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Zhang T, Wei Y, Xu L, Tang X, Hu Y, Liu H, Wang Z, Chen T, Li C, Wang J. Association between serum cytokines and timeframe for conversion from clinical high-risk to psychosis. Psychiatry Clin Neurosci 2024; 78:385-392. [PMID: 38591426 DOI: 10.1111/pcn.13670] [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: 01/04/2024] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
AIM Although many studies have explored the link between inflammatory markers and psychosis, there is a paucity of research investigating the temporal progression in individuals at clinical high-risk (CHR) who eventually develop full psychosis. To address this gap, we investigated the correlation between serum cytokine levels and Timeframe for Conversion to Psychosis (TCP) in individuals with CHR. METHODS We enrolled 53 individuals with CHR who completed a 5-year follow-up with a confirmed conversion to psychosis. Granulocyte macrophage-colony stimulating factor (GM-CSF), interleukin (IL)-1β, 2, 6, 8, 10, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) levels were measured at baseline and 1-year. Correlation and quantile regression analyses were performed. RESULTS The median TCP duration was 14 months. A significantly shorter TCP was associated with higher levels of TNF-α (P = 0.022) and VEGF (P = 0.016). A negative correlation was observed between TCP and TNF-α level (P = 0.006) and VEGF level (P = 0.04). Quantile regression indicated negative associations between TCP and GM-CSF levels below the 0.5 quantile, IL-10 levels below the 0.3 quantile, IL-2 levels below the 0.25 quantile, IL-6 levels between the 0.65 and 0.75 quantiles, TNF-α levels below the 0.8 quantile, and VEGF levels below the 0.7 quantile. A mixed linear effects model identified significant time effects for IL-10 and IL-2, and significant group effects for changes in IL-2 and TNF-α. CONCLUSIONS Our findings underscore that a more pronounced baseline inflammatory state is associated with faster progression of psychosis in individuals with CHR. This highlights the importance of considering individual inflammatory profiles during early intervention and of tailoring preventive measures for risk profiles.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
- Labor and Worklife Program, Harvard University, Cambridge, Massachusetts, USA
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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Zhang T, Xu L, Wei Y, Cui H, Tang X, Hu Y, Tang Y, Wang Z, Liu H, Chen T, Li C, Wang J. Advancements and Future Directions in Prevention Based on Evaluation for Individuals With Clinical High Risk of Psychosis: Insights From the SHARP Study. Schizophr Bull 2024:sbae066. [PMID: 38741342 DOI: 10.1093/schbul/sbae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS This review examines the evolution and future prospects of prevention based on evaluation (PBE) for individuals at clinical high risk (CHR) of psychosis, drawing insights from the SHARP (Shanghai At Risk for Psychosis) study. It aims to assess the effectiveness of non-pharmacological interventions in preventing psychosis onset among CHR individuals. STUDY DESIGN The review provides an overview of the developmental history of the SHARP study and its contributions to understanding the needs of CHR individuals. It explores the limitations of traditional antipsychotic approaches and introduces PBE as a promising framework for intervention. STUDY RESULTS Three key interventions implemented by the SHARP team are discussed: nutritional supplementation based on niacin skin response blunting, precision transcranial magnetic stimulation targeting cognitive and brain functional abnormalities, and cognitive behavioral therapy for psychotic symptoms addressing symptomatology and impaired insight characteristics. Each intervention is evaluated within the context of PBE, emphasizing the potential for tailored approaches to CHR individuals. CONCLUSIONS The review highlights the strengths and clinical applications of the discussed interventions, underscoring their potential to revolutionize preventive care for CHR individuals. It also provides insights into future directions for PBE in CHR populations, including efforts to expand evaluation techniques and enhance precision in interventions.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - ZiXuan Wang
- Department of Psychology, Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
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Zhang T, Wei Y, Tang X, Cui H, Xu L, Hu Y, Tang Y, Hu Q, Liu H, Wang Z, Chen T, Li C, Wang J. Cognitive functions following initiation of antipsychotic medication in adolescents and adults at clinical high risk for psychosis: a naturalistic sub group analysis using the MATRICS consensus cognitive battery. Child Adolesc Psychiatry Ment Health 2024; 18:53. [PMID: 38704567 PMCID: PMC11070077 DOI: 10.1186/s13034-024-00743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The effects of antipsychotic (AP) medications on cognitive functions in individuals at clinical high-risk (CHR) of psychosis are poorly understood. This study compared the effects of AP treatment on cognitive improvement in CHR adolescents and adults. METHODS A total of 327 CHR participants, with an age range of 13 to 45 years, who underwent baseline neuropsychological assessments and a 1-year clinical follow-up were included. Participants with CHR were categorized into four groups based on their age: adolescents (aged < 18) and adults (aged ≥ 18), as well as their antipsychotic medication status (AP+ or AP-). Therefore, the four groups were defined as Adolescent-AP-, Adolescent-AP+, Adult-AP-, and Adult-AP+. RESULTS During the follow-up, 231 CHR patients received AP treatment, 94 converted to psychosis, and 161 completed the 1-year follow-up. The Adolescent-AP+ group had more positive symptoms, lower general functions, and cognitive impairments than the Adolescent-AP- group at baseline, but no significant differences were observed among adults. The Adolescent-AP+ group showed a significant increase in the risk of conversion to psychosis (p < 0.001) compared to the Adolescent-AP- group. The Adult-AP+ group showed a decreasing trend in the risk of conversion (p = 0.088) compared to the Adult-AP- group. The Adolescent-AP- group had greater improvement in general functions (p < 0.001), neuropsychological assessment battery mazes (p = 0.025), and brief visuospatial memory test-revised (p = 0.020), as well as a greater decrease in positive symptoms (p < 0.001) at follow-up compared to the Adolescent-AP+ group. No significant differences were observed among adults. CONCLUSIONS Early use of AP was not associated with a positive effect on cognitive function in CHR adolescents. Instead, the absence of AP treatment was associated with better cognitive recovery, suggesting that AP exposure might not be the preferred choice for cognitive recovery in CHR adolescents, but may be more reasonable for use in adults.
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Affiliation(s)
- TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China.
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - Qiang Hu
- Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, People's Republic of China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, 200240, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - ChunBo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China.
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, People's Republic of China.
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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Hartmann S, Cearns M, Pantelis C, Dwyer D, Cavve B, Byrne E, Scott I, Yuen HP, Gao C, Allott K, Lin A, Wood SJ, Wigman JTW, Amminger GP, McGorry PD, Yung AR, Nelson B, Clark SR. Combining Clinical With Cognitive or Magnetic Resonance Imaging Data for Predicting Transition to Psychosis in Ultra High-Risk Patients: Data From the PACE 400 Cohort. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:417-428. [PMID: 38052267 DOI: 10.1016/j.bpsc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/19/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Multimodal modeling that combines biological and clinical data shows promise in predicting transition to psychosis in individuals who are at ultra-high risk. Individuals who transition to psychosis are known to have deficits at baseline in cognitive function and reductions in gray matter volume in multiple brain regions identified by magnetic resonance imaging. METHODS In this study, we used Cox proportional hazards regression models to assess the additive predictive value of each modality-cognition, cortical structure information, and the neuroanatomical measure of brain age gap-to a previously developed clinical model using functioning and duration of symptoms prior to service entry as predictors in the Personal Assessment and Crisis Evaluation (PACE) 400 cohort. The PACE 400 study is a well-characterized cohort of Australian youths who were identified as ultra-high risk of transitioning to psychosis using the Comprehensive Assessment of At Risk Mental States (CAARMS) and followed for up to 18 years; it contains clinical data (from N = 416 participants), cognitive data (n = 213), and magnetic resonance imaging cortical parameters extracted using FreeSurfer (n = 231). RESULTS The results showed that neuroimaging, brain age gap, and cognition added marginal predictive information to the previously developed clinical model (fraction of new information: neuroimaging 0%-12%, brain age gap 7%, cognition 0%-16%). CONCLUSIONS In summary, adding a second modality to a clinical risk model predicting the onset of a psychotic disorder in the PACE 400 cohort showed little improvement in the fit of the model for long-term prediction of transition to psychosis.
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Affiliation(s)
- Simon Hartmann
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Micah Cearns
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Carlton South, Melbourne, Victoria, Australia; Western Centre for Health Research & Education, Western Hospital Sunshine, The University of Melbourne, St. Albans, Victoria, Australia
| | - Dominic Dwyer
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Blake Cavve
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Enda Byrne
- Child Health Research Center, The University of Queensland, Brisbane, Queensland, Australia
| | - Isabelle Scott
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Gao
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephen J Wood
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia; School of Psychology, The University of Birmingham, Birmingham, England, United Kingdom
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G Paul Amminger
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Rintell LS, Carroll D, Wales M, Gonzalez-Heydrich J, D'Angelo E. Heterogeneity of clinical symptomatology in pediatric patients at clinical high risk for psychosis. BMC Res Notes 2024; 17:88. [PMID: 38532408 DOI: 10.1186/s13104-024-06742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE Widespread use of diagnostic tools like the Structured Interview for Prodromal Symptoms (SIPS) has highlighted that youth at Clinical High Risk for Psychosis (CHR-P) present with heterogeneous symptomatology. This pilot study aims to highlight the range of clinical characteristics of CHR-P youth, investigate the role of the non-positive (negative, disorganization, and general) symptoms in risk assessment, and determine if specific profiles are associated with severe symptomatology. METHODS 38 participants aged 7-18 were administered the SIPS and designated as CHR-P. Descriptive statistics and mean difference t-tests were used to describe the range in prevalence and severity of SIPS symptoms and to identify symptoms associated with greater overall symptomatology. RESULTS Participants who had a greater number of positive symptoms also had significantly more negative, disorganization, and general symptoms. A number of SIPS symptoms were associated with greater number of positive symptoms. CONCLUSION CHR-P youth represent a heterogeneous group, presenting with a wide range in clinical presentation as reflected in both the number of SIPS symptoms and their severity. Though the severity and duration of positive SIPS symptoms determines the CHR-P classification, high ratings on several of the other SIPS negative, disorganization, and general items may be useful indicators of elevated symptomatology.
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Affiliation(s)
- L Sophia Rintell
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Ave, 02115, Boston, MA, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 N Green Bay Rd., 60064, North Chicago, IL, USA
| | - Devon Carroll
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Ave, 02115, Boston, MA, USA
- College of Nursing, University of Rhode Island, 350 Eddy St, 02903, Providence, RI, USA
| | - Meghan Wales
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Ave, 02115, Boston, MA, USA
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Ave, 02115, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 401 Park Dr, 02215, Boston, MA, USA
| | - Eugene D'Angelo
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, 300 Longwood Ave, 02115, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, 401 Park Dr, 02215, Boston, MA, USA.
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Plakunova VV, Omelchenko MA, Kaleda VG, Migalina VV, Alfimova MV. [Willingness to expend effort for rewards in individuals at clinical high-risk for psychosis: a relationship with the severity and stability of negative symptoms]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:109-115. [PMID: 38465818 DOI: 10.17116/jnevro2024124021109] [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: 03/12/2024]
Abstract
OBJECTIVE To identify the deficit in willingness to expend effort and its association with negative symptoms in the high-risk for psychosis (CHR) group. MATERIAL AND METHODS The study included young men: 45 patients, who met CHR criteria and were treated for a depressive episode, and 15 controls. All subjects completed a modified version of the Effort Expenditure for Rewards Task (EEfRT). The CHR group was assessed with the SOPS, SANS and HDRS at the beginning and at the end of treatment. EEfRT was performed only at the end of treatment. RESULTS The CHR group was significantly less likely to choose high effort tasks across reward probability and magnitude levels compared with the control group (all p<0.001). No significant correlations were found between the rate of selecting the high effort task and the negative syndrome domains of amotivation and diminished expression. The subgroups of CHR with stable and transient (i.e., with a reduction >50% during treatment) negative symptoms, which were identified by a cluster analysis, did not differ in the willingness to expend effort. CONCLUSION The study confirmed a decrease in the willingness to expend effort in the CHR group; however, this deficit was only weakly correlated with negative symptoms and persisted after the symptoms reduction during treatment, which requires future studies to investigate mechanisms underlying impaired effort expenditure for rewards in CHR.
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Affiliation(s)
| | | | - V G Kaleda
- Mental Health Research Center, Moscow, Russia
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Lewis-Fernández R, Chen CN, Olfson M, Interian A, Alegría M. Clinical significance of psychotic-like experiences across U.S. ethnoracial groups. Psychol Med 2023; 53:7666-7676. [PMID: 37272381 PMCID: PMC10755236 DOI: 10.1017/s0033291723001496] [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: 12/06/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Prevalence of psychotic-like experiences (PLEs) - reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder - varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups? METHODS We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest. RESULTS Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0-11.9%) and mean number (0.09 v. 0.11-0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers. CONCLUSIONS While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.
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Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Chih-nan Chen
- Department of Economics, National Taipei University, Taipei, Taiwan, Republic of China
| | - Mark Olfson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Zhang T, Xu L, Tang X, Wei Y, Hu Y, Cui H, Tang Y, Li C, Wang J. Comprehensive review of multidimensional biomarkers in the ShangHai At Risk for Psychosis (SHARP) program for early psychosis identification. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e152. [PMID: 38868725 PMCID: PMC11114265 DOI: 10.1002/pcn5.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 06/14/2024]
Abstract
Psychosis is recognized as one of the largest contributors to nonfatal health loss, and early identification can largely improve routine clinical activity by predicting the psychotic course and guiding treatment. Clinicians have used the clinical high-risk for psychosis (CHR) paradigm to better understand the risk factors that contribute to the onset of psychotic disorders. Clinical factors have been widely applied to calculate the individualized risks for conversion to psychosis 1-2 years later. However, there is still a dearth of valid biomarkers to predict psychosis. Biomarkers, in the context of this paper, refer to measurable biological indicators that can provide valuable information about the early identification of individuals at risk for psychosis. The aim of this paper is to critically review studies assessing CHR and suggest possible biomarkers for application of prediction. We summarized the studies on biomarkers derived from the findings of the ShangHai at Risk for Psychosis (SHARP) program, including those that are considered to have the most potential. This comprehensive review was conducted based on expert opinions within the SHARP research team, and the selection of studies and results presented in this paper reflects the collective expertise of the team in the field of early psychosis identification. The three dimensions with potential candidates include neuroimaging dimension of brain structure and function, electrophysiological dimension of event-related potentials (ERPs), and immune dimension of inflammatory cytokines and complement proteins, which proved to be useful in supporting the prediction of psychosis from the CHR state. We suggest that these three dimensions could be useful as risk biomarkers for treatment optimization. In the future, when available for the integration of multiple dimensions, clinicians may be able to obtain a comprehensive report with detailed information of psychosis risk and specific indications about preferred prevention.
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Affiliation(s)
- TianHong Zhang
- Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - ChunBo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health CenterShanghai Jiaotong University School of MedicineShanghaiChina
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT)Chinese Academy of SciencesShanghaiChina
- Institute of Psychology and Behavioral ScienceShanghai Jiaotong UniversityShanghaiChina
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Caballero N, Machiraju S, Diomino A, Kennedy L, Kadivar A, Cadenhead KS. Recent Updates on Predicting Conversion in Youth at Clinical High Risk for Psychosis. Curr Psychiatry Rep 2023; 25:683-698. [PMID: 37755654 PMCID: PMC10654175 DOI: 10.1007/s11920-023-01456-2] [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] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in the prediction and treatment of psychotic conversion. Over the past 25 years, research into the prodromal phase of psychotic illness has expanded with the promise of early identification of individuals at clinical high risk (CHR) for psychosis who are likely to convert to psychosis. RECENT FINDINGS Meta-analyses highlight conversion rates between 20 and 30% within 2-3 years using existing clinical criteria while research into more specific risk factors, biomarkers, and refinement of psychosis risk calculators has exploded, improving our ability to predict psychotic conversion with greater accuracy. Recent studies highlight risk factors and biomarkers likely to contribute to earlier identification and provide insight into neurodevelopmental abnormalities, CHR subtypes, and interventions that can target specific risk profiles linked to neural mechanisms. Ongoing initiatives that assess longer-term (> 5-10 years) outcome of CHR participants can provide valuable information about predictors of later conversion and diagnostic outcomes while large-scale international biomarker studies provide hope for precision intervention that will alter the course of early psychosis globally.
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Affiliation(s)
- Noe Caballero
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Siddharth Machiraju
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Anthony Diomino
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Leda Kennedy
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Armita Kadivar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA.
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Worthington MA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Lympus CA, Mathalon DH, Perkins DO, Stone WS, Walker EF, Woods SW, Zhao Y, Cannon TD. Dynamic Prediction of Outcomes for Youth at Clinical High Risk for Psychosis: A Joint Modeling Approach. JAMA Psychiatry 2023; 80:1017-1025. [PMID: 37531131 PMCID: PMC10398543 DOI: 10.1001/jamapsychiatry.2023.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/03/2023] [Indexed: 08/03/2023]
Abstract
Importance Leveraging the dynamic nature of clinical variables in the clinical high risk for psychosis (CHR-P) population has the potential to significantly improve the performance of outcome prediction models. Objective To improve performance of prediction models and elucidate dynamic clinical profiles using joint modeling to predict conversion to psychosis and symptom remission. Design, Setting, and Participants Data were collected as part of the third wave of the North American Prodrome Longitudinal Study (NAPLS 3), which is a 9-site prospective longitudinal study. Participants were individuals aged 12 to 30 years who met criteria for a psychosis-risk syndrome. Clinical, neurocognitive, and demographic variables were collected at baseline and at multiple follow-up visits, beginning at 2 months and up to 24 months. An initial feature selection process identified longitudinal clinical variables that showed differential change for each outcome group across 2 months. With these variables, a joint modeling framework was used to estimate the likelihood of eventual outcomes. Models were developed and tested in a 10-fold cross-validation framework. Clinical data were collected between February 2015 and November 2018, and data were analyzed from February 2022 to December 2023. Main Outcomes and Measures Prediction models were built to predict conversion to psychosis and symptom remission. Participants met criteria for conversion if their positive symptoms reached the fully psychotic range and for symptom remission if they were subprodromal on the Scale of Psychosis-Risk Symptoms for a duration of 6 months or more. Results Of 488 included NAPLS 3 participants, 232 (47.5%) were female, and the mean (SD) age was 18.2 (3.4) years. Joint models achieved a high level of accuracy in predicting conversion (balanced accuracy [BAC], 0.91) and remission (BAC, 0.99) compared with baseline models (conversion: BAC, 0.65; remission: BAC, 0.60). Clinical variables that showed differential change between outcome groups across a 2-month span, including measures of symptom severity and aspects of functioning, were also identified. Further, intra-individual risks for each outcome were more negatively correlated when using joint models (r = -0.92; P < .001) compared with baseline models (r = -0.50; P < .001). Conclusions and Relevance In this study, joint models significantly outperformed baseline models in predicting both conversion and remission, demonstrating that monitoring short-term clinical change may help to parse heterogeneous dynamic clinical trajectories in a CHR-P population. These findings could inform additional study of targeted treatment selection and could move the field closer to clinical implementation of prediction models.
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Affiliation(s)
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Department of Psychology, University of California, Los Angeles
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston
| | - Cole A. Lympus
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Daniel H. Mathalon
- Department of Psychiatry, San Francisco VA Medical Center, University of California, San Francisco
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill
| | - William S. Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, Georgia
- Department of Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W. Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Yize Zhao
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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11
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Hitczenko K, Segal Y, Keshet J, Goldrick M, Mittal VA. Speech characteristics yield important clues about motor function: Speech variability in individuals at clinical high-risk for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:60. [PMID: 37717025 PMCID: PMC10505148 DOI: 10.1038/s41537-023-00382-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND AND HYPOTHESIS Motor abnormalities are predictive of psychosis onset in individuals at clinical high risk (CHR) for psychosis and are tied to its progression. We hypothesize that these motor abnormalities also disrupt their speech production (a highly complex motor behavior) and predict CHR individuals will produce more variable speech than healthy controls, and that this variability will relate to symptom severity, motor measures, and psychosis-risk calculator risk scores. STUDY DESIGN We measure variability in speech production (variability in consonants, vowels, speech rate, and pausing/timing) in N = 58 CHR participants and N = 67 healthy controls. Three different tasks are used to elicit speech: diadochokinetic speech (rapidly-repeated syllables e.g., papapa…, pataka…), read speech, and spontaneously-generated speech. STUDY RESULTS Individuals in the CHR group produced more variable consonants and exhibited greater speech rate variability than healthy controls in two of the three speech tasks (diadochokinetic and read speech). While there were no significant correlations between speech measures and remotely-obtained motor measures, symptom severity, or conversion risk scores, these comparisons may be under-powered (in part due to challenges of remote data collection during the COVID-19 pandemic). CONCLUSION This study provides a thorough and theory-driven first look at how speech production is affected in this at-risk population and speaks to the promise and challenges facing this approach moving forward.
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Affiliation(s)
- Kasia Hitczenko
- Laboratoire de Sciences Cognitives et Psycholinguistique, Département d'Études Cognitives, ENS, EHESS, CNRS, PSL University, Paris, France.
| | - Yael Segal
- Faculty of Electrical and Computer Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Joseph Keshet
- Faculty of Electrical and Computer Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Matthew Goldrick
- Department of Linguistics, Northwestern University, Evanston, IL, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Cognitive Science Program, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Cognitive Science Program, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Evanston, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Evanston/Chicago, IL, USA
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12
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Strauss GP, Walker EF, Pelletier-Baldelli A, Carter NT, Ellman LM, Schiffman J, Luther L, James SH, Berglund AM, Gupta T, Ristanovic I, Mittal VA. Development and Validation of the Negative Symptom Inventory-Psychosis Risk. Schizophr Bull 2023; 49:1205-1216. [PMID: 37186040 PMCID: PMC10483448 DOI: 10.1093/schbul/sbad038] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND HYPOTHESES Early identification and prevention of psychosis is limited by the availability of tools designed to assess negative symptoms in those at clinical high-risk for psychosis (CHR). To address this critical need, a multi-site study was established to develop and validate a clinical rating scale designed specifically for individuals at CHR: The Negative Symptom Inventory-Psychosis Risk (NSI-PR). STUDY DESIGN The measure was developed according to guidelines recommended by the NIMH Consensus Conference on Negative Symptoms using a transparent, iterative, and data-driven process. A 16-item version of the NSI-PR was designed to have an overly inclusive set of items and lengthier interview to support the ultimate intention of creating a new briefer measure. Psychometric properties of the 16-item NSI-PR were evaluated in a sample of 218 CHR participants. STUDY RESULTS Item-level analyses indicated that men had higher scores than women. Reliability analyses supported internal consistency, inter-rater agreement, and temporal stability. Associations with measures of negative symptoms and functioning supported convergent validity. Small correlations with positive, disorganized, and general symptoms supported discriminant validity. Structural analyses indicated a 5-factor structure (anhedonia, avolition, asociality, alogia, and blunted affect). Item response theory identified items for removal and indicated that the anchor range could be reduced. Factor loadings, item-level correlations, item-total correlations, and skew further supported removal of certain items. CONCLUSIONS These findings support the psychometric properties of the NSI-PR and guided the creation of a new 11-item NSI-PR that will be validated in the next phase of this multi-site scale development project.
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Affiliation(s)
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | | | - Nathan T Carter
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California- Irvine, Irvine, CA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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13
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Gupta T, Osborne KJ, Nadig A, Haase CM, Mittal VA. Alterations in facial expressions in individuals at risk for psychosis: a facial electromyography approach using emotionally evocative film clips. Psychol Med 2023; 53:5829-5838. [PMID: 36285533 PMCID: PMC10130238 DOI: 10.1017/s0033291722003087] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Negative symptoms such as blunted facial expressivity are characteristic of schizophrenia. However, it is not well-understood if and what abnormalities are present in individuals at clinical high-risk (CHR) for psychosis. METHODS This experimental study employed facial electromyography (left zygomaticus major and left corrugator supercilia) in a sample of CHR individuals (N = 34) and healthy controls (N = 32) to detect alterations in facial expressions in response to emotionally evocative film clips and to determine links with symptoms. RESULTS Findings revealed that the CHR group showed facial blunting manifested in reduced zygomatic activity in response to an excitement (but not amusement, fear, or sadness) film clip compared to controls. Reductions in zygomatic activity in the CHR group emerged in response to the emotionally evocative peak period of the excitement film clip. Lower zygomaticus activity during the excitement clip was related to anxiety while lower rates of change in zygomatic activity during the excitement video clip were related to higher psychosis risk conversion scores. CONCLUSIONS Together, these findings inform vulnerability/disease driving mechanisms and biomarker and treatment development.
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Affiliation(s)
- Tina Gupta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - K. Juston Osborne
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ajay Nadig
- Harvard/MIT MD-PhD Program, Harvard Medical School, Boston, MA, 02115
| | - Claudia M. Haase
- Department of Psychology, Northwestern University, Evanston, IL, USA
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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14
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Loch AA, Gondim JM, Argolo FC, Lopes-Rocha AC, Andrade JC, van de Bilt MT, de Jesus LP, Haddad NM, Cecchi GA, Mota NB, Gattaz WF, Corcoran CM, Ara A. Detecting at-risk mental states for psychosis (ARMS) using machine learning ensembles and facial features. Schizophr Res 2023; 258:45-52. [PMID: 37473667 PMCID: PMC10448183 DOI: 10.1016/j.schres.2023.07.011] [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: 12/06/2022] [Revised: 04/26/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
AIMS Our study aimed to develop a machine learning ensemble to distinguish "at-risk mental states for psychosis" (ARMS) subjects from control individuals from the general population based on facial data extracted from video-recordings. METHODS 58 non-help-seeking medication-naïve ARMS and 70 healthy subjects were screened from a general population sample. At-risk status was assessed with the Structured Interview for Prodromal Syndromes (SIPS), and "Subject's Overview" section was filmed (5-10 min). Several features were extracted, e.g., eye and mouth aspect ratio, Euler angles, coordinates from 51 facial landmarks. This elicited 649 facial features, which were further selected using Gradient Boosting Machines (AdaBoost combined with Random Forests). Data was split in 70/30 for training, and Monte Carlo cross validation was used. RESULTS Final model reached 83 % of mean F1-score, and balanced accuracy of 85 %. Mean area under the curve for the receiver operator curve classifier was 93 %. Convergent validity testing showed that two features included in the model were significantly correlated with Avolition (SIPS N2 item) and expression of emotion (SIPS N3 item). CONCLUSION Our model capitalized on short video-recordings from individuals recruited from the general population, effectively distinguishing between ARMS and controls. Results are encouraging for large-screening purposes in low-resource settings.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.
| | - João Medrado Gondim
- Instituto de Computação, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Felipe Coelho Argolo
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Caroline Lopes-Rocha
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Julio Cesar Andrade
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Martinus Theodorus van de Bilt
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Leonardo Peroni de Jesus
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Mansur Haddad
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Natalia Bezerra Mota
- Instituto de Psiquiatria (IPUB), Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Research Department at Motrix Lab - Motrix, Rio de Janeiro, Brazil
| | - Wagner Farid Gattaz
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Cheryl Mary Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters VA Medical Center Bronx, NY, USA
| | - Anderson Ara
- Statistics Department, Federal University of Paraná, Curitiba, PR, Brazil
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15
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Kohler CG, Wolf DH, Abi-Dargham A, Anticevic A, Cho YT, Fonteneau C, Gil R, Girgis RR, Gray DL, Grinband J, Javitch JA, Kantrowitz JT, Krystal JH, Lieberman JA, Murray JD, Ranganathan M, Santamauro N, Van Snellenberg JX, Tamayo Z, Gur RC, Gur RE, Calkins ME. Illness Phase as a Key Assessment and Intervention Window for Psychosis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:340-350. [PMID: 37519466 PMCID: PMC10382701 DOI: 10.1016/j.bpsgos.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
The phenotype of schizophrenia, regardless of etiology, represents the most studied psychotic disorder with respect to neurobiology and distinct phases of illness. The early phase of illness represents a unique opportunity to provide effective and individualized interventions that can alter illness trajectories. Developmental age and illness stage, including temporal variation in neurobiology, can be targeted to develop phase-specific clinical assessment, biomarkers, and interventions. We review an earlier model whereby an initial glutamate signaling deficit progresses through different phases of allostatic adaptation, moving from potentially reversible functional abnormalities associated with early psychosis and working memory dysfunction, and ending with difficult-to-reverse structural changes after chronic illness. We integrate this model with evidence of dopaminergic abnormalities, including cortical D1 dysfunction, which develop during adolescence. We discuss how this model and a focus on a potential critical window of intervention in the early stages of schizophrenia impact the approach to research design and clinical care. This impact includes stage-specific considerations for symptom assessment as well as genetic, cognitive, and neurophysiological biomarkers. We examine how phase-specific biomarkers of illness phase and brain development can be incorporated into current strategies for large-scale research and clinical programs implementing coordinated specialty care. We highlight working memory and D1 dysfunction as early treatment targets that can substantially affect functional outcome.
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Affiliation(s)
- Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H. Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anissa Abi-Dargham
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Alan Anticevic
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Youngsun T. Cho
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Clara Fonteneau
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Roberto Gil
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Ragy R. Girgis
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - David L. Gray
- Cerevel Therapeutics Research and Development, East Cambridge, Massachusetts
| | - Jack Grinband
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Jonathan A. Javitch
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York
| | - Joshua T. Kantrowitz
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
- New York State Psychiatric Institute, New York
- Nathan Kline Institute, Orangeburg, New York
| | - John H. Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey A. Lieberman
- Departments of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - John D. Murray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mohini Ranganathan
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nicole Santamauro
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jared X. Van Snellenberg
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook
| | - Zailyn Tamayo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Pratt DN, Bridgwater M, Schiffman J, Ellman LM, Mittal VA. Do the Components of Attenuated Positive Symptoms Truly Represent One Construct? Schizophr Bull 2023; 49:788-798. [PMID: 36454660 PMCID: PMC10154719 DOI: 10.1093/schbul/sbac182] [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] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND HYPOTHESES Psychosis-risk inventories, like the Structured Interview for Psychosis-Risk Syndromes (SIPS), utilize symptom components and coalesce the information into a single-severity rating. These components include frequency, duration, in-the-moment conviction, retrospective insight, distress, and effect on social/role functioning. While combining components distills a great deal of important information into one practical symptom rating, this approach may mask important details of the greater clinical picture. STUDY DESIGN Individuals at clinical high risk for psychosis (n = 115) were assessed with the SIPS Score Separable Components (SSSC) scale, created to accompany the SIPS positive items by dividing each item into the 7 components identified above. The latent structure of the SSSC was identified with an exploratory factor analysis (EFA). The factors were followed up with validation analyses including hypothesized cognitive, functioning, and symptom measures. Finally, clinical utility analyses were conducted to understand relationships between psychosis risk and common comorbidities. STUDY RESULTS EFA revealed that the SSSC had 3 interpretable factors with the appropriate fit (rmsr = 0.018, TLI = 0.921): Conviction (in-the-moment conviction, retrospective insight), Distress-Impairment (distress, social/role functioning), and Frequency/Duration (frequency, duration). Conviction was minimally valid, Distress-Impairment had excellent validity, and Frequency/Duration was not related to any of the candidate validators. Conviction significantly predicted elevated psychosis risk. Distress-Impairment was related to common comorbid symptoms. Notably, the factors associated more strongly with clinical features than the traditional SIPS scores. CONCLUSIONS The SSSC offers a supplemental approach to single-severity ratings, providing useful clinical insight, mechanistic understanding, and the potential for better capturing heterogeneity in this population.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Miranda Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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17
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Karp EL, Williams TF, Ellman LM, Strauss GP, Walker EF, Corlett PR, Woods SW, Powers AR, Gold JM, Schiffman JE, Waltz JA, Silverstein SM, Mittal VA. Self-reported Gesture Interpretation and Performance Deficits in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:746-755. [PMID: 36939086 PMCID: PMC10154698 DOI: 10.1093/schbul/sbac197] [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] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Deficits in performing and interpreting communicative nonverbal behaviors, such as gesture, have been linked to varied psychopathology and dysfunction. Some evidence suggests that individuals at risk for psychosis have deficits in gesture interpretation and performance; however, individuals with internalizing disorders (eg, depression) may have similar deficits. No previous studies have examined whether gesture deficits in performance and interpretation are specific to those at risk for psychosis. Additionally, the underlying mechanisms (eg, cognition) and consequences (eg, functioning) of these deficits are poorly understood. STUDY DESIGN This study examined self-reported gesture interpretation (SRGI) and performance (SRGP) in those at clinical high risk for psychosis (CHR; N = 88), those with internalizing disorders (INT; N = 51), and healthy controls (HC; N = 53). Participants completed questionnaires, clinical interviews, and neurocognitive tasks. STUDY RESULTS Results indicated that the CHR group was characterized by significantly lower SRGI scores than the HC or INT groups (d = 0.41); there were no differences among groups in SRGP. Within CHR participants, greater deficits in SRGP were associated with lower verbal learning and memory (r = -.33), but not general intelligence or processing speed. Furthermore, gesture deficits were associated with higher cross-sectional risk for conversion to a full psychotic disorder in the CHR group. CONCLUSIONS Overall, these findings suggest that specific subdomains of gesture may reflect unique vulnerability for psychosis, self-report may be a viable assessment tool in understanding these phenomena, and gesture dysfunction may signal risk for transition to psychosis.
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Affiliation(s)
- Erica L Karp
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Jason E Schiffman
- Department of Psychological Science, University of California, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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18
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Zhang T, Tang X, Zhang Y, Xu L, Wei Y, Hu Y, Cui H, Tang Y, Liu H, Chen T, Li C, Wang J. Multivariate joint models for the dynamic prediction of psychosis in individuals with clinical high risk. Asian J Psychiatr 2023; 81:103468. [PMID: 36669290 DOI: 10.1016/j.ajp.2023.103468] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
This study attempted to construct and validate dynamic prediction via multivariate joint models and compare the prognostic performance of these models to both static and univariate joint models. Individuals with clinical high risk(CHR)(n = 289) were recruited and re-assessed for positive symptoms, general functions, and conversion to psychosis at 2-months, 1-year, and 2-years to develop the dynamic models. A multivariate joint model of positive psychotic symptoms was assessed using the Structured Interview for Prodromal Symptoms(SIPSp) and general function assessed by global assessment of functioning scores(GAFs) with time-to-conversion to psychosis. The area under the receiver operating characteristic(ROC) curve(AUC) was used to test the accuracy of the models. Among 298 CHR individuals, 68 converted to psychosis within 2 years after the initial assessments. Multivariate joint models showed that declining GAFs and increasing SIPSp corresponded to significant and trending to significantly increased risk of psychosis onset and had much higher prognostic accuracy (cross-validated AUC=0.9) compared to the static model(AUC=0.6) and univariate joint models(cross-validated AUC=0.6-0.8). Our results showed that multivariate joint models could be highly efficient in forecasting psychosis onset for CHR individuals. Longitudinal assessments for psychopathology and general functions can be useful for dynamically predicting the prognosis of the pre-morbid phase of psychosis.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Yue Zhang
- Department of Bioinformatics and Biostatistics, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, PR China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Ontario, Canada; Senior Research Fellow, Labor and Worklife Program, Harvard University, MA, USA
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China.
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19
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Strauss GP, Bartolomeo LA, Luther L. Reduced willingness to expend effort for rewards is associated with risk for conversion and negative symptom severity in youth at clinical high-risk for psychosis. Psychol Med 2023; 53:714-721. [PMID: 34120660 DOI: 10.1017/s003329172100204x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and predictive of conversion to illness. Mechanisms underlying negative symptoms are unclear in the CHR population. METHODS The current study evaluated whether CHR participants demonstrated deficits in the willingness to expend effort for rewards and whether these impairments are associated with negative symptoms and greater risk for conversion. Participants included 44 CHR participants and 32 healthy controls (CN) who completed the Effort Expenditure for Reward Task (EEfRT). RESULTS Compared to CN, CHR participants displayed reduced likelihood of exerting high effort for high probability and magnitude rewards. Among CHR participants, reduced effort expenditure was associated with greater negative symptom severity and greater probability of conversion to a psychotic disorder on a cross-sectional risk calculator. CONCLUSIONS Findings suggest that effort-cost computation is a marker of illness liability and a transphasic mechanism underlying negative symptoms in the SZ spectrum.
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Affiliation(s)
| | | | - Lauren Luther
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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20
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Adewuya AO, Oladipo OE, Imarah T, Asmal L, Emsley R. The 3-year progression of clinically significant psychotic-like experiences in a general adult population in Lagos, Nigeria. Soc Psychiatry Psychiatr Epidemiol 2023; 58:91-103. [PMID: 36098756 DOI: 10.1007/s00127-022-02358-z] [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: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The study assessed the 3-year progression of clinically significant psychotic-like experience (CS-PLE) symptoms in an adult general population in terms of stability or remission of symptoms and transition to psychosis. METHODS Participants (n = 1292) aged 18-65 years with CS-PLE were assessed at baseline for sociodemographic details, family history of mental illness, functioning status, common mental disorders, alcohol, and substance use disorders. Three years later they were reassessed for diagnosis of psychosis, presence or remission of PLE symptoms, and contact with mental health services. RESULTS The mean age of the participants at baseline in years was 36.56 (SD = 11.66) and there were 855 (66.2%) females. By the 3rd year follow-up, 95 (7.3%) had transited to psychosis, while 850 (65.5%) had persistent CS-PLE symptoms and the rest 347 (27.2%) were in remission. Only history of mental illness in the immediate family (HR 4.81, 95% CI 1.40-16.47, P = 0.013) and regular use of cannabis at less than 18 years of age (HR 0.65, 95% CI 0.55-0.77, P < 0.001) were the independent predictors of conversion to psychosis at 3 years. CONCLUSION The rate of TTP in the non-clinical population with elevated risk may be lower than that earlier reported in the western literature. Interventions aimed at preventing transition to psychosis in high risk groups must pay attention to early onset users of cannabis and those with family history of mental illness.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Behavioral Medicine, Lagos State University College of Medicine, 1-5, Oba Akinjobi Way, GRA, Ikeja, Lagos, Nigeria.
- Centre for Mental Health Research and Initiative, Lagos, Nigeria.
| | | | - Tomilola Imarah
- Centre for Mental Health Research and Initiative, Lagos, Nigeria
| | - Laila Asmal
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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21
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Pratt DN, Luther L, Kinney KS, Osborne KJ, Corlett PR, Powers AR, Woods SW, Gold JM, Schiffman J, Ellman LM, Strauss GP, Walker EF, Zinbarg R, Waltz JA, Silverstein SM, Mittal VA. Comparing a Computerized Digit Symbol Test to a Pen-and-Paper Classic. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad027. [PMID: 37868160 PMCID: PMC10590153 DOI: 10.1093/schizbullopen/sgad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background and Hypothesis Processing speed dysfunction is a core feature of psychosis and predictive of conversion in individuals at clinical high risk (CHR) for psychosis. Although traditionally measured with pen-and-paper tasks, computerized digit symbol tasks are needed to meet the increasing demand for remote assessments. Therefore we: (1) assessed the relationship between traditional and computerized processing speed measurements; (2) compared effect sizes of impairment for progressive and persistent subgroups of CHR individuals on these tasks; and (3) explored causes contributing to task performance differences. Study Design Participants included 92 CHR individuals and 60 healthy controls who completed clinical interviews, the Brief Assessment of Cognition in Schizophrenia Symbol Coding test, the computerized TestMyBrain Digit Symbol Matching Test, a finger-tapping task, and a self-reported motor abilities measure. Correlations, Hedges' g, and linear models were utilized, respectively, to achieve the above aims. Study Results Task performance was strongly correlated (r = 0.505). A similar degree of impairment was seen between progressive (g = -0.541) and persistent (g = -0.417) groups on the paper version. The computerized task uniquely identified impairment for progressive individuals (g = -477), as the persistent group performed similarly to controls (g = -0.184). Motor abilities were related to the computerized version, but the paper version was more related to symptoms and psychosis risk level. Conclusions The paper symbol coding task measures impairment throughout the CHR state, while the computerized version only identifies impairment in those with worsening symptomatology. These results may be reflective of sensitivity differences, an artifact of existing subgroups, or evidence of mechanistic differences.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Kyle S Kinney
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | | | | | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA
- Department of Neuroscience, University of Georgia, Athens, GA, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - James A Waltz
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA
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22
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Chen Y, Wang J, Xu L, Wei Y, Tang X, Hu Y, Zhou L, Wang J, Zhang T. Age-related changes in self-reported psychotic experiences in clinical help-seeking population: From 15 to 45 years. Early Interv Psychiatry 2022; 16:1359-1367. [PMID: 35460330 DOI: 10.1111/eip.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/08/2022] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIMS Psychotic experiences differ with age. It is currently unknown whether there were specific patterns and associations between the presentation of psychotic experiences and age. This study aimed to explore age-related differences (15-45 years) in self-reported psychotic experiences in a large-scale clinical population. METHODS A total of 2542 consecutive new patients aged 15-45 years were recruited on their first visit to the Shanghai Mental Health Center and screened with the PRIME Screen-Revised (PS-R). According to the clinical diagnostic information of patients from their outpatient medical records compiled by their clinicians, four diagnostic categories were applied: 1) psychotic disorder; 2) mood disorder; 3) anxiety disorder and 4) others. RESULTS The PS-R scores of self-reported psychotic experiences declined with age, except for two age ranges: ≤18 years for overall sample (≤18 vs. 19-34 years: t = 5.531, df = 2202, p < .001) and 37-40 years for female sample (37-40 vs. >40 years: t = 1.985, df = 138, p = .049), which showed upward trends, contrary to those of others. There were no significant differences in self-reported psychotic experiences between age groups in patients with psychotic disorders, while significant age differences were found in all nonpsychotic patients. CONCLUSION These findings support the view that frequent PS-R screening demonstrated that psychotic experiences decline with age in the clinical population. Early detection of psychosis should focus on not only adolescents but also women aged >36 years.
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Affiliation(s)
- YingMei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - JunJie Wang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LinLin Zhou
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Beijing, China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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23
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Lee TY, Hwang WJ, Kim NS, Park I, Lho SK, Moon SY, Oh S, Lee J, Kim M, Woo CW, Kwon JS. Prediction of psychosis: model development and internal validation of a personalized risk calculator. Psychol Med 2022; 52:2632-2640. [PMID: 33315005 PMCID: PMC9647536 DOI: 10.1017/s0033291720004675] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Over the past two decades, early detection and early intervention in psychosis have become essential goals of psychiatry. However, clinical impressions are insufficient for predicting psychosis outcomes in clinical high-risk (CHR) individuals; a more rigorous and objective model is needed. This study aims to develop and internally validate a model for predicting the transition to psychosis within 10 years. METHODS Two hundred and eight help-seeking individuals who fulfilled the CHR criteria were enrolled from the prospective, naturalistic cohort program for CHR at the Seoul Youth Clinic (SYC). The least absolute shrinkage and selection operator (LASSO)-penalized Cox regression was used to develop a predictive model for a psychotic transition. We performed k-means clustering and survival analysis to stratify the risk of psychosis. RESULTS The predictive model, which includes clinical and cognitive variables, identified the following six baseline variables as important predictors: 1-year percentage decrease in the Global Assessment of Functioning score, IQ, California Verbal Learning Test score, Strange Stories test score, and scores in two domains of the Social Functioning Scale. The predictive model showed a cross-validated Harrell's C-index of 0.78 and identified three subclusters with significantly different risk levels. CONCLUSIONS Overall, our predictive model showed a predictive ability and could facilitate a personalized therapeutic approach to different risks in high-risk individuals.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Nahrie S. Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Inkyung Park
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong-Wan Woo
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Neuroscience, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
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24
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Motion energy analysis during speech tasks in medication-naïve individuals with at-risk mental states for psychosis. SCHIZOPHRENIA 2022; 8:73. [PMID: 36114187 PMCID: PMC9481869 DOI: 10.1038/s41537-022-00283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/03/2022] [Indexed: 12/16/2022]
Abstract
Movement abnormalities are commonly observed in schizophrenia and at-risk mental states (ARMS) for psychosis. They are usually detected with clinical interviews, such that automated analysis would enhance assessment. Our aim was to use motion energy analysis (MEA) to assess movement during free-speech videos in ARMS and control individuals, and to investigate associations between movement metrics and negative and positive symptoms. Thirty-two medication-naïve ARMS and forty-six healthy control individuals were filmed during speech tasks. Footages were analyzed using MEA software, which assesses movement by differences in pixels frame-by-frame. Two regions of interest were defined—head and torso—and mean amplitude, frequency, and coefficient of variability of movements for them were obtained. These metrics were correlated with the Structured Interview for Prodromal Syndromes (SIPS) symptoms, and with the risk of conversion to psychosis—inferred with the SIPS risk calculator. ARMS individuals had significantly lower mean amplitude of head movement and higher coefficients of movement variability for both head and torso, compared to controls. Higher coefficient of variability was related to higher risk of conversion. Negative correlations were seen between frequency of movement and most SIPS negative symptoms. All positive symptoms were correlated with at least one movement variable. Movement abnormalities could be automatically detected in medication-naïve ARMS subjects by means of a motion energy analysis software. Significant associations of movement metrics with symptoms were found, supporting the importance of movement analysis in ARMS. This could be a potentially important tool for early diagnosis, intervention, and outcome prediction.
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25
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Verdolini N, Borràs R, Sparacino G, Garriga M, Sagué‐Vilavella M, Madero S, Palacios‐Garrán R, Serra M, Forte MF, Salagre E, Aedo A, Salgado‐Pineda P, Salvatierra IM, Sánchez Gistau V, Pomarol‐Clotet E, Ramos‐Quiroga JA, Carvalho AF, Garcia‐Rizo C, Undurraga J, Reinares M, Martinez Aran A, Bernardo M, Vieta E, Pacchiarotti I, Amoretti S. Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood. Acta Psychiatr Scand 2022; 146:36-50. [PMID: 35170748 PMCID: PMC9305219 DOI: 10.1111/acps.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/29/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies. METHODS Patients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Chi-squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models. RESULTS The total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal-directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM. CONCLUSION Early characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.
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Affiliation(s)
- Norma Verdolini
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Roger Borràs
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Giulio Sparacino
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - Marina Garriga
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Maria Sagué‐Vilavella
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Santiago Madero
- Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Roberto Palacios‐Garrán
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,University Hospital Santa MariaUniversity of LleidaLleidaSpain
| | - Maria Serra
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Maria Florencia Forte
- Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Estela Salagre
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Alberto Aedo
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Bipolar Disorders UnitDepartment of PsychiatrySchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Pilar Salgado‐Pineda
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
| | - Irene Montoro Salvatierra
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Hospital Universitari Institut Pere MataInstitut d'Investigació Sanitària Pere Virgili (IISPV)Universitat Rovira i VirgiliReusSpain
| | - Vanessa Sánchez Gistau
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Hospital Universitari Institut Pere MataInstitut d'Investigació Sanitària Pere Virgili (IISPV)Universitat Rovira i VirgiliReusSpain
| | - Edith Pomarol‐Clotet
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
| | - Josep Antoni Ramos‐Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Group of PsychiatryMental Health and AddictionsVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Psychiatric Genetics UnitVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Department of Psychiatry and Legal MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Andre F. Carvalho
- The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research CentreSchool of MedicineBarwon HealthDeakin UniversityGeelongVictoriaAustralia
| | - Clemente Garcia‐Rizo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Juan Undurraga
- Department of Neurology and PsychiatryFaculty of MedicineClinica Alemana Universidad del DesarrolloSantiagoChile,Early Intervention ProgramInstituto Psiquiátrico Dr. J. Horwitz BarakSantiagoChile
| | - María Reinares
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Anabel Martinez Aran
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Miguel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Barcelona Clinic Schizophrenia UnitInstitute of NeurosciencesUniversity of BarcelonaIDIBAPSBarcelonaSpain
| | - Eduard Vieta
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSBarcelonaSpain,Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain
| | - Silvia Amoretti
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM)BarcelonaSpain,Group of PsychiatryMental Health and AddictionsVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Psychiatric Genetics UnitVall d’Hebron Research Institute (VHIR)BarcelonaSpain,Department of Psychiatry and Legal MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
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26
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Crouse JJ, Ho N, Scott J, Parker R, Park SH, Couvy-Duchesne B, Mitchell BL, Byrne EM, Hermens DF, Medland SE, Martin NG, Gillespie NA, Hickie IB. Dynamic networks of psychological symptoms, impairment, substance use, and social support: The evolution of psychopathology among emerging adults. Eur Psychiatry 2022; 65:e32. [PMID: 35694845 PMCID: PMC9280922 DOI: 10.1192/j.eurpsy.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Subthreshold/attenuated syndromes are established precursors of full-threshold mood and psychotic disorders. Less is known about the individual symptoms that may precede the development of subthreshold syndromes and associated social/functional outcomes among emerging adults. METHODS We modeled two dynamic Bayesian networks (DBN) to investigate associations among self-rated phenomenology and personal/lifestyle factors (role impairment, low social support, and alcohol and substance use) across the 19Up and 25Up waves of the Brisbane Longitudinal Twin Study. We examined whether symptoms and personal/lifestyle factors at 19Up were associated with (a) themselves or different items at 25Up, and (b) onset of a depression-like, hypo-manic-like, or psychotic-like subthreshold syndrome (STS) at 25Up. RESULTS The first DBN identified 11 items that when endorsed at 19Up were more likely to be reendorsed at 25Up (e.g., hypersomnia, impaired concentration, impaired sleep quality) and seven items that when endorsed at 19Up were associated with different items being endorsed at 25Up (e.g., earlier fatigue and later role impairment; earlier anergia and later somatic pain). In the second DBN, no arcs met our a priori threshold for inclusion. In an exploratory model with no threshold, >20 items at 19Up were associated with progression to an STS at 25Up (with lower statistical confidence); the top five arcs were: feeling threatened by others and a later psychotic-like STS; increased activity and a later hypo-manic-like STS; and anergia, impaired sleep quality, and/or hypersomnia and a later depression-like STS. CONCLUSIONS These probabilistic models identify symptoms and personal/lifestyle factors that might prove useful targets for indicated preventative strategies.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Ho
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom.,Université de Paris, Paris, France.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Shin Ho Park
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Baptiste Couvy-Duchesne
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia.,Paris Brain Institute (ICM), INSERM U 1127, CNRS UMR 7225, Sorbonne University, Inria, Aramis Project-Team, 75013Paris, France
| | | | - Enda M Byrne
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ian B Hickie
- Youth Mental Health & Technology Team, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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27
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Metabolic disturbances, hemoglobin A1c, and social cognition impairment in Schizophrenia spectrum disorders. Transl Psychiatry 2022; 12:233. [PMID: 35668078 PMCID: PMC9170776 DOI: 10.1038/s41398-022-02002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022] Open
Abstract
Social cognitive impairments are core features of schizophrenia spectrum disorders (SSD) and are associated with greater functional impairment and decreased quality of life. Metabolic disturbances have been related to greater impairment in general neurocognition, but their relationship to social cognition has not been previously reported. In this study, metabolic measures and social cognition were assessed in 245 participants with SSD and 165 healthy comparison subjects (HC), excluding those with hemoglobin A1c (HbA1c) > 6.5%. Tasks assessed emotion processing, theory of mind, and social perception. Functional connectivity within and between social cognitive networks was measured during a naturalistic social task. Among SSD, a significant inverse relationship was found between social cognition and cumulative metabolic burden (β = -0.38, p < 0.001) and HbA1c (β = -0.37, p < 0.001). The relationship between social cognition and HbA1c was robust across domains and measures of social cognition and after accounting for age, sex, race, non-social neurocognition, hospitalization, and treatment with different antipsychotic medications. Negative connectivity between affect sharing and motor resonance networks was a partial mediator of this relationship across SSD and HC groups (β = -0.05, p = 0.008). There was a group x HbA1c effect indicating that SSD participants were more adversely affected by increasing HbA1c. Thus, we provide the first report of a robust relationship in SSD between social cognition and abnormal glucose metabolism. If replicated and found to be causal, insulin sensitivity and blood glucose may present as promising targets for improving social cognition, functional outcomes, and quality of life in SSD.
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28
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Williams TF, Powers AR, Ellman LM, Corlett PR, Strauss GP, Schiffman J, Waltz JA, Silverstein SM, Woods SW, Walker EF, Gold JM, Mittal VA. Three prominent self-report risk measures show unique and overlapping utility in characterizing those at clinical high-risk for psychosis. Schizophr Res 2022; 244:58-65. [PMID: 35597134 PMCID: PMC9829103 DOI: 10.1016/j.schres.2022.05.006] [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: 01/12/2022] [Revised: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 01/12/2023]
Abstract
Self-report questionnaires have been developed to efficiently assess psychosis risk and vulnerability. Despite this, the validity of these questionnaires for assessing specific positive symptoms in those at clinical high risk for psychosis (CHR) is unclear. Positive symptoms have largely been treated as a uniform construct in this critical population and there have been no reports on the construct validity of questionnaires for assessing specific symptoms. The present study examined the convergent, discriminant, and criterion validity of the Launay Slade Hallucination Scale-Revised (LSHS-R), Prodromal Questionnaire-Brief (PQB), and Community Assessment of Psychic Experiences positive scale (CAPE-P) using a multimethod approach. CHR individuals (N = 71) and healthy controls (HC; N = 71) completed structured clinical interviews, self-report questionnaires, and neuropsychological tests. Questionnaire intercorrelations indicated strong convergent validity (i.e., all rs > .50); however, evidence for discriminant validity was more variable. In examining relations to interviewer-assessed psychosis symptoms, all questionnaires demonstrated evidence of criterion validity, though the PQB showed the strongest convergent correlations (e.g., r = .48 with total symptoms). In terms of discriminant validity for specific positive symptoms, results were again more variable. PQB subscales demonstrated limited specificity with positive symptoms, whereas CAPE-P subscales showed some specificity and the LSHS-R showed high specificity. In addition, when correlations with internalizing and externalizing symptoms were examined, only the PQB showed consistent significant correlations. These results are interpreted in terms of the strengths and limitations of each measure, their value for screening, and their potential utility for clarifying differences between specific positive symptoms.
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Affiliation(s)
- Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, 30602, USA
| | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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29
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Gan R, Wei Y, Wu G, Zeng J, Hu Y, Xu L, Tang X, Liu X, Liu H, Chen T, Wang J, Zhang T. Attenuated niacin-induced skin flush response in individuals with clinical high risk for psychosis. Gen Psychiatr 2022; 35:e100748. [PMID: 35572776 PMCID: PMC9039376 DOI: 10.1136/gpsych-2022-100748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022] Open
Abstract
Background Impaired sensitivity of the skin flush response to niacin is one of the most replicated findings in patients with schizophrenia. However, prior studies have usually focused on postonset psychosis, and little is known about the clinical high-risk (CHR) phase of niacin sensitivity in psychosis. Aims To profile and compare the niacin flush response among CHR individuals (converters and non-converters), patients with first-episode schizophrenia (FES) and healthy controls (HCs). Methods Sensitivity to four concentrations (0.1-0.0001 M) of aqueous methylnicotinate was tested in 105 CHR individuals, 57 patients with FES and 52 HCs. CHR individuals were further grouped as converters and non-converters according to the 2-year follow-up outcomes. Skin flush response scores were rated on a 4-point scale. Results Of the 105 CHR individuals, 21 individuals were lost during the study, leaving 84 CHR individuals; 16 (19.0%) converted to full psychosis at 2 years of follow-up. Flush response scores identified in the CHR samples were characterised as modest degree levels, intermediate between those of HC individuals and patients with FES. The flush responses in the CHR group mimicked the responses observed in the FES group at higher concentrations (0.01 M, 0.1 M) and longer time points (15 min, 20 min); however, these became comparable with the responses in the HC group at the shorter time points and at lower concentrations. The converters exhibited lower mean flush response scores than the non-converters. Conclusions Attenuated niacin-induced flushing emerged during the early phase of psychosis. New devices should be developed and verified for objective quantification of skin responses in the CHR population.
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Affiliation(s)
- Ranpiao Gan
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Wei
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guisen Wu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahui Zeng
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yegang Hu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Xu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochen Tang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Liu
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haichun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, Ontario, Canada
| | - Jijun Wang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Tianhong Zhang
- Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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30
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Preti A, Raballo A, Meneghelli A, Cocchi A, Meliante M, Barbera S, Malvini L, Monzani E, Percudani M. Antipsychotics are related to psychometric conversion to psychosis in ultra-high-risk youth. Early Interv Psychiatry 2022; 16:342-351. [PMID: 33951751 PMCID: PMC9291179 DOI: 10.1111/eip.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/31/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prescription of antipsychotics outside overt psychotic conditions remains controversial, especially in youth where it is relatively widespread. Furthermore, some studies seem to indicate that antipsychotic exposure in individuals at ultra-high-risk (UHR) for psychosis is associated with higher conversion rates. This study was set up to test whether the inter-current prescription of antipsychotics in UHR patients was related to the psychometric threshold for a diagnosis of psychosis. METHODS The 24-item Brief Psychiatric Rating Scale (BPRS) was used to quantify treatment response up to 2 years in 125 UHR participants. Standard psychometric criteria were used to quantify conversion to psychosis. Kaplan-Mayer and Cox proportional hazard survival analysis were applied to determine the impact of having or not received the prescription of an antipsychotic drug. RESULTS Over the study period 30 (24%) subjects received the prescription of an antipsychotic. In the sample, there were 31 participants (25%) who had reached the psychometric threshold for conversion to psychosis after 2 years of treatment. UHR people who received a prescription of antipsychotics during the first 2 years of treatment were statistically more likely to reach the psychometric threshold for conversion to psychosis on the BPRS: Hazard ratio = 3.03 (95%CI: 1.49-6.16); p = .003. CONCLUSION This finding supports the hypothesis that the prescription of antipsychotics within UHR cohorts is to be considered a red flag for higher incipient risk of conversion to psychosis.
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Affiliation(s)
- Antonio Preti
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy.,Department of Neuroscience, University of Turin, Turin, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
| | - Anna Meneghelli
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Angelo Cocchi
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria Meliante
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Simona Barbera
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Lara Malvini
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Emiliano Monzani
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Mauro Percudani
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
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31
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Osborne KJ, Mittal VA. Postural sway and neurocognition in individuals meeting criteria for a clinical high-risk syndrome. Eur Arch Psychiatry Clin Neurosci 2022; 272:155-160. [PMID: 33606092 PMCID: PMC8373991 DOI: 10.1007/s00406-021-01234-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/23/2021] [Indexed: 02/03/2023]
Abstract
Neurocognitive deficits are implicated in individuals that meet criteria for a clinical high-risk (CHR) syndrome. Evidence in patients with schizophrenia suggests that cerebellar dysfunction may underlie neurocognitive deficits. However, little research has examined if similar associations are present in those meeting CHR criteria. This study examined associations between the MATRICS cognitive battery, postural sway (an index of cerebellar functioning), and SIPS-RC psychosis risk scores in a CHR sample (N = 66). Poorer working memory and processing speed were associated with less postural control. Consistent with the cognitive dysmetria theory of schizophrenia, neurocognitive deficits are associated with cerebellar dysfunction in this critical population.
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Affiliation(s)
- K. Juston Osborne
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
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32
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MacNeill LA, Allen NB, Poleon RB, Vargas T, Osborne KJ, Damme KSF, Barch DM, Krogh-Jespersen S, Nielsen AN, Norton ES, Smyser CD, Rogers CE, Luby JL, Mittal VA, Wakschlag LS. Translating RDoC to Real-World Impact in Developmental Psychopathology: A Neurodevelopmental Framework for Application of Mental Health Risk Calculators. Dev Psychopathol 2021; 33:1665-1684. [PMID: 35095215 PMCID: PMC8794223 DOI: 10.1017/s0954579421000651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The National Institute of Mental Health Research Domain Criteria's (RDoC) has prompted a paradigm shift from categorical psychiatric disorders to considering multiple levels of vulnerability for probabilistic risk of disorder. However, the lack of neurodevelopmentally-based tools for clinical decision-making has limited RDoC's real-world impact. Integration with developmental psychopathology principles and statistical methods actualize the clinical implementation of RDoC to inform neurodevelopmental risk. In this conceptual paper, we introduce the probabilistic mental health risk calculator as an innovation for such translation and lay out a research agenda for generating an RDoC- and developmentally-informed paradigm that could be applied to predict a range of developmental psychopathologies from early childhood to young adulthood. We discuss methods that weigh the incremental utility for prediction based on intensity and burden of assessment, the addition of developmental change patterns, considerations for assessing outcomes, and integrative data approaches. Throughout, we illustrate the risk calculator approach with different neurodevelopmental pathways and phenotypes. Finally, we discuss real-world implementation of these methods for improving early identification and prevention of developmental psychopathology. We propose that mental health risk calculators can build a needed bridge between RDoC's multiple units of analysis and developmental science.
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Affiliation(s)
- Leigha A MacNeill
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Norrina B Allen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roshaye B Poleon
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL
| | | | | | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
| | - Ashley N Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Elizabeth S Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Christopher D Smyser
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Vijay A Mittal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
- Department of Psychology, Northwestern University, Evanston, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Institute for Policy Research, Northwestern University, Evanston, IL
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
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33
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Koutsouleris N, Worthington M, Dwyer DB, Kambeitz-Ilankovic L, Sanfelici R, Fusar-Poli P, Rosen M, Ruhrmann S, Anticevic A, Addington J, Perkins DO, Bearden CE, Cornblatt BA, Cadenhead KS, Mathalon DH, McGlashan T, Seidman L, Tsuang M, Walker EF, Woods SW, Falkai P, Lencer R, Bertolino A, Kambeitz J, Schultze-Lutter F, Meisenzahl E, Salokangas RKR, Hietala J, Brambilla P, Upthegrove R, Borgwardt S, Wood S, Gur RE, McGuire P, Cannon TD. Toward Generalizable and Transdiagnostic Tools for Psychosis Prediction: An Independent Validation and Improvement of the NAPLS-2 Risk Calculator in the Multisite PRONIA Cohort. Biol Psychiatry 2021; 90:632-642. [PMID: 34482951 PMCID: PMC8500930 DOI: 10.1016/j.biopsych.2021.06.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transition to psychosis is among the most adverse outcomes of clinical high-risk (CHR) syndromes encompassing ultra-high risk (UHR) and basic symptom states. Clinical risk calculators may facilitate an early and individualized interception of psychosis, but their real-world implementation requires thorough validation across diverse risk populations, including young patients with depressive syndromes. METHODS We validated the previously described NAPLS-2 (North American Prodrome Longitudinal Study 2) calculator in 334 patients (26 with transition to psychosis) with CHR or recent-onset depression (ROD) drawn from the multisite European PRONIA (Personalised Prognostic Tools for Early Psychosis Management) study. Patients were categorized into three risk enrichment levels, ranging from UHR, over CHR, to a broad-risk population comprising patients with CHR or ROD (CHR|ROD). We assessed how risk enrichment and different predictive algorithms influenced prognostic performance using reciprocal external validation. RESULTS After calibration, the NAPLS-2 model predicted psychosis with a balanced accuracy (BAC) (sensitivity, specificity) of 68% (73%, 63%) in the PRONIA-UHR cohort, 67% (74%, 60%) in the CHR cohort, and 70% (73%, 66%) in patients with CHR|ROD. Multiple model derivation in PRONIA-CHR|ROD and validation in NAPLS-2-UHR patients confirmed that broader risk definitions produced more accurate risk calculators (CHR|ROD-based vs. UHR-based performance: 67% [68%, 66%] vs. 58% [61%, 56%]). Support vector machines were superior in CHR|ROD (BAC = 71%), while ridge logistic regression and support vector machines performed similarly in CHR (BAC = 67%) and UHR cohorts (BAC = 65%). Attenuated psychotic symptoms predicted psychosis across risk levels, while younger age and reduced processing speed became increasingly relevant for broader risk cohorts. CONCLUSIONS Clinical-neurocognitive machine learning models operating in young patients with affective and CHR syndromes facilitate a more precise and generalizable prediction of psychosis. Future studies should investigate their therapeutic utility in large-scale clinical trials.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom.
| | | | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alan Anticevic
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, California; San Francisco VA Medical Center, San Francisco, California
| | - Thomas McGlashan
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ming Tsuang
- University of California San Diego, San Diego, California
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Germany
| | | | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom; School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Stephen Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Orygen, National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip McGuire
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut; Department of Psychiatry, Yale University, New Haven, Connecticut
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Zhang T, Xu L, Chen Y, Wei Y, Tang X, Hu Y, Li Z, Gan R, Wu G, Cui H, Tang Y, Hui L, Li C, Wang J. Conversion to psychosis in adolescents and adults: similar proportions, different predictors. Psychol Med 2021; 51:2003-2011. [PMID: 32248862 DOI: 10.1017/s0033291720000756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age effects may be important for improving models for the prediction of conversion to psychosis for individuals in the clinical high risk (CHR) state. This study aimed to explore whether adolescent CHR individuals (ages 9-17 years) differ significantly from adult CHR individuals (ages 18-45 years) in terms of conversion rates and predictors. METHOD Consecutive CHR individuals (N = 517) were assessed for demographic and clinical characteristics and followed up for 3 years. Individuals with CHR were classified as adolescent (n = 244) or adult (n = 273) groups. Age-specific prediction models of psychosis were generated separately using Cox regression. RESULTS Similar conversion rates were found between age groups; 52 out of 216 (24.1%) adolescent CHR individuals and 55 out of 219 (25.1%) CHR adults converted to psychosis. The conversion outcome was best predicted by negative symptoms compared to other clinical variables in CHR adolescents (χ2 = 7.410, p = 0.006). In contrast, positive symptoms better predicted conversion in CHR adults (χ2 = 6.585, p = 0.01). CONCLUSIONS Adolescent and adult CHR individuals may require a different approach to early identification and prediction. These results can inform the development of more precise prediction models based on age-specific approaches.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Ying Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - ZhiXing Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - RanPiao Gan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - GuiSen Wu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Li Hui
- Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, PR China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Gupta T, Strauss GP, Cowan HR, Pelletier-Baldelli A, Ellman LM, Schiffman J, Mittal VA. Secondary Sources of Negative Symptoms in Those Meeting Criteria for a Clinical High-Risk Syndrome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:210-218. [PMID: 35415704 PMCID: PMC8996819 DOI: 10.1016/j.bpsgos.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Negative symptoms are diagnostic characteristics of schizophrenia. They can result from primary (i.e., idiopathic) or secondary (i.e., due to other factors such as depression, anxiety, psychosis, disorganization, medication effects) features of the illness. Although secondary sources of negative symptoms are prevalent among individuals meeting criteria for clinical high-risk syndromes that are due to high rates of comorbidity, the extent to which secondary sources account for variance in negative symptom domains is unknown. Addressing this gap is an important step in informing vulnerability models and treatments for negative symptoms. This study aimed to investigate secondary sources of negative symptoms in those meeting criteria for a clinical high-risk syndrome (N = 192). METHODS Simultaneous regression and hierarchical partitioning methods were used to determine the proportion of variance explained by selective serotonin reuptake inhibitor use, anxiety, depression, unusual thought content, and disorganized communication in predicting severity of five negative symptom domains (avolition, anhedonia, asociality, blunted affect, and alogia). RESULTS Findings revealed that depression explained the largest proportion of variance in avolition, asociality, and anhedonia. Anxiety was the most predictive of blunted affect, and selective serotonin reuptake inhibitor use explained the most variance in alogia. Analyses within male and female samples revealed that in males, depression explained a large proportion of variance in several negative symptom domains, while in females, selective serotonin reuptake inhibitor use explained variance in alogia. CONCLUSIONS Results highlight heterogeneity in variance explained by secondary sources of negative symptoms. These findings guide treatment development for secondary sources of negative symptoms. Furthermore, results inform etiologic models of psychosis and negative symptom conceptualizations.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Henry R. Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
- Department of Psychological Science, University of California, Irvine, Irvine, California
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Psychiatry, Northwestern University, Evanston, Illinois
- Department of Medical Social Science, Northwestern University, Evanston, Illinois
- Institute for Policy Research, Northwestern University, Evanston, Illinois
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Clay KB, Raugh IM, Bartolomeo LA, Strauss GP. Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Early Interv Psychiatry 2021; 15:865-873. [PMID: 32743974 DOI: 10.1111/eip.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. METHODS Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. RESULTS Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. CONCLUSIONS Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.
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Affiliation(s)
- Kendall B Clay
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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37
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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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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Pelletier-Baldelli A, Strauss GP, Kuhney FS, Chun C, Gupta T, Ellman LM, Schiffman J, Mittal VA. Perceived stress influences anhedonia and social functioning in a community sample enriched for psychosis-risk. J Psychiatr Res 2021; 135:96-103. [PMID: 33460840 PMCID: PMC7914219 DOI: 10.1016/j.jpsychires.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Existing animal and human research support the causal role of stress in the emergence of anhedonia, and in turn, the influence of anhedonia in social functioning. However, this model has not been tested in relation to psychosis-risk; this literature gap is notable given that both anhedonia and declining social functioning represent key markers of risk of developing a psychotic disorder such as schizophrenia. The current research tested the evidence for this model using structural equation modeling in 240 individuals selected based on a range of psychosis-risk symptomatology from the general community. Results supported this model in comparison with alternative models, and additionally emphasized the direct role of perceived stress in social functioning outcomes. Findings suggest the clinical relevance of targeting early perceptions of stress in individuals meeting psychosis-risk self-report criteria in an effort to prevent subsequent anhedonia and declines in social functioning.
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Affiliation(s)
| | | | - Franchesca S Kuhney
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA
| | - Charlotte Chun
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Tina Gupta
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | - Lauren M Ellman
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry, Evanston, IL, USA; Northwestern University, Institute for Policy Research, Evanston, IL, USA; Northwestern University, Department of Medical Social Science, Evanston, IL, USA
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40
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Zhang T, Xu L, Wei Y, Tang X, Hu Y, Cui H, Tang Y, Xie B, Li C, Wang J. When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis? Aust N Z J Psychiatry 2021; 55:314-323. [PMID: 33143440 DOI: 10.1177/0004867420969810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Antipsychotic drugs are widely used for treating patients with first episode of psychosis, targeting threshold psychotic symptoms. The clinical high risk of psychosis is characterized as subthreshold psychotic symptoms and it is unclear whether they can also benefit from antipsychotic drugs treatment. This study attempted to determine whether initiating antipsychotic drugs treatment in the clinical high risk of psychosis phase was superior to initiating antipsychotic drugs treatment in the first episode of psychosis phase, after the 2-year symptomatic and functional outcomes. METHOD Drawing on 517 individuals with clinical high risk of psychosis from the ShangHai At Risk for Psychosis program, we identified 105 patients who converted to first episode of psychosis within the following 2 years. Patients who initiated antipsychotic drugs while at clinical high risk of psychosis (CHR_AP; n = 70) were compared with those who initiated antipsychotic drugs during a first episode of psychosis (FEP_AP; n = 35). Summary scores on positive symptoms and the global function scores at baseline and at 2 months, 1 year and 2 years of follow-up were analyzed to evaluate outcomes. RESULTS The CHR_AP and FEP_AP groups were not different in the severity of positive symptoms and functioning at baseline. However, the CHR_AP group exhibited significantly more serious negative symptoms and total symptoms than the FEP_AP group. Both groups exhibited a significant reduction in positive symptoms and function (p < 0.001). Repeated-measures analysis of variance revealed group by time interaction for symptomatic (F = 3.196, df = 3, p = 0.024) and functional scores (F = 7.306, df = 3, p < 0.001). The FEP_AP group showed higher remission rates than the CHR_AP group (χ2 = 22.270, p < 0.001). Compared to initiating antipsychotic drug treatments in the clinical high risk of psychosis state, initiating antipsychotic drugs treatments in the first episode of psychosis state predicted remission in a regression model for FEP_AP (odds ratio = 5.567, 95% confidence interval = [1.783, 17.383], p = 0.003). CONCLUSION For clinical high risk of psychosis, antipsychotic drugs might be not the first choice in terms of long-term remission, which is more reasonable to use at the first episode of psychosis phase.
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Affiliation(s)
- TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Bin Xie
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - ChunBo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, P.R. China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Rosen M, Betz LT, Schultze-Lutter F, Chisholm K, Haidl TK, Kambeitz-Ilankovic L, Bertolino A, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Ruhrmann S, Salokangas RKR, Upthegrove R, Wood SJ, Koutsouleris N, Kambeitz J. Towards clinical application of prediction models for transition to psychosis: A systematic review and external validation study in the PRONIA sample. Neurosci Biobehav Rev 2021; 125:478-492. [PMID: 33636198 DOI: 10.1016/j.neubiorev.2021.02.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/14/2021] [Accepted: 02/20/2021] [Indexed: 01/13/2023]
Abstract
A multitude of prediction models for a first psychotic episode in individuals at clinical high-risk (CHR) for psychosis have been proposed, but only rarely validated. We identified transition models based on clinical and neuropsychological data through a registered systematic literature search and evaluated their external validity in 173 CHRs from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. Discrimination performance was assessed with the area under the receiver operating characteristic curve (AUC), and compared to the prediction of clinical raters. External discrimination performance varied considerably across the 22 identified models (AUC 0.40-0.76), with two models showing good discrimination performance. None of the tested models significantly outperformed clinical raters (AUC = 0.75). Combining predictions of clinical raters and the best model descriptively improved discrimination performance (AUC = 0.84). Results show that personalized prediction of transition in CHR is potentially feasible on a global scale. For implementation in clinical practice, further rounds of external validation, impact studies, and development of an ethical framework is necessary.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK; Department of Psychology, Aston University, Birmingham, UK
| | - Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany; Department of Psychiatry, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stephen J Wood
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK; Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Max-Planck Institute of Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
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Zhang T, Xu L, Li H, Cui H, Tang Y, Wei Y, Tang X, Hu Y, Hui L, Li C, Niznikiewicz MA, Shenton ME, Keshavan MS, Stone WS, Wang J. Individualized risk components guiding antipsychotic delivery in patients with a clinical high risk of psychosis: application of a risk calculator. Psychol Med 2021; 52:1-10. [PMID: 33593473 DOI: 10.1017/s0033291721000064] [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: 11/05/2022]
Abstract
BACKGROUND Antipsychotics are widely used for treating patients with psychosis, and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) for psychosis are characterized by subthreshold psychotic symptoms. It is currently unclear who might benefit from antipsychotic treatment. Our objective was to apply a risk calculator (RC) to identify people that would benefit from antipsychotics. METHODS Drawing on 400 CHR individuals recruited between 2011 and 2016, 208 individuals who received antipsychotic treatment were included. Clinical and cognitive variables were entered into an individualized RC for psychosis; personal risk was estimated and 4 risk components (negative symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive symptoms-RC-PS) were constructed. The sample was further stratified according to the risk level. Higher risk was defined based on the estimated risk score (20% or higher). RESULTS In total, 208 CHR individuals received daily antipsychotic treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR increased, the conversion rate decreased. A small group (15%) of CHR individuals at higher-risk and an FR >1 benefitted from the antipsychotic treatment. CONCLUSIONS Through applying a personal risk assessment, the administration of antipsychotics should be limited to CHR individuals with predominantly positive symptoms and related function decline. A strict antipsychotic prescription strategy should be introduced to reduce inappropriate use.
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Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - HuiJun Li
- Department of Psychology, Florida A & M University, Tallahassee, Florida32307, USA
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Li Hui
- Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou215137, Jiangsu, PR China
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China
| | - Margaret A Niznikiewicz
- Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA02130, USA
| | - Martha E Shenton
- Brigham and Women's Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA02130, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA02115, USA
| | - JiJun Wang
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
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43
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Koutsouleris N, Dwyer DB, Degenhardt F, Maj C, Urquijo-Castro MF, Sanfelici R, Popovic D, Oeztuerk O, Haas SS, Weiske J, Ruef A, Kambeitz-Ilankovic L, Antonucci LA, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Kambeitz J, Haidl TK, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Walger P, Franscini M, Traber-Walker N, Schimmelmann BG, Flückiger R, Michel C, Rössler W, Borisov O, Krawitz PM, Heekeren K, Buechler R, Pantelis C, Falkai P, Salokangas RKR, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Wood SJ, Upthegrove R, Schultze-Lutter F, Theodoridou A, Meisenzahl E. Multimodal Machine Learning Workflows for Prediction of Psychosis in Patients With Clinical High-Risk Syndromes and Recent-Onset Depression. JAMA Psychiatry 2021; 78:195-209. [PMID: 33263726 PMCID: PMC7711566 DOI: 10.1001/jamapsychiatry.2020.3604] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Diverse models have been developed to predict psychosis in patients with clinical high-risk (CHR) states. Whether prediction can be improved by efficiently combining clinical and biological models and by broadening the risk spectrum to young patients with depressive syndromes remains unclear. OBJECTIVES To evaluate whether psychosis transition can be predicted in patients with CHR or recent-onset depression (ROD) using multimodal machine learning that optimally integrates clinical and neurocognitive data, structural magnetic resonance imaging (sMRI), and polygenic risk scores (PRS) for schizophrenia; to assess models' geographic generalizability; to test and integrate clinicians' predictions; and to maximize clinical utility by building a sequential prognostic system. DESIGN, SETTING, AND PARTICIPANTS This multisite, longitudinal prognostic study performed in 7 academic early recognition services in 5 European countries followed up patients with CHR syndromes or ROD and healthy volunteers. The referred sample of 167 patients with CHR syndromes and 167 with ROD was recruited from February 1, 2014, to May 31, 2017, of whom 26 (23 with CHR syndromes and 3 with ROD) developed psychosis. Patients with 18-month follow-up (n = 246) were used for model training and leave-one-site-out cross-validation. The remaining 88 patients with nontransition served as the validation of model specificity. Three hundred thirty-four healthy volunteers provided a normative sample for prognostic signature evaluation. Three independent Swiss projects contributed a further 45 cases with psychosis transition and 600 with nontransition for the external validation of clinical-neurocognitive, sMRI-based, and combined models. Data were analyzed from January 1, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES Accuracy and generalizability of prognostic systems. RESULTS A total of 668 individuals (334 patients and 334 controls) were included in the analysis (mean [SD] age, 25.1 [5.8] years; 354 [53.0%] female and 314 [47.0%] male). Clinicians attained a balanced accuracy of 73.2% by effectively ruling out (specificity, 84.9%) but ineffectively ruling in (sensitivity, 61.5%) psychosis transition. In contrast, algorithms showed high sensitivity (76.0%-88.0%) but low specificity (53.5%-66.8%). A cybernetic risk calculator combining all algorithmic and human components predicted psychosis with a balanced accuracy of 85.5% (sensitivity, 84.6%; specificity, 86.4%). In comparison, an optimal prognostic workflow produced a balanced accuracy of 85.9% (sensitivity, 84.6%; specificity, 87.3%) at a much lower diagnostic burden by sequentially integrating clinical-neurocognitive, expert-based, PRS-based, and sMRI-based risk estimates as needed for the given patient. Findings were supported by good external validation results. CONCLUSIONS AND RELEVANCE These findings suggest that psychosis transition can be predicted in a broader risk spectrum by sequentially integrating algorithms' and clinicians' risk estimates. For clinical translation, the proposed workflow should undergo large-scale international validation.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | | | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck School of Cognition, Leipzig, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S. Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Education, Psychology, and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa K. Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Anita Riecher-Rössler
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Laura Egloff
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Petra Walger
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic Düsseldorf, Düsseldorf, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M. Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy I, LVR Hospital Cologne, Cologne, Germany
| | - Roman Buechler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephen J. Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Xu L, Zhang M, Wang S, Wei Y, Cui H, Qian Z, Wang Y, Tang X, Hu Y, Tang Y, Zhang T, Wang J. Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals. Front Psychiatry 2021; 12:753130. [PMID: 34867540 PMCID: PMC8637962 DOI: 10.3389/fpsyt.2021.753130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS). Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0-3, 4-6, 7-12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R. Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0-3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power. Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.
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Affiliation(s)
- LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mei Zhang
- Department of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, China
| | - ShuQin Wang
- Department of Chinese Language Teaching, Shanghong Middle School, Shanghai, China
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ZhenYing Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingChan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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45
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Worthington MA, Cannon TD. Prediction and Prevention in the Clinical High-Risk for Psychosis Paradigm: A Review of the Current Status and Recommendations for Future Directions of Inquiry. Front Psychiatry 2021; 12:770774. [PMID: 34744845 PMCID: PMC8569129 DOI: 10.3389/fpsyt.2021.770774] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Prediction and prevention of negative clinical and functional outcomes represent the two primary objectives of research conducted within the clinical high-risk for psychosis (CHR-P) paradigm. Several multivariable "risk calculator" models have been developed to predict the likelihood of developing psychosis, although these models have not been translated to clinical use. Overall, less progress has been made in developing effective interventions. In this paper, we review the existing literature on both prediction and prevention in the CHR-P paradigm and, primarily, outline ways in which expanding and combining these paths of inquiry could lead to a greater improvement in individual outcomes for those most at risk.
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Affiliation(s)
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States.,Department of Psychiatry, Yale University, New Haven, CT, United States
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46
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Mittal VA, Addington JM. Embracing heterogeneity creates new opportunities for understanding and treating those at clinical-high risk for psychosis. Schizophr Res 2021; 227:1-3. [PMID: 33288356 DOI: 10.1016/j.schres.2020.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Vijay A Mittal
- Departments of Psychology, Psychiatry, and Medical Social Sciences, Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Northwestern University, USA.
| | - Jean M Addington
- Hotchkiss Brain Institute, Department of Psychiatry University of Calgary, Canada
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47
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Ju M, Wang J, Xu L, Wei Y, Tang X, Hu Y, Hui L, Qiao Y, Wang J, Zhang T. Frequency of Self-reported Psychotic Symptoms among 2542 Outpatients at Their First Visit for Mental Health Services. Psychiatry 2021; 84:57-67. [PMID: 33406016 DOI: 10.1080/00332747.2020.1855936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Psychotic symptoms are prevalent in both clinical settings and the general population. The distribution of psychotic symptoms across patients with different types of psychotic and non-psychotic mental disorders is helpful for understanding symptom specificity. This study aimed to explore the distribution differences of psychotic symptoms in an outpatient population in terms of frequency, age, gender, and psychotic and non-psychotic disorders.Methods: Outpatients were recruited consecutively at their first visit to the Shanghai Mental Health Center. Psychotic symptoms over the preceding year were self-reported through the PRIME Screen-Revised (PS-R) questionnaire. Seven categories of psychotic symptoms were grouped: perplexity and delusional mood (Item-1,5); first rank symptoms (Item-3,6,11); overvalued beliefs (Item-2,4); suspiciousness/persecutory ideas (Item-7), grandiose ideas (Item 8), perceptual abnormalities (Item-9,10), and disorganized communication (Item-12). Comparisons were made with respect to age group, sex, and diagnostic category.Results: Of 2542 outpatients, 1448(57.0%) were screened as positive, which was defined as having two or more symptoms with at least "somewhat agree" scores, ranging from 0 to 6. The threshold of one or more "yes" items was an endorsement to categorize the participant as positive for psychotic symptoms. The frequency of psychotic symptoms declined with age. Younger patients tended to report more psychotic symptoms than older patients(p < .001). Suspiciousness(p = .038) and disorganized communication (p = .004) were more common in females than males. Age, first rank symptoms, suspiciousness/persecutory ideas, grandiose ideas, and perceptual abnormalities were found to significantly differ between psychotic and non-psychotic disorders.Conclusions: Psychotic symptoms appear to be common in the clinical population and represent nonspecific indicators of psychopathology. The difference between psychotic and non-psychotic psychopathologies is more a function of the presence, frequency, and severity of psychotic symptoms.
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Incorporating cortisol into the NAPLS2 individualized risk calculator for prediction of psychosis. Schizophr Res 2021; 227:95-100. [PMID: 33046334 PMCID: PMC8287972 DOI: 10.1016/j.schres.2020.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/10/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Risk calculators are useful tools that can help clinicians and researchers better understand an individual's risk of conversion to psychosis. The North American Prodrome Longitudinal Study (NAPLS2) Individualized Risk Calculator has good predictive accuracy but could be potentially improved by the inclusion of a biomarker. Baseline cortisol, a measure of hypothalamic-pituitary-adrenal (HPA) axis functioning that is impacted by biological vulnerability to stress and exposure to environmental stressors, has been shown to be higher among individuals at clinical high-risk for psychosis (CHRP) who eventually convert to psychosis than those who do not. We sought to determine whether the addition of baseline cortisol to the NAPLS2 risk calculator improved the performance of the risk calculator. METHODS Participants were drawn from the NAPLS2 study. A subset of NAPLS2 participants provided salivary cortisol samples. A multivariate Cox proportional hazards regression evaluated the likelihood of an individual's eventual conversion to psychosis based on demographic and clinical variables in addition to baseline cortisol levels. RESULTS A total of 417 NAPLS2 participants provided salivary cortisol and were included in the analysis. Higher levels of cortisol were predictive of conversion to psychosis in a univariate model (C-index = 0.59, HR = 21.5, p-value = 0.004). The inclusion of cortisol in the risk calculator model resulted in a statistically significant improvement in performance from the original risk calculator model (C-index = 0.78, SE = 0.028). CONCLUSIONS Salivary cortisol is an inexpensive and non-invasive biomarker that could improve individual predictions about conversion to psychosis and treatment decisions for CHR-P individuals.
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Oliver D, Wong CMJ, Bøg M, Jönsson L, Kinon BJ, Wehnert A, Jørgensen KT, Irving J, Stahl D, McGuire P, Raket LL, Fusar-Poli P. Transdiagnostic individualized clinically-based risk calculator for the automatic detection of individuals at-risk and the prediction of psychosis: external replication in 2,430,333 US patients. Transl Psychiatry 2020; 10:364. [PMID: 33122625 PMCID: PMC7596040 DOI: 10.1038/s41398-020-01032-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
The real-world impact of psychosis prevention is reliant on effective strategies for identifying individuals at risk. A transdiagnostic, individualized, clinically-based risk calculator to improve this has been developed and externally validated twice in two different UK healthcare trusts with convincing results. The prognostic performance of this risk calculator outside the UK is unknown. All individuals who accessed primary or secondary health care services belonging to the IBM® MarketScan® Commercial Database between January 2015 and December 2017, and received a first ICD-10 index diagnosis of nonorganic/nonpsychotic mental disorder, were included. According to the risk calculator, age, gender, ethnicity, age-by-gender, and ICD-10 cluster diagnosis at index date were used to predict development of any ICD-10 nonorganic psychotic disorder. Because patient-level ethnicity data were not available city-level ethnicity proportions were used as proxy. The study included 2,430,333 patients with a mean follow-up of 15.36 months and cumulative incidence of psychosis at two years of 1.43%. There were profound differences compared to the original development UK database in terms of case-mix, psychosis incidence, distribution of baseline predictors (ICD-10 cluster diagnoses), availability of patient-level ethnicity data, follow-up time and availability of specialized clinical services for at-risk individuals. Despite these important differences, the model retained accuracy significantly above chance (Harrell's C = 0.676, 95% CI: 0.672-0.679). To date, this is the largest international external replication of an individualized prognostic model in the field of psychiatry. This risk calculator is transportable on an international scale to improve the automatic detection of individuals at risk of psychosis.
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Affiliation(s)
- Dominic Oliver
- Early Psychosis: Interventions and Clinical detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | | | | | - Linus Jönsson
- H. Lundbeck A/S, Valby, Denmark
- Karolinska Institutet, Stockholm, Sweden
| | - Bruce J Kinon
- Lundbeck Pharmaceuticals LLC, Deerfield, IL, 60015, USA
| | | | | | - Jessica Irving
- Early Psychosis: Interventions and Clinical detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Philip McGuire
- OASIS Service, South London and the Maudsley NHS National Health Service Foundation Trust, London, SE5 8AZ, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Lars Lau Raket
- H. Lundbeck A/S, Valby, Denmark
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - 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, SE5 8AF, UK.
- OASIS Service, South London and the Maudsley NHS National Health Service Foundation Trust, London, SE5 8AZ, UK.
- Department of Brain and Behavioural Sciences, University of Pavia, 27100, Pavia, Italy.
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Gold JM, Corlett PR, Strauss GP, Schiffman J, Ellman LM, Walker EF, Powers AR, Woods SW, Waltz JA, Silverstein SM, Mittal VA. Enhancing Psychosis Risk Prediction Through Computational Cognitive Neuroscience. Schizophr Bull 2020; 46:1346-1352. [PMID: 32648913 PMCID: PMC7707066 DOI: 10.1093/schbul/sbaa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Research suggests that early identification and intervention with individuals at clinical high risk (CHR) for psychosis may be able to improve the course of illness. The first generation of studies suggested that the identification of CHR through the use of specialized interviews evaluating attenuated psychosis symptoms is a promising strategy for exploring mechanisms associated with illness progression, etiology, and identifying new treatment targets. The next generation of research on psychosis risk must address two major limitations: (1) interview methods have limited specificity, as recent estimates indicate that only 15%-30% of individuals identified as CHR convert to psychosis and (2) the expertise needed to make CHR diagnosis is only accessible in a handful of academic centers. Here, we introduce a new approach to CHR assessment that has the potential to increase accessibility and positive predictive value. Recent advances in clinical and computational cognitive neuroscience have generated new behavioral measures that assay the cognitive mechanisms and neural systems that underlie the positive, negative, and disorganization symptoms that are characteristic of psychotic disorders. We hypothesize that measures tied to symptom generation will lead to enhanced sensitivity and specificity relative to interview methods and the cognitive intermediate phenotype measures that have been studied to date that are typically indicators of trait vulnerability and, therefore, have a high false positive rate for conversion to psychosis. These new behavioral measures have the potential to be implemented on the internet and at minimal expense, thereby increasing accessibility of assessments.
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Affiliation(s)
- James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD,To whom correspondence should be addressed; Maryland Psychiatric Research Center, PO Box 21247, Baltimore, MD 21228; tel: +1-410-402-7871, fax: +1-410-401-7198, e-mail:
| | - Philip R Corlett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | | | | | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | | | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - James A Waltz
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester Medical Center, Rochester, NY
| | - Vijay A Mittal
- Departments of Psychology, Psychiatry, Medical Social Sciences, Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Evanston and Chicago, IL
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