without. While TH was positively associated with several SIPS subscales, including Unusual Thought Content, Perceptual Abnormalities/Hallucinations, Bizarre Thinking, Sleep Disturbances, and Dysphoric Mood, and negatively associated with Expressed Emotion, results indicated that TH was not significantly related to conversion to psychosis. Moreover, baseline SI was unrelated to conversion and baseline DSM diagnosis, with the exception of Post-Traumatic Stress Disorder (PTSD). These results suggest that traumatic experiences may significantly impact the severity of attenuated positive symptoms and suicidality in the CHR state, providing new windows for further research and potential intervention.
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Masucci MD, Lister A, Corcoran CM, Brucato G, Girgis RR. Motor Dysfunction as a Risk Factor for Conversion to Psychosis Independent of Medication Use in a Psychosis-Risk Cohort. J Nerv Ment Dis 2018; 206:356-361. [PMID: 29561299 PMCID: PMC5899031 DOI: 10.1097/nmd.0000000000000806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Structured Interview for Psychosis-Risk Syndromes (SIPS) contains criteria for the Attenuated Positive Symptom Syndrome (APSS), a period of subthreshold positive symptoms that predates full-blown psychosis. Motor abnormalities are often associated with these symptoms but have not been adequately studied. We assessed a diverse sample of 192 APSS participants (27.1% female; 47.9% white; mean age = 20.03 years) for motor dysfunction (SIPS G.3. score) at baseline and conversion to psychosis every 3 months for up to 2 years. Fifty-nine (30.7%) participants converted to psychosis. Baseline G.3. score was significantly higher among converters than nonconverters (mean difference = 0.66; t[95.929] = 2.579, p < 0.05). No significant differences in baseline G.3. were found between demographic groups or those with differential medication use. These results point to the use of G.3. as a potential predictor of psychosis among APSS individuals and potentially implicate the shared biological underpinnings of motor dysfunction in the APSS and full-blown psychotic illnesses.
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Affiliation(s)
- Michael D. Masucci
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA,Corresponding author: Michael Masucci, Mailing Address: 643 West 172nd St., 56, New York, NY 10032., Phone: (315) 281-7205,
| | - Amanda Lister
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Cheryl M. Corcoran
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Gary Brucato
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Ragy R. Girgis
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
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Ribolsi M, Lin A, Wardenaar KJ, Pontillo M, Mazzone L, Vicari S, Armando M. Clinical presentation of Attenuated Psychosis Syndrome in children and adolescents: Is there an age effect? Psychiatry Res 2017; 252:169-174. [PMID: 28282534 DOI: 10.1016/j.psychres.2017.02.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/04/2017] [Accepted: 02/15/2017] [Indexed: 01/11/2023]
Abstract
There is limited research on clinical features related to age of presentation of the Attenuated Psychosis Syndrome in children and adolescents (CAD). Based on findings in CAD with psychosis, we hypothesized that an older age at presentation of Attenuated Psychosis Syndrome would be associated with less severe symptoms and better psychosocial functioning than presentation in childhood or younger adolescence. Ninety-four CAD (age 9-18) meeting Attenuated Psychosis Syndrome criteria participated in the study. The sample was divided and compared according to the age of presentation of Attenuated Psychosis Syndrome (9-14 vs 15-18 years). The predictive value of age of Attenuated Psychosis Syndrome presentation was investigated using receiver operating characteristic (ROC)-curve calculations. The two Attenuated Psychosis Syndrome groups were homogeneous in terms of gender distribution, IQ scores and comorbid diagnoses. Older Attenuated Psychosis Syndrome patients showed better functioning and lower depressive scores. ROC curves revealed that severity of functional impairment was best predicted using an age of presentation cut-off of 14.9 years for social functioning and 15.9 years for role functioning. This study partially confirmed our hypothesis; older age at presentation of Attenuated Psychosis Syndrome was associated with less functional impairment, but age was not associated with psychotic symptoms.
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Affiliation(s)
- Michele Ribolsi
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, 6008 Western Australia, Australia
| | - Klaas J Wardenaar
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Luigi Mazzone
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy; Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.
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