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Melillo A, Caporusso E, Giordano GM, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Mucci A, Galderisi S. Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review. J Clin Med 2023; 12:7095. [PMID: 38002707 PMCID: PMC10672428 DOI: 10.3390/jcm12227095] [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: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The present review aims to identify correlations between negative symptoms (NS) and deficits in neurocognition and social cognition in subjects with first-episode psychosis (FEP) and at-high-risk populations (HR). A systematic search of the literature published between 1 January 2005 and 31 December 2022 was conducted on PubMed, Scopus, and PsycInfo. Out of the 4599 records identified, a total of 32 studies met our inclusion/exclusion criteria. Data on a total of 3086 FEP and 1732 HR were collected. The available evidence shows that NS correlate with executive functioning and theory of mind deficits in FEP subjects, and with deficits in the processing speed, attention and vigilance, and working memory in HR subjects. Visual learning and memory do not correlate with NS in either FEP or HR subjects. More inconsistent findings were retrieved in relation to other cognitive domains in both samples. The available evidence is limited by sample and methodological heterogeneity across studies and was rated as poor or average quality for the majority of included studies in both FEP and CHR populations. Further research based on shared definitions of first-episode psychosis and at-risk states, as well as on more recent conceptualizations of negative symptoms and cognitive impairment, is highly needed.
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Affiliation(s)
| | | | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, 80138 Naples, Italy
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Millman ZB, Schiffman J, Gold JM, Akouri-Shan L, Demro C, Fitzgerald J, Rakhshan Rouhakhtar PJ, Klaunig M, Rowland LM, Waltz JA. Linking Salience Signaling With Early Adversity and Affective Distress in Individuals at Clinical High Risk for Psychosis: Results From an Event-Related fMRI Study. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac039. [PMID: 35799887 PMCID: PMC9250803 DOI: 10.1093/schizbullopen/sgac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Evidence suggests dysregulation of the salience network in individuals with psychosis, but few studies have examined the intersection of stress exposure and affective distress with prediction error (PE) signals among youth at clinical high-risk (CHR). Here, 26 individuals at CHR and 19 healthy volunteers (HVs) completed a monetary incentive delay task in conjunction with fMRI. We compared these groups on the amplitudes of neural responses to surprising outcomes—PEs without respect to their valence—across the whole brain and in two regions of interest, the anterior insula and amygdala. We then examined relations of these signals to the severity of depression, anxiety, and trauma histories in the CHR group. Relative to HV, youth at CHR presented with aberrant PE-evoked activation of the temporoparietal junction and weaker deactivation of the precentral gyrus, posterior insula, and associative striatum. No between-group differences were observed in the amygdala or anterior insula. Among youth at CHR, greater trauma histories were correlated with stronger PE-evoked amygdala activation. No associations were found between affective symptoms and the neural responses to PE. Our results suggest that unvalenced PE signals may provide unique information about the neurobiology of CHR syndromes and that early adversity exposure may contribute to neurobiological heterogeneity in this group. Longitudinal studies of young people with a range of risk syndromes are needed to further disentangle the contributions of distinct aspects of salience signaling to the development of psychopathology.
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Affiliation(s)
- Zachary B Millman
- Psychotic Disorders Division, McLean Hospital , 115 Mill Street, Belmont, MA 02478 , USA
- Department of Psychiatry, Harvard Medical School , 25 Shattuck Street, Boston, MA 02114 , USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine , 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085 , USA
- Department of Psychology, University of Maryland , Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250 , USA
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine , 55 Wade Avenue, Catonsville, MD 21228 , USA
| | - LeeAnn Akouri-Shan
- Department of Psychology, University of Maryland , Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250 , USA
| | - Caroline Demro
- Department of Psychology, University of Minnesota, 75 East River Parkway , Minneapolis, MN 55455 , USA
| | - John Fitzgerald
- Department of Psychology, University of Maryland , Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250 , USA
| | - Pamela J Rakhshan Rouhakhtar
- Department of Psychology, University of Maryland , Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250 , USA
| | - Mallory Klaunig
- Department of Psychology, University of Maryland , Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250 , USA
| | - Laura M Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine , 55 Wade Avenue, Catonsville, MD 21228 , USA
| | - James A Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine , 55 Wade Avenue, Catonsville, MD 21228 , USA
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3
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Woodberry KA, Powers KS, Bryant C, Downing D, Verdi MB, Elacqua KM, Reuman ARL, Kennedy L, Shapiro DI, West ML, Huang D, Crump FM, Grivel MM, Blasco DA, Herrera SN, Corcoran CM, Seidman LJ, Link BG, McFarlane WR, Yang LH. Emotional and stigma-related experiences relative to being told one is at risk for psychosis. Schizophr Res 2021; 238:44-51. [PMID: 34598105 PMCID: PMC8633064 DOI: 10.1016/j.schres.2021.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/03/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information. METHODS Participants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information. RESULTS Participants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them. CONCLUSION This is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.
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Affiliation(s)
- Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center,Department of Psychiatry, Tufts School of Medicine,Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School
| | | | - Caitlin Bryant
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychology, University of Massachusetts Boston
| | - Donna Downing
- Center for Psychiatric Research, Maine Medical Center
| | - Mary B. Verdi
- Center for Psychiatric Research, Maine Medical Center
| | | | | | - Leda Kennedy
- Department of Psychiatry, Beth Israel Deaconess Medical Center,New York Psychiatric Institute, Columbia University
| | - Daniel I. Shapiro
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School,Department of Psychiatry and Behavioral Sciences, University of California Davis
| | - Michelle L. West
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School,Anschutz Medical Campus, University of Colorado,Department of Psychiatry, University of Colorado School of Medicine
| | - Debbie Huang
- Mailman School of Public Health, Columbia University
| | | | | | - Drew A. Blasco
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | | | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai,James J Peter Veterans Affairs Medical Center
| | - Larry J. Seidman
- Department of Psychiatry, Beth Israel Deaconess Medical Center,Department of Psychiatry, Harvard Medical School
| | - Bruce G. Link
- Department of Sociology, University of California, Riverside
| | - William R. McFarlane
- Center for Psychiatric Research, Maine Medical Center,Department of Psychiatry, Tufts School of Medicine
| | - Lawrence H. Yang
- Mailman School of Public Health, Columbia University,School of Global Public Health, New York University
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Ai AL, Appel HB, Lee J, Fincham F. Family Factors Related to Three Major Mental Health Issues Among Asian-Americans Nationwide. J Behav Health Serv Res 2021; 49:4-21. [PMID: 34097207 DOI: 10.1007/s11414-021-09760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
Asian-Americans (AAs) constitute the fastest growing minority group in the USA. AAs share a common emphasis on collective cultural strengths, especially family values. Using the National Latino and Asian American Study (NLAAS) data, this study investigated the roles of family cohesiveness, along with other cultural strength factors and negative family interactions in three psychiatric disorders. Supporting the study's hypotheses, multivariate analyses showed that family cohesiveness was associated with a lower incidence of general anxiety disorder (GAD), while regular religious attendance was linked with a lower likelihood of having substance use disorder (SUD). Conversely, negative family interactions increased the likelihood of experiencing major depression disorder (MDD) and SUD. Whereas perceived discrimination was related to higher odds of all diagnoses, family cohesiveness moderated the relationship between discrimination and GAD. These findings suggest that family relationships play a critical role in AAs' mental health and should be further explored through a prospective design.
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Affiliation(s)
- Amy L Ai
- Colleges of Social Work, Medicine, and Nursing, Florida State University, 2570 University Building C, Tallahassee, FL, 32306, USA.
| | - Hoa B Appel
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, 98011, USA
| | - Jungup Lee
- Department of Sociall Work, National University of Singapore, Singapore, 117570, Singapore
| | - Frank Fincham
- Colleges of Family Sciences, Florida State University, Tallahassee, FL, 32306, USA
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Chang WC, Ng CM, Chan KN, Lee HC, Chan SI, Chiu SS, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Chan CWH, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Psychiatric comorbidity in individuals at-risk for psychosis: Relationships with symptoms, cognition and psychosocial functioning. Early Interv Psychiatry 2021; 15:616-623. [PMID: 32441490 DOI: 10.1111/eip.12992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/01/2020] [Accepted: 04/28/2020] [Indexed: 02/04/2023]
Abstract
AIM Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals. METHODS One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS). Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition non-psychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted. RESULTS Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. CONCLUSION Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings underscore a potential critical role of psychiatric comorbidity in determining social functioning and subjective QoL in at-risk individuals. Further longitudinal research is required to clarify trajectories of comorbid disorder status and its prospective impact on clinical and functional outcomes in ARMS populations.
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Affiliation(s)
- Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Chung Mun Ng
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwun Nam Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hoi Ching Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Suet In Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Shirley Sanyin Chiu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | | | - Kwok Ling Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Wai Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Lam Wai Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Shiu Yin Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Man Wa Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Tak Lam Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Man Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Lap Tak Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Wai Chung Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Yip Chau Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Wai Sau Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Yi Man Mo
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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6
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Heun-Johnson H, Menchine M, Axeen S, Lung K, Claudius I, Wright T, Seabury SA. Association Between Race/Ethnicity and Disparities in Health Care Use Before First-Episode Psychosis Among Privately Insured Young Patients. JAMA Psychiatry 2021; 78:311-319. [PMID: 33355626 PMCID: PMC7758828 DOI: 10.1001/jamapsychiatry.2020.3995] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Racial/ethnic disparities in health care use and clinical outcomes for behavioral health disorders, including psychosis, are well documented, but less is known about these disparities during the period leading up to first-episode psychosis (FEP). OBJECTIVE To describe the racial/ethnic disparities in behavioral health care use and prescription drug use of children and young adults before the diagnosis of FEP. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted using medical and prescription drug claims from January 1, 2007, to September 30, 2015, obtained from Optum's deidentified Clinformatics Data Mart Database, a commercial claims database augmented with race/ethnicity and socioeconomic variables. Data analysis was performed from February 6, 2018, to October 10, 2020. First-episode psychosis was determined by the presence of psychosis diagnoses on claims for at least 1 hospitalization or 2 outpatient events, with a continuous enrollment requirement of at least 2 years before the first diagnosis. Participants included 3017 Black, Hispanic, or White patients who were continually enrolled in commercial insurance plans and received an FEP diagnosis between the ages of 10 and 21 years. MAIN OUTCOMES AND MEASURES Race/ethnicity was determined from a commercial claims database. Rates of inpatient admission, emergency department presentation, and outpatient visits (including psychotherapy), behavioral health disorder diagnoses, and antipsychotic/antidepressant prescription fills were determined for the year before FEP. Race/ethnicity was also obtained from Optum's claims database. With use of multivariable logistic regression, results were adjusted for covariates including estimated household income, age, sex, and geographic division in the US. RESULTS Of the 3017 patients with FEP, 643 Black or Hispanic patients (343 [53.3%] Black, 300 [46.7%] Hispanic, 324 [50.4%] male, mean [SD] age, 17.2 [2.76] years) were less likely than 2374 White patients (1210 [51.0%] male, mean age, 17.0 [2.72] years) to receive comorbid behavioral health disorder diagnoses in the year before the diagnosis of FEP (410 [63.8%] vs 1806 [76.1%], χ2 = 39.3; P < .001). Except for emergency care, behavioral health care use rates were lower in Black and Hispanic patients vs White patients (424 [65.9%] vs 1868 [78.7%]; χ2 = 45.0; P < .001), particularly for outpatient visits with behavioral health care professionals (232 [36.1%] vs 1236 [52.1%]; χ2 = 51.7; P < .001). After adjustment for socioeconomic covariates, behavioral health care use rates (68.9% vs 79.2%; P < .001), outpatient visits with behavioral health professionals (37.7% vs 51.2%; P < .001), and other outcomes remained significantly lower for Black and Hispanic patients vs White patients. CONCLUSIONS AND RELEVANCE The results of this study extend existing research findings of well-known racial/ethnic disparities in the population of patients who are diagnosed with FEP. These differences were apparent in young patients with continuous commercial health insurance and after controlling for household income. Providing equal access to preventive outpatient behavioral health care may increase opportunities for timely detection of psychotic symptoms and early intervention and improve differential outcomes after FEP.
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Affiliation(s)
- Hanke Heun-Johnson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Michael Menchine
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sarah Axeen
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Khristina Lung
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Ilene Claudius
- Department of Emergency Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Tyler Wright
- LAC+USC Medical Center, Los Angeles, California,University of Southern California, Los Angeles
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
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7
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Yang LH, Woodberry KA, Link BG, Corcoran CM, Bryant C, Shapiro DI, Downing D, Girgis RR, Brucato G, Huang D, Crump FM, Verdi M, McFarlane WR, Seidman LJ. Impact of "psychosis risk" identification: Examining predictors of how youth view themselves. Schizophr Res 2019; 208:300-307. [PMID: 30792136 PMCID: PMC7079577 DOI: 10.1016/j.schres.2019.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/07/2019] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Identifying young people as at clinical high-risk (CHR) for psychosis affords opportunities for intervention to possibly prevent psychosis onset. Yet such CHR identification could plausibly increase stigma. We do not know whether these youth already perceive themselves to be at psychosis-risk (PR) or how their being told they are at PR might impact how they think about themselves. METHODS 148 CHR youth were asked about labels they had been given by others (labeling by others) or with which they personally identified (self-labeling). They were then asked which had the greatest impact on how they thought about themselves. We evaluated whether being told vs. thinking they were at PR had stronger effects. FINDINGS The majority identified nonpsychotic disorders rather than PR labels as having the greatest impact on sense of self (67.6% vs. 27.7%). However, participants who identified themselves as at PR had an 8.8 (95% CI = 2.0-39.1) increase in the odds of the PR label having the greatest impact (p < 0.01). Additionally, having been told by others that they were at PR was associated with a 4.0 increase in odds (95% CI = 1.1-15.0) that the PR label had the most impact (p < 0.05). INTERPRETATION Nonpsychotic disorder labels appear to have a greater impact on CHR youth than psychosis-risk labels. However, thinking they are at PR, and, secondarily, being told they are at PR, appears to increase the relative impact of the PR label. Understanding self- and other-labeling may be important to how young people think of themselves, and may inform early intervention strategies.
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Affiliation(s)
- Lawrence H. Yang
- New York University College of Global Public Health, 715 Broadway, New York, NY 10003.,Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032
| | - Kristen A. Woodberry
- Maine Medical Center Research Institute, Portland Maine 04102,Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bruce G. Link
- University of California at Riverside, 900 University Ave, Riverside, CA 92521
| | - Cheryl M. Corcoran
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 1 Gustave L. Levy Pl., New York, NY 10029,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peter Veterans Affairs Medical Center, 130 West Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Caitlin Bryant
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,University of Massachusetts, Boston, 100 Morrissey Boulevard, Boston, MA 02125
| | - Daniel I. Shapiro
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Donna Downing
- Maine Medical Center Research Institute, Portland Maine 04102
| | - Ragy R. Girgis
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Dr. New York, NY 10032,The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Gary Brucato
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Dr. New York, NY 10032,The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Debbie Huang
- Mailman School of Public Health, Columbia University. 722 W 168th St, New York, NY 10032
| | - Francesca M. Crump
- The Center of Prevention and Evaluation (COPE), New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032
| | - Mary Verdi
- Maine Medical Center Research Institute, Portland Maine 04102
| | - William R. McFarlane
- Maine Medical Center Research Institute, Portland Maine 04102,Department of Psychiatry, School of Medicine, Tufts University, 0 Park Plaza #1101, Boston, MA 02116
| | - Larry J. Seidman
- Commonwealth Research Center (CRC), Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Beth Israel Deaconess Medical Center (BIDMC), Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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8
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Farris MS, MacQueen G, Goldstein BI, Wang J, Kennedy SH, Bray S, Lebel C, Addington J. Treatment History of Youth At-Risk for Serious Mental Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:145-154. [PMID: 30071747 PMCID: PMC6405799 DOI: 10.1177/0706743718792195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to describe treatment history including medications, psychosocial therapy and hospital visits of participants in the Canadian Psychiatric Risk and Outcomes Study (PROCAN). METHODS PROCAN is a 2-site study of 243 youth/young adults aged 12 to 25 y, categorized into 4 groups: healthy controls ( n = 42), stage 0 (non-help seeking, asymptomatic with risk mainly family history of serious mental illness (SMI); n = 41), stage 1a (distress disorders; n = 52) and stage 1b (attenuated syndromes; n = 108). Participants were interviewed regarding lifetime and current treatments, including medications, psychosocial therapies and hospital visits. RESULTS The number receiving baseline medications differed significantly across groups ( P < 0.001): 0% healthy controls, 14.6% stage 0, 32.7% stage 1a and 34.3% stage 1b. Further, 26.9% and 49.1% of stage 1a and stage 1b participants received psychosocial therapy at baseline, indicative of statistically significant differences among the groups ( P < 0.001). Similar results were observed for lifetime treatment history; stage 1b participants had the highest frequency of lifetime treatment. Medications started in adulthood (>18 y of age) were the most common for initiation of treatment compared to childhood (0 to 12 y) and adolescence (13 to 17 y) for stage 1a and 1b participants. Lifetime mental health hospital visits differed significantly across groups ( P < 0.001) and were most common in stage 1b participants (29.6%) followed by stage 1a (13.5%), stage 0 (4.9%) and healthy controls (2.4%). CONCLUSION We found that treatment history for participants in the PROCAN study differed among the at-risk groups. Future initiatives focused on determining the effects of treatment history on SMI are warranted.
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Affiliation(s)
- Megan S Farris
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Glenda MacQueen
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin I Goldstein
- 2 Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Departments of Psychiatry and Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - JianLi Wang
- 4 Work & Mental health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,5 Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sidney H Kennedy
- 6 Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,7 Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada.,8 Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,9 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,10 Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Signe Bray
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,11 Department of Radiology, University of Calgary, Calgary, Alberta Canada.,12 Alberta Children's Hospital Research Institute, Calgary, Alberta Canada.,13 Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Catherine Lebel
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,11 Department of Radiology, University of Calgary, Calgary, Alberta Canada.,12 Alberta Children's Hospital Research Institute, Calgary, Alberta Canada.,13 Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Jean Addington
- 1 Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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9
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Kennedy L, Johnson KA, Cheng J, Woodberry KA. A Public Health Perspective on Screening for Psychosis Within General Practice Clinics. Front Psychiatry 2019; 10:1025. [PMID: 32082199 PMCID: PMC7006053 DOI: 10.3389/fpsyt.2019.01025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/24/2019] [Indexed: 12/24/2022] Open
Abstract
Screening for major mental illness in adolescents and young adults has lagged behind screening for physical illness for a myriad of reasons. Existing pediatric behavioral health screening tools screen primarily for disorders of attention, disruptive behaviors, depression, and anxiety. A few also screen for substance use and suicide risk. Although it is now possible to reliably identify young people at imminent risk for a psychotic disorder, arguably the most severe of mental illnesses, general practitioners (GP) rarely screen for psychotic symptoms or recognize when to refer patients for a specialized risk assessment. Research suggests that barriers such as inadequate knowledge or insufficient access to mental health resources can be overcome with intensive GP education and the integration of physical and mental health services. Under the lens of two public health models outlining the conditions under which disease screening is warranted, we examine additional evidence for and against population-based screening for psychosis in adolescents and young adults. We argue that systematic screening within general health settings awaits a developmentally well-normed screening tool that includes probes for psychosis, is written at a sufficiently low reading level, and has acceptable sensitivity and, in particular, specificity for detecting psychosis and psychosis risk in both adolescents and young adults. As integrated healthcare models expand around the globe and psychosis-risk assessments and treatments improve, a stratified screening and careful risk management protocol for GP settings could facilitate timely early intervention that effectively balances the benefit/risk ratio of employing such a screening tool at the population level.
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Affiliation(s)
- Leda Kennedy
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Columbia Irving Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Kelsey A Johnson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joyce Cheng
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Wellesley College, Wellesley, MA, United States
| | - Kristen A Woodberry
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Center for Psychiatric Research, Maine Medical Center, Portland, ME, United States
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10
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Hampton JN, Trotman HD, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Mathalon DH, McGlashan TH, Tsuang MT, Perkins DO, Seidman LJ, Woods SW, Walker EF. The relation of atypical antipsychotic use and stress with weight in individuals at clinical high risk for psychosis. Stress Health 2018; 34:591-600. [PMID: 29956456 PMCID: PMC6289596 DOI: 10.1002/smi.2819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/10/2018] [Accepted: 04/21/2018] [Indexed: 12/18/2022]
Abstract
Atypical antipsychotics (AT) and stress are related to weight gain in individuals with severe mental illness. This cross-sectional study examines AT use, stressful life events, and baseline weight in a sample of youth at clinical high risk for psychosis. Results showed that dependent and desirable life events moderated the relationship between AT use and weight after controlling for demographic factors and selective serotonin reuptake inhibitor antidepressant (AD) use. The relation of AD and weight was explored as a secondary analysis and showed no relation between AD use and weight. Further, stress did not moderate the relationship between AD medication and weight after controlling for antipsychotic use. Results suggest that stress exposure may exacerbate the relationship between ATs and increased weight in clinical high-risk populations. Findings have implications for the development of interventions to address psychosocial factors that worsen or buffer the adverse effects of antipsychotic medication on weight.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Larry J. Seidman
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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11
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Depression and clinical high-risk states: Baseline presentation of depressed vs. non-depressed participants in the NAPLS-2 cohort. Schizophr Res 2018; 192:357-363. [PMID: 28578922 PMCID: PMC6342468 DOI: 10.1016/j.schres.2017.05.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/20/2022]
Abstract
Depressed mood appears to be highly prevalent in clinical high risk (CHR) samples. However, many prior CHR studies utilize modest size samples and do not report on the specific impact of depression on CHR symptoms. The aim of the current paper is to investigate the prevalence of depressive disorders and the impact of lifetime depression on baseline clinical presentation and longitudinal outcomes in a large cohort of individuals meeting CHR criteria in the second phase of the North American Prodrome Longitudinal Study (NAPLS-2). Depression was assessed both categorically (via DSM-IV-TR diagnoses) and symptomatically (using a clinician-rated scale of depressive symptoms) within a sample of 764 individuals at CHR and 279 controls. Current and lifetime depressive disorders were highly prevalent (60%) in this sample. Depression diagnoses were associated with more pronounced negative and general symptoms; individuals with remitted depression had significantly less severe negative, disorganized, and general symptoms and better social and role functioning relative to those with current depression. Current mood disturbance, as measured by scores on a clinician-rated symptom scale, contributed beyond the impact of positive and negative symptoms to impairments in social functioning. Both symptomatic and diagnostic baseline depression was significantly associated with decreased likelihood of remission from CHR status; however depression did not differentially distinguish persistent CHR status from transition to psychosis at follow-up. These findings suggest that depressed mood may function as a marker of poor prognosis in CHR, yet effective treatment of depression within this population can yield improvements in symptoms and functioning.
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12
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Development of a Boston Treatment Program for Youth at Clinical High Risk for Psychosis: Center for Early Detection, Assessment, and Response to Risk (CEDAR). Harv Rev Psychiatry 2018; 26:274-286. [PMID: 30188339 PMCID: PMC6130908 DOI: 10.1097/hrp.0000000000000181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past two decades, increasing attention has been given to the importance of early intervention for psychosis. This article describes the development of the Center for Early Detection, Assessment and Response to Risk (CEDAR), which focuses on early identification and treatment of youth at clinical high risk for psychosis. There are relatively few models in the United States for such programs, and we present our developmental story, focusing mainly on the CEDAR Clinic, as a case study of how such a program can develop. We describe the rationale, infrastructure, and services provided at the CEDAR Clinic, and present some descriptive data from the CEDAR Clinic through 2016. A case example is provided to illustrate treatment at CEDAR. We hope that the cultural history of our program's development is informative for clinicians and policy makers as one model of how to build an early intervention service. We believe that this article is timely in view of the growing momentum in the United States for developing programs for intervening as early as possible for youth at clinical high risk for psychosis.
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13
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Agnew-Blais J, Seidman LJ, Fitzmaurice GM, Smoller JW, Goldstein JM, Buka SL. The interplay of childhood behavior problems and IQ in the development of later schizophrenia and affective psychoses. Schizophr Res 2017; 184:45-51. [PMID: 28062262 PMCID: PMC6140330 DOI: 10.1016/j.schres.2016.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
Schizophrenia and affective psychoses are both associated with impaired social functioning, but the extent to which childhood behavioral impairments are present prior to onset of illness is less well studied. Moreover, the concurrent relationship of childhood behavior problems and premorbid IQ with subsequent psychotic disorder has not been established. We investigated whether childhood behavior problems are associated with increased risk for adult schizophrenia or affective psychosis, independently and in combination with IQ. The study included individuals with schizophrenia (N=47), affective psychoses (N=45) and non-psychotic controls (N=1496) from the New England Family Study. Behavior problems were prospectively assessed from standardized clinician observations at ages 4 and 7. IQ was assessed with the Stanford-Binet at age 4 and the Wechsler Intelligence Scale for Children at age 7. We found externalizing problems at age 4 and externalizing and internalizing problems at age 7 were associated with later schizophrenia, and both internalizing and externalizing problems at ages 4 and 7 were associated with later development of affective psychoses. Lower IQ at ages 4 and 7 was associated with schizophrenia, while lower IQ was associated with affective psychoses at age 7 only. Examined simultaneously, both lower IQ and behavior problems remained associated with risk of schizophrenia, while only behavior problems remained associated with affective psychoses. Behavior problems appear to be a general marker of risk of adult psychotic disorder, while lower childhood IQ is more specific to risk of schizophrenia. Future research should clarify the premorbid evolution of behavior and cognitive problems into adult psychosis.
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Affiliation(s)
- Jessica Agnew-Blais
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
| | - Larry J. Seidman
- Harvard Medical School, Department of Psychiatry, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA,Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Garrett M. Fitzmaurice
- Harvard Medical School, Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA 02478,Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115
| | - Jordan W. Smoller
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA 02114
| | - Jill M. Goldstein
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Department of Psychiatry, Division of Women’s Health, Connors Center for Women’s Health & Gender Biology, Boston, MA 02120
| | - Stephen L. Buka
- Brown University, Department of Epidemiology, Providence, RI 02912
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14
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Abstract
The transdiagnostic expression of psychotic experiences in common mental disorder (anxiety/depression/substance use disorder) is associated with a poorer prognosis, and a small minority of people may indeed develop a clinical picture that meets criteria for schizophrenia. However, it appears neither useful nor valid to observe early states of multidimensional psychopathology in young people through the "schizo"-prism, and apply misleadingly simple, unnecessary and inefficient binary concepts of "risk" and "transition". A review of the "ultra-high risk" (UHR) or "clinical high risk" (CHR) literature indicates that UHR/CHR samples are highly heterogeneous and represent individuals diagnosed with common mental disorder (anxiety/depression/substance use disorder) and a degree of psychotic experiences. Epidemiological research has shown that psychotic experiences are a (possibly non-causal) marker of the severity of multidimensional psychopathology, driving poor outcome, yet notions of "risk" and "transition" in UHR/CHR research are restrictively defined on the basis of positive psychotic phenomena alone, ignoring how baseline differences in multidimensional psychopathology may differentially impact course and outcome. The concepts of "risk" and "transition" in UHR/CHR research are measured on the same dimensional scale, yet are used to produce artificial diagnostic shifts. In fact, "transition" in UHR/CHR research occurs mainly as a function of variable sample enrichment strategies rather than the UHR/CHR "criteria" themselves. Furthermore, transition rates in UHR/CHR research are inflated as they do not exclude false positives associated with the natural fluctuation of dimensional expression of psychosis. Biological associations with "transition" thus likely represent false positive findings, as was the initial claim of strong effects of omega-3 polyunsatured fatty acids in UHR samples. A large body of UHR/CHR intervention research has focused on the questionable outcome of "transition", which shows lack of correlation with functional outcome. It may be more productive to consider the full range of person-specific psychopathology in all young individuals who seek help for mental health problems, instead of "policing" youngsters for the transdiagnostic dimension of psychosis. Instead of the relatively inefficient medical high-risk approach, a public health perspective, focusing on improved access to a low-stigma, high-hope, small scale and youth-specific environment with acceptable language and interventions may represent a more useful and efficient strategy.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and PsychologyMaastricht University Medical CentreMaastrichtthe Netherlands,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of PsychiatryLondonUK
| | - Sinan Guloksuz
- Department of Psychiatry and PsychologyMaastricht University Medical CentreMaastrichtthe Netherlands,Department of Psychiatry, Yale University School of MedicineNew HavenCTUSA
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Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, McGuire P. Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis. JAMA Psychiatry 2017; 74:493-500. [PMID: 28355424 PMCID: PMC5470394 DOI: 10.1001/jamapsychiatry.2017.0284] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Importance The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
| | - Grazia Rutigliano
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniel Stahl
- National Institute for Health Research Biomedical Research Centre for Mental Health, IoPPN, King’s College London, London, England
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Ilaria Bonoldi
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- Outreach and Support in South London Service, South London and the Maudsley National Health Service Foundation Trust, London, England
| | - Thomas Reilly
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, England
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