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Pedruzo B, Aymerich C, Pacho M, Herrero J, Laborda M, Bordenave M, Giuliano AJ, McCutcheon RA, Gutiérrez-Rojas L, McGuire P, Stone WS, Fusar-Poli P, González-Torres MÁ, Catalan A. Longitudinal change in neurocognitive functioning in children and adolescents at clinical high risk for psychosis: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02221-9. [PMID: 37199754 DOI: 10.1007/s00787-023-02221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/29/2023] [Indexed: 05/19/2023]
Abstract
Clinical high risk of psychosis (CHR-P) population has become an attractive area of interest in preventing transitions to psychosis. The consequences of developing a psychotic disorder may be worse in cases of early onset. Thus, childhood and adolescence represent a critical developmental window, where opportunities to gain social and adaptive abilities depend on the individuals' neurocognitive performance. There have been previous syntheses of the evidence regarding neurocognitive functioning in CHR-P individuals and its longitudinal changes. However, there has been less focus on children and adolescents at CHR-P. A multistep literature search was performed from database inception until July 15th, 2022. PRIMSA/MOOSE compliant systematic review and PROSPERO protocol were used to identify studies reporting on longitudinal changes in neurocognitive functioning in children and adolescents (mean age of sample ≤ 18 years) at CHR-P and matched healthy control (HC) group. A systematic review of identified studies was then undertaken. Three articles were included, resulting in a total sample size of 151 CHR-P patients [mean (SD) age, 16.48 (2.41) years; 32.45% female] and 64 HC individuals [mean (SD) age, 16.79 (2.38) years; 42.18% female]. CHR-P individuals had worse outcomes in verbal learning, sustained attention and executive functioning domains compared to HC. Individuals taking antidepressants had better outcomes in verbal learning in contrast with those taking antipsychotics. In children and adolescents, neurocognition may be already impaired before the psychosis onset, and remains stable during the transition to psychosis. Further study should be performed to obtain more robust evidence.
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Affiliation(s)
- Borja Pedruzo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
| | - Claudia Aymerich
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Malein Pacho
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Jon Herrero
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - María Laborda
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Marta Bordenave
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Anthony J Giuliano
- Worcester Recovery Center and Hospital, Massachusetts Department of Mental Health, Boston, USA
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre, London, UK
- Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, UK
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paolo Fusar-Poli
- National Institute for Health Research Biomedical Research Centre, London, UK
- Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Miguel Ángel González-Torres
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Ana Catalan
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERSAM. Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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Rodríguez-Pascual M, Álvarez-Subiela X, Tor J, Pardo M, de la Serna E, Sugranyes G, Puig O, Baeza I, Dolz M. Major depressive disorder and attenuated negative symptoms in a child and adolescent sample with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry 2022; 31:1431-1440. [PMID: 33893893 DOI: 10.1007/s00787-021-01793-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/19/2021] [Indexed: 01/21/2023]
Abstract
Some 70-80% of subjects with psychotic risk syndrome (PRS) have lifetime comorbidity, with depressive disorders being the most common. A high proportion of patients with PRS present nonspecific symptoms which can be confounding factors for diagnosis. Depressive and negative symptoms may be difficult to distinguish and it is important to differentiate them. The aim of this study is to assess the presence of depressive disorder in a child and adolescent sample of PRS and to examine the presence of negative symptoms and detect possible confounding characteristics between them and depressive symptoms. This is a naturalistic multi-site study with subjects who met PRS criteria. A sample of 89 PRS adolescent patients was included. Major depressive disorder (MDD) is the most prevalent comorbid disorder (34.83%). The sample was divided into patients who met criteria for MDD (PRS-MDD, n = 31) and those who did not have this disorder (PRS-ND, n = 44). We obtained significant differences in the attenuated negative symptoms (ANS) between PRS-MDD and PRS-ND (68.18 vs. 90.32%, respectively, p = 0.021). Subjects with MDD presented a higher score in ANS and Hamilton Depression Rating Scale (HDRS). Moreover, we obtained a correlation between negative symptomatology and HDRS score with a higher score on HDRS in subjects with higher negative symptom scores (r = 0.533, p < 0.001). More research is needed to fine tune differentiation between depressive and negative symptoms and learn more about the possible impact of MDD on PRS children and adolescents.
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Affiliation(s)
- Marta Rodríguez-Pascual
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain.
| | - Xavier Álvarez-Subiela
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Jordina Tor
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Marta Pardo
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Gisela Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari of Barcelona (2017SGR881), Villarroel 170, 08036, Barcelona, Spain
- Institut Clinic of Neurosciences, CERCA-IDIBAPS, Institut d'Investigacions Biomèdiques August Pi Sunyer), Rosselló, 149, Barcelona, Spain
- Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - Montserrat Dolz
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, Esplugues de Llobregat, 08950, Barcelona, Spain
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, Esplugues de Llobregat, 08950, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
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Premorbid characteristics of patients with DSM-IV psychotic disorders. Compr Psychiatry 2022; 115:152310. [PMID: 35385814 DOI: 10.1016/j.comppsych.2022.152310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic bipolar spectrum disorders (PBD). The atypical clinical presentations of PNOS conditions may lead to uncertainty regarding treatment choices and expected outcomes. PNOS is understudied, and little is known about patients' premorbid characteristics including premorbid adjustment, prevalence of early cannabis use and childhood trauma. Knowledge about early illness phases can increase our understanding of this diagnostic group. METHODS We included 1099 participants from the Norwegian TOP-study; 688 with narrow SSD diagnoses (schizophrenia, schizoaffective disorder, schizophreniform disorder), 274 with PBD (psychotic bipolar 1 and bipolar NOS) and 137 with PNOS diagnosed with the SCID-I for DSM-IV. Participants were assessed with the Premorbid Adjustment Scale (PAS) divided into the areas of premorbid academic and social functioning. We obtained information on age at first exposure to cannabis and use of cannabis before the age of 16. The participants also provided information regarding early traumatic experiences using the Childhood Trauma Questionnaire (CTQ). RESULTS Participants with PNOS and SSD had poorer premorbid academic functioning than those with PBD (F2, 1029 = 7.81, p < 0.001, pη2 = 0.015). Premorbid social adjustment was significantly worse in the SSD group compared to the PBD group (F2, 1024 = 3.10, p = 0.045, pη2 = 0.006), with PNOS in the middle position. Significantly more of the participants with PNOS (17.5%) and SSD (11.5%) used cannabis before the age of 16 compared with PBD (5.3%, Wald χ2 = 6.86, p = 0.03). There were no significant differences between the three groups regarding mean CTQ scores or in the proportion of participants who had experienced at least one type of childhood adversity. CONCLUSIONS Participants with PNOS appear as more similar to participants with SSD than to those with PBD regarding early premorbid adjustment and early cannabis use. The results indicate that many conditions classified as PNOS have functional impairments and problematic substance use from an early age. The prevalence of childhood adversities are high in all three groups.
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López-Díaz Á, Ayesa-Arriola R, Ortíz-García de la Foz V, Suárez-Pinilla P, Ramírez-Bonilla ML, Vázquez-Bourgon J, Ruiz-Veguilla M, Crespo-Facorro B. Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study. Acta Psychiatr Scand 2021; 144:578-588. [PMID: 34431080 DOI: 10.1111/acps.13364] [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: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Brief psychotic disorder (BPD) is a relatively uncommon and underexplored psychotic condition. Even though BPD has been related to a more favorable outcome than other schizophrenia spectrum disorders (SSD), current knowledge of its predictive factors remains scant. This study aimed to examine its prevalence and find early predictors of BPD diagnostic stability. METHODS SSD diagnosis following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria was explored in a large epidemiological cohort (n = 569) of non-affective first-episode psychosis (FEP) patients enrolled in a three-year longitudinal intervention program (PAFIP). Premorbid, sociodemographic, and clinical information was collected to characterize BPD patients and determine factors predictive of diagnostic stability. Multivariate analysis included predictors selected from clinical knowledge and also those that had achieved marginal significance (p ≤ 0.1) in univariate analysis. RESULTS A total of 59 patients enrolled in the PAFIP program (10.4% of the whole cohort) met DSM-IV criteria for BPD, of whom 40 completed the three-year follow-up. The temporal stability of BPD in our sample was as high as 40% (n = 16). Transition from BPD to schizophrenia occurred in 37% (n = 15) of patients. Fewer hallucinations at baseline and better insight independently significantly predicted BPD diagnostic stability over time. CONCLUSION Our findings confirm that BPD is a clinical condition with moderate-to-low temporal stability and demonstrate that approximately two-thirds of FEP individuals experiencing BPD will develop a long-lasting psychotic disorder during follow-up, mainly schizophrenia.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Ortíz-García de la Foz
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Paula Suárez-Pinilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Luz Ramírez-Bonilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Vázquez-Bourgon
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ruiz-Veguilla
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
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Ang MS, Rekhi G, Lee J. Associations of living arrangements with symptoms and functioning in schizophrenia. BMC Psychiatry 2021; 21:497. [PMID: 34635064 PMCID: PMC8507381 DOI: 10.1186/s12888-021-03488-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Living arrangements and accommodation are closely related, but no study had concurrently investigated their associations with outcomes in schizophrenia. This study seeks to describe and compare socio-demographic, clinical and functioning profiles of people with schizophrenia in different living arrangements and accommodation, and to examine the associations of living arrangements and accommodation with symptomatic remission and functioning. METHODS Community dwelling outpatients with schizophrenia (n = 276) were inquired on living arrangements, accommodation, socio-demographics and assessed on the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). Socio-demographics, symptoms and functioning of outpatients in different living arrangements and accommodation were compared. Symptomatic remission was investigated using logistic regression with living arrangements, socio-demographics and clinical variables as independent variables. Functioning was investigated using multiple regression with the same set of independent variables and the addition of PANSS factors. The same analyses were conducted with accommodation as independent variable. RESULTS 185 (67.03%) participants lived with family and 195 (70.65%) participants lived in owned accommodation. People living with their spouses had significantly higher SOFAS, lower PANSS Total and PANSS Positive than people living with family, independently, or in rehabilitation centres. They also had lower PANSS Negative than people living with family and a higher likelihood to have achieved symptomatic remission. Types of accommodation was not associated with symptoms, symptomatic remission, and functioning. CONCLUSION Living arrangements, but not types of accommodation, were associated with symptoms and functioning in schizophrenia. Family education and support is important to help maintain a conducive environment for people with schizophrenia. People living independently may need more support.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Gurpreet Rekhi
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore ,grid.414752.10000 0004 0469 9592North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Abstract
BACKGROUND Patients in every stage of the psychosis continuum can present with negative symptoms. While no treatment is currently available to address these symptoms, a more refined characterization of their course over the lifetime could help in elaborating interventions. Previous reports have separately investigated the prevalence of negative symptoms within each stage of the psychosis continuum. Our aim in this review is to compare those prevalences across stages, thereby disclosing the course of negative symptoms. METHODS We searched several databases for studies reporting prevalences of negative symptoms in each one of our predetermined stages of the psychosis continuum: clinical or ultra-high risk (UHR), first-episode of psychosis (FEP), and younger and older patients who have experienced multiple episodes of psychosis (MEP). We combined results using the definitions of negative symptoms detailed in the Brief Negative Symptom Scale, a recently developed tool. For each negative symptom, we averaged and weighted by the combined sample size the prevalences of each negative symptom at each stage. RESULTS We selected 47 studies totaling 1872 UHR, 2947 FEP, 5039 younger MEP, and 669 older MEP patients. For each negative symptom, the prevalences showed a comparable course. Each negative symptom decreased from the UHR to FEP stages and then increased from the FEP to MEP stages. CONCLUSIONS Certain psychological, environmental, and treatment-related factors may influence the cumulative impact of negative symptoms, presenting the possibility for early intervention to improve the long-term course.
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Lee TY, Lee J, Lee HJ, Lee Y, Rhee SJ, Park DY, Paek MJ, Kim EY, Kim E, Roh S, Jung HY, Kim M, Kim SH, Han D, Ahn YM, Ha K, Kwon JS. Study Protocol for a Prospective Longitudinal Cohort Study to Identify Proteomic Predictors of Pluripotent Risk for Mental Illness: The Seoul Pluripotent Risk for Mental Illness Study. Front Psychiatry 2020; 11:340. [PMID: 32372992 PMCID: PMC7186772 DOI: 10.3389/fpsyt.2020.00340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Seoul Pluripotent Risk for Mental Illness (SPRIM) study was designed to identify predictors leading to mental illness in help-seeking individuals by securing sufficient statistical power through transdiagnostic approaches. The SPRIM study aims to examine the clinical characteristics of high-risk individuals for mental illness and to identify proteomic biomarkers that can predict the onset of mental illness. METHODS This paper describes the study protocol of the SPRIM study. We aim to recruit 150 participants who meet the criteria for high risk for major mental illness, 150 patients with major psychiatric disorders (schizophrenia, bipolar disorder, and major depressive disorder), and 50 matched healthy control subjects for 2 years. Clinical evaluations, self-report measures, and proteomic analyses will be implemented. The assessment points are at baseline, 6, 12, 18, and 24 months. CONCLUSIONS In the present study, we introduced the study protocol of the SPRIM study, which is the first prospective cohort study of transdiagnostic high-risk concepts using proteomic biomarkers. This study has a paradigm that encompasses various diseases without aiming at predicting and preventing the development of a specific mental illness in help-seeking individuals. The transdiagnostic high-risk concept could be extended to provide a perspective for people with various psychopathological tendencies below a threshold, such that they do not meet the existing diagnostic criteria of mental illnesses, to determine what may lead them to a specific disease and help identify appropriate preventative interventions.
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Affiliation(s)
- Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Junhee Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Yunna Lee
- Department of Neuropsychiatry, Kosin University Gospel Hospital, Pusan, South Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Dong Yeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, South Korea
| | - Myung Jae Paek
- Department of Psychiatry, The Armed Forces Capital Hospital, Seongnam, South Korea
| | - Eun Young Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Euitae Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sungwon Roh
- Department of Neuropsychiatry, Hanyang University Hospital, Seoul, South Korea
| | - Hee Yeon Jung
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Dohyun Han
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Kyooseob Ha
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
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Widing L, Simonsen C, Flaaten CB, Haatveit B, Vik RK, Wold KF, Åsbø G, Ueland T, Melle I. Symptom Profiles in Psychotic Disorder Not Otherwise Specified. Front Psychiatry 2020; 11:580444. [PMID: 33281644 PMCID: PMC7688897 DOI: 10.3389/fpsyt.2020.580444] [Citation(s) in RCA: 6] [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: 07/06/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Approximately 10% of patients with psychotic disorders receive the diagnosis "Psychotic disorder not otherwise specified" (PNOS). However, there is a lack of knowledge about the clinical presentations captured by this diagnosis in the mental health services. Therefore, we examined the symptom profiles of participants with PNOS compared to participants with bipolar disorder (BD) and schizophrenia spectrum disorder (SZ) diagnoses. Methods: We here included 1,221 participants from the Thematically Organized Psychosis-study at Oslo University Hospital; 792 with SZ, 283 with BD, and 146 with PNOS, assessed with SCID-I for DSM-IV. The participants with PNOS were categorized into subgroups based on SCID information. The GAF, PANSS, Alcohol Use Disorders Identification Test (AUDIT), and Drug Use Disorders Identification Test (DUDIT) were used to assess function, clinical symptoms, and substance use. Results: In the PNOS group, 44% did not meet the criteria for any specific psychotic disorder, 35.5% had contradictory information making a specific diagnosis difficult, and 20.5% had inadequate information to make a specific diagnosis. The most frequent reason for a PNOS diagnosis was difficulty ruling out a substance-induced psychotic disorder (n = 41, 28%). Participants with PNOS were younger and more often first-episode than participants with BD and SZ. They were intermediate between BD and SZ for GAF scores (BD>PNOS>SZ) and PANSS scores (BD<PNOS<SZ) and more often scored above the clinical cut-off for substance misuse as measured by the AUDIT (BD = PNOS<SZ), DUDIT (BD = SZ<PNOS) and for the combination of both these measures. Conclusions: A PNOS diagnosis is more common in first-episode than in multi-episode patients. The diagnosis captures a heterogeneous group of psychotic syndromes, with a severity of symptoms and functional loss that is intermediate between BD and SZ.
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Affiliation(s)
- Line Widing
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Camilla B Flaaten
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Beathe Haatveit
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Ruth Kristine Vik
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kristin F Wold
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Gina Åsbø
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital and University of Oslo, Oslo, Norway
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Palaniyappan L. Inefficient neural system stabilization: a theory of spontaneous resolutions and recurrent relapses in psychosis. J Psychiatry Neurosci 2019; 44:367-383. [PMID: 31245961 PMCID: PMC6821513 DOI: 10.1503/jpn.180038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022] Open
Abstract
A striking feature of psychosis is its heterogeneity. Presentations of psychosis vary from transient symptoms with no functional consequence in the general population to a tenacious illness at the other extreme, with a wide range of variable trajectories in between. Even among patients with schizophrenia, who are diagnosed on the basis of persistent deterioration, marked variation is seen in response to treatment, frequency of relapses and degree of eventual recovery. Existing theoretical accounts of psychosis focus almost exclusively on how symptoms are initially formed, with much less emphasis on explaining their variable course. In this review, I present an account that links several existing notions of the biology of psychosis with the variant clinical trajectories. My aim is to incorporate perspectives of systems neuroscience in a staging framework to explain the individual variations in illness course that follow the onset of psychosis.
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Affiliation(s)
- Lena Palaniyappan
- From the Department of Psychiatry and Robarts Research Institute, University of Western Ontario and Lawson Health Research Institute, London, Ont., Canada
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10
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Can G, Bora E, Ildız A, Ulas G, Ongun CH, Sprooten E, Frangou S, Inal NE, Ozerdem A. Neurocognition in young offspring of individuals with bipolar disorder: The role of co-existing familial and clinical high-risk for bipolar disorder. Psychiatry Res 2019; 281:112565. [PMID: 31586839 DOI: 10.1016/j.psychres.2019.112565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 12/01/2022]
Abstract
Bipolar disorder (BD) is associated with cognitive dysfunction which has also been reported in offspring of individuals with BD (BDoff). However, it remains unclear whether cognitive underperformance in BDoff is associated with the presence of history of subclinical syndromes associated with risk for BD. To address this knowledge gap we assessed executive function, visual and verbal memory, working memory, processing speed and verbal fluency in 21 offspring with clinical high risk (CHR; BDoff+CHR), 54 offspring without CHR (BDoff-non-CHR), and 50 healthy individuals without familial risk of BD. BDoff underperformed compared to controls in most cognitive tasks. There was no significant neurocognitive difference between BDoff+CHR and BDoff-non-CHR except in the fluency/central executive domain (Cohen's d = 0.60, p = 0.03). Our results suggest that cognitive dysfunction in multiple domains is associated with familial predisposition to BD regardless of CHR status. On the other hand, abnormalities in central executive processes might be more pronounced in BDoff+CHR than BDoff-non-CHR. Further longitudinal studies investigating cognitive trajectory of BDoff and its interaction with the emergence of subclinical syndromes are needed to fully characterize the relationship between cognition and mood dysregulation in BD.
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Affiliation(s)
- Gunes Can
- Department of Psychiatry, Mardin State Hospital, Mardin, Turkey
| | - Emre Bora
- Dokuz Eylul University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Dokuz Eylul University, Institute of Neuroscience, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne.
| | - Aysegul Ildız
- Dokuz Eylul University, Institute of Neuroscience, Izmir, Turkey
| | - Gozde Ulas
- Department of Child and Adolescent Psychiatry, Çankırı State Hospital, Çankırı, Turkey
| | | | - Emma Sprooten
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Neslihan Emiroglu Inal
- Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Aysegul Ozerdem
- Dokuz Eylul University, Faculty of Medicine, Department of Psychiatry, Izmir, Turkey; Dokuz Eylul University, Institute of Neuroscience, Izmir, Turkey; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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11
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Dolz M, Tor J, De la Serna E, Pardo M, Muñoz-Samons D, Rodríguez-Pascual M, Puig O, Sugranyes G, Usall J, Sánchez-Gistau V, Baeza I. Characterization of children and adolescents with psychosis risk syndrome: The Children and Adolescents Psychosis Risk Syndrome (CAPRIS) study. Early Interv Psychiatry 2019; 13:1062-1072. [PMID: 30478873 DOI: 10.1111/eip.12728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/20/2018] [Accepted: 07/29/2018] [Indexed: 01/18/2023]
Abstract
AIM Despite the interest in psychosis risk syndrome (PRS) in children and adolescents, information on the syndrome in this population is scarce. METHODS Prospective naturalistic multi-site study in which 10- to 17-year-old help-seeking subjects who met PRS criteria (positive or negative attenuated symptoms; brief limited intermittent psychotic symptoms; genetic risk or schizotypal personality disorder plus impairment in functioning) were included, along with 45 age and sex-matched healthy controls (HC). All subjects were clinically and functionally assessed. RESULTS Ninety-one PRS subjects (PRSS) with a mean age of 15.5 ± 1.4 met inclusion criteria (IC). Compared with HC, PRSS presented worse global and academic functioning in the previous year, had experienced more psychiatric and psychological problems, and presented gestational ages outside the normal range. More than 80% of PRSS met ≥2 IC, with 65.9% having one Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision diagnosis, and 61.7% of those having ≥2 diagnoses. Some 49.5% of PRSS had a first- or second-degree family history (FH) of psychosis. Patients with first- and second-degree FH do not differ in their clinical expression. CONCLUSIONS Children and adolescents with PRS are a patient group with a pattern of neurodevelopmental impairment and clinical complexity similar to patients with schizophrenia spectrum disorders, highlighting the importance of assessing these variables in child and adolescent samples. PRSS with first- and second-degree relatives with FH do not present differences in their clinical presentation, suggesting that including these two groups of patients in the genetic risk criteria would enrich knowledge of these criteria.
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Affiliation(s)
- Montserrat Dolz
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Jordina Tor
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Elena De la Serna
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Marta Pardo
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain
| | - Marta Rodríguez-Pascual
- Child and Adolescent Mental Health Research Group, Sant Joan de Déu Research Insitute, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
| | - Judith Usall
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | - Vanessa Sánchez-Gistau
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Early Intervention Service, Pere Mata Institut Universitary Hospital, IISPV (Institut d'Investigació Sanitaria Pere Vigili), Rovira Virgili University and CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Reus, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Universitari of Barcelona. CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), (2014SGR489), Barcelona, Spain.,Institut Clinic of Neurosciences, CERCA-IDIBAPS. (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain
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12
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Braider L, La Lima C, Crimarco N, Hollander B, Reid-Russell A, Kane J, Greenwald B. Characterization of psychiatrically hospitalized college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:654-660. [PMID: 30365917 DOI: 10.1080/07448481.2018.1500471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 05/31/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
Objective: To characterize contemporary college students requiring psychiatric hospitalization. Participants and methods: Sociodemographic and diagnostic information was gathered retrospectively and analyzed from the electronic medical records (EMRs) of the consecutive inpatient hospitalizations of 905 college students admitted to a psychiatric inpatient unit. Results: Significantly more females compared to males experienced the following: more hospitalizations, more family and financial stressors, more depression, and less psychotic and bipolar disorder. The most frequent diagnosis was a depressive disorder, followed by bipolar disorder, psychotic disorder, and personality disorder, most frequently borderline personality disorder. Half of participants had comorbid diagnoses with substance abuse most common. More than two-thirds of students endorsed social or intimate relationship, academic, and family challenges as psychosocial stressors. In all, 15% of participants had repeat admissions. Conclusions: The present study provides demographic data from a sample of psychiatrically hospitalized college students. Findings can help improve screening and identification of decompensation in college students.
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Affiliation(s)
- Laura Braider
- Department of Psychiatry, Northwell Health Zucker Hillside Hospital , Glen Oaks , NY , USA
| | - Candice La Lima
- Department of Psychiatry, Northwell Health Zucker Hillside Hospital , Glen Oaks , NY , USA
| | | | - Beth Hollander
- Student Counseling, Adelphi University , Garden City, NY , USA
| | | | - John Kane
- Department of Psychiatry, Northwell Health Zucker Hillside Hospital , Glen Oaks , NY , USA
| | - Blaine Greenwald
- Department of Psychiatry, Northwell Health Zucker Hillside Hospital , Glen Oaks , NY , USA
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13
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Kafali HY, Bildik T, Bora E, Yuncu Z, Erermis HS. Distinguishing prodromal stage of bipolar disorder and early onset schizophrenia spectrum disorders during adolescence. Psychiatry Res 2019; 275:315-325. [PMID: 30953877 DOI: 10.1016/j.psychres.2019.03.051] [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: 12/20/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 12/14/2022]
Abstract
Prodromal symptoms of bipolar disorder (BD) and early onset schizophrenia spectrum disorder (EOSSD) overlap. To date, there has been no study directly comparing the prodromal stage of both disorders. Thus, the current study is aimed at determining which prodromal symptom clusters differentiate BD and EOSSD. One hundred twenty one adolescents (33 BD-1, 30 EOSSD, 58 healthy controls) were evaluated for the presence of 79 prodromal symptoms, divided into 7 prodromal symptom clusters. Great than 2 subsyndromal manic symptoms and ADHD comorbidity were significantly more specific for BD than schizophrenia; brief limited intermittent psychotic symptoms (BLIPS) were more likely to be part of EOSSD. In contrast, attenuated psychotic symptoms, and negative symptoms were not specifically related to the diagnosis of EOSSD. In conclusion, subsyndromal manic symptoms, BLIPS, and ADHD might be useful for predicting the trajectory of an emerging affective disorder versus schizophrenia and thus valuable for early detection, and intervention strategies.
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Affiliation(s)
- Helin Yilmaz Kafali
- Ankara Children's Hematology Oncology Training and Research Hospital, Department of Child and Adolescent Psychiatry, Sehit Omer Halisdemir Cad, Kurtdereli, 06110 Ankara, Turkey.
| | - Tezan Bildik
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Emre Bora
- Dokuz Eylül University School of Medicine, Department of Psychiatry, Izmir, Turkey; The Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, VIC, Australia
| | - Zeki Yuncu
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - H Serpil Erermis
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Izmir, Turkey
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14
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Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:683-700. [PMID: 28914382 DOI: 10.1007/s00787-017-1046-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.
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15
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Course of clinical high-risk states for psychosis beyond conversion. Eur Arch Psychiatry Clin Neurosci 2018; 268:39-48. [PMID: 28054132 DOI: 10.1007/s00406-016-0764-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The main focus of research on clinical high-risk states for psychosis (CHR) has been the development of algorithms to predict psychosis. Consequently, other outcomes have been neglected, and little is known about the long-term diagnostic and functional outcome among those not converting to psychosis. METHODS In a naturalistic study, incidence, persistence, and remission rates of CHR states according to symptomatic ultra-high risk or cognitive disturbances criteria were investigated in 160 of 246 outpatients of an early detection of psychoses service (21.1% CHR negative and 78.9% CHR positive at baseline) who had not converted to psychosis within follow-up (median 53.7 months, range 13.9-123.7 months). RESULTS Remission rate of CHR status was 43.3% of all 194 CHR-positive cases, including converters, or 72.4% if only the 116 non-converters were considered, persistence rate was 27.6%, and new occurrence rate in initially CHR-negative patients was 9.1%. At follow-up, 54.5% of the non-converters met criteria of at least one Axis-I diagnosis, mainly affective and anxiety disorders, and had functional problems. The severity of risk at baseline was not associated with a higher presence of Axis-I diagnosis at follow-up. CONCLUSIONS During follow-up, CHR symptoms remitted in one-third of initially CHR-positive patients, while almost 10% met CHR criteria newly in CHR-negative adults presenting at early detection services. The presence of CHR criteria seems to maintain the risk for lower functioning and mental disorders, particularly for affective disorders. Thus, therapeutic efforts targeting CHR patients should also focus on the current mental disorders as well as social and role functions to improve the long-term outcome.
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16
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Ratheesh A, Cotton SM, Davey CG, Lin A, Wood S, Yuen HP, Bechdolf A, McGorry PD, Yung A, Berk M, Nelson B. Pre-onset risk characteristics for mania among young people at clinical high risk for psychosis. Schizophr Res 2018; 192:345-350. [PMID: 28768599 DOI: 10.1016/j.schres.2017.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/18/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Psychosis and mania share conceptual, genetic and clinical features, which suggest the possibility that they have common antecedents. Participants identified to be at-risk for psychosis might also be at-risk for mania. We aimed to identify the rate and predictors of transition to mania in a cohort of youth with clinical or familial risk for psychosis. METHODS Among a cohort of 416 young people with an at-risk mental state for psychosis defined using the Ultra-High-Risk (UHR) criteria, 74.7% were followed up between 5 and 13years from their baseline assessment. We undertook a matched case-control examination of those who developed mania over the follow-up period compared to those who did not develop mania or psychosis. Transition to mania was determined using either a structured clinical interview, or diagnoses from a state-wide public mental health contact registry. Clinical characteristics and risk factors were examined at baseline using information from structured interviews, clinical file notes, rating scales and unstructured assessments. RESULTS Eighteen participants developed mania (UHR-Manic transition or UHR-M, 4.3%). In comparison with participants matched on age, gender and baseline-study who developed neither mania nor psychosis, more UHR-M participants had subthreshold manic symptoms or were prescribed antidepressants at baseline. They also had lower global functioning. DISCUSSION In addition to the UHR criteria, features such as subthreshold manic symptoms and antidepressant use may help identify at-risk groups that predict the onset of mania in addition to transition to psychosis. Presence of manic symptoms may also indicate syndrome specificity early in the prodromal phase.
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Affiliation(s)
- Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
| | - Susan M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Christopher G Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen Wood
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; School of Psychology, University of Birmingham, UK
| | - Hok Pan Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Andreas Bechdolf
- Vivantes Hospital am Urban and Vivantes Hopital im Friedrichshain, Charite Medical University, Berlin, Germany
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Alison Yung
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Berk
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Deakin University, IMPACT Strategic Research Centre, Barwon Health, Geelong, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
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Gkintoni E, Pallis EG, Bitsios P, Giakoumaki SG. Neurocognitive performance, psychopathology and social functioning in individuals at high risk for schizophrenia or psychotic bipolar disorder. J Affect Disord 2017; 208:512-520. [PMID: 27810272 DOI: 10.1016/j.jad.2016.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although cognitive deficits are consistent endophenotypes of schizophrenia and bipolar disorder, findings in psychotic bipolar disorder (BDP) are inconsistent. In this study we compared adult unaffected first-degree relatives of schizophrenia and BDP patients on cognition, psychopathology, social functioning and quality of life. METHODS Sixty-six unaffected first-degree relatives of schizophrenia patients (SUnR), 36 unaffected first-degree relatives of BDP patients (BDPUnR) and 102 controls participated in the study. Between-group differences were examined and Discriminant Function Analysis (DFA) predicted group membership. RESULTS Visual memory, control inhibition, working memory, cognitive flexibility and abstract reasoning were linearly impaired in the relatives' groups. Poorer verbal fluency and processing speed were evident only in the SUnR group. The SUnR group had higher depressive and somatization symptoms while the BDPUnR group had higher anxiety and lower social functioning compared with the controls. Individuals with superior cognition were more likely to be classified as controls; those with higher social functioning, prolonged processing speed and lower anxiety were more likely to be classified as SUnR. LIMITATIONS The relatives' sample is quite heterogeneous; the effects of genetic or environmental risk-factors were not examined. CONCLUSIONS Cognitive functions mediated by a fronto-parietal network, show linear impairments in unaffected relatives of BDP and schizophrenia patients; processing speed and verbal fluency impairments were evident only in schizophrenia relatives. Self-perceived symptomatology and social functioning also differ between schizophrenia and BDP relatives. The continuum seen in patients in several indices was also seen in the cognitive impairments in unaffected relatives of schizophrenia and BDP patients.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece
| | - Eleftherios G Pallis
- Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Panos Bitsios
- Department of Psychiatry & Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stella G Giakoumaki
- Department of Psychology, Gallos University campus, University of Crete, Rethymno, Crete, Greece.
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Carrión RE, Correll CU, Auther AM, Cornblatt BA. A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program. Schizophr Bull 2017; 43:64-74. [PMID: 28053131 PMCID: PMC5216868 DOI: 10.1093/schbul/sbw155] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Clinical staging improved the possibility of intervening during the psychosis prodrome to limit progression of illness. The current study aimed to validate a novel 4-stage severity-based model with a focus on clinical change over time and risk for conversion to psychosis. One hundred seventy-one individuals at clinical high risk (CHR) for psychosis were followed prospectively (3 ± 1.6 y) as part of the Recognition and Prevention (RAP) program and divided into 4 diagnostic stages according to absence/presence and severity of attenuated positive symptoms. Twenty-two percent of the combined sample recovered (no prodromal symptoms) by study outcome. The negative symptoms only subgroup had the highest symptom stability (70%), but the lowest conversion rate at 5.9%. The subgroup with more severe baseline attenuated positive symptom levels had a higher conversion rate (28%) and a more rapid onset when compared to the moderate attenuated positive symptom subgroup (11%). Finally, the Schizophrenia-Like Psychosis (SLP) subgroup showed low stability (3%), with 49% developing a specific psychotic disorder. The proposed stage model provides a more finely grained classification system than the standard diagnostic approach for prodromal individuals. All 4 stages are in need of early intervention because of low recovery rates. The negative symptom only stage is possibly a separate clinical syndrome, with an increased risk of functional disability. Both subgroups with attenuated positive symptoms are appropriate for studying the mechanisms of psychosis risk, however, individuals with more severe baseline positive symptoms appear better suited to clinical trials. Finally, the SLP category represents an intermediate outcome group appropriate for preventative intervention research but questionable for inclusion in prodromal studies of mechanisms.
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Affiliation(s)
- Ricardo E. Carrión
- *To whom correspondence should be addressed; Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59, 263rd Street, Glen Oaks, NY 11004, US; tel: 718-470-8878, fax: 718-470-5815, e-mail:
| | | | - Andrea M. Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
- Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY
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Vernal DL, Kapoor S, Al-Jadiri A, Sheridan EM, Borenstein Y, Mormando C, David L, Singh S, Seidman AJ, Carbon M, Gerstenberg M, Saito E, Kane JM, Steinhausen HC, Correll CU. Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study. J Child Adolesc Psychopharmacol 2015; 25:535-47. [PMID: 26375767 PMCID: PMC4696429 DOI: 10.1089/cap.2014.0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. METHODS The study was a prospective, naturalistic, inception cohort study of youth ≤19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and ≤24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. RESULTS Altogether, 130 youth with SCZ-S (n=42) or PsyNOS (n=88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4±2.1 vs. 14.8±3.2, p=0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p=0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0±0.9 vs. 5.5±0.8, p=0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6±9.2 vs. 36.1±8.9, p=0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS≤40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p=0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p=0.97), or nonadherence (29.3% vs. 30.9%, p=0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p=0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups (p=0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores (p=0.012) and more frequently reached higher categorical CGAS group status (p=0.021) than SCZ-S patients. CONCLUSIONS Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.
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Affiliation(s)
- Ditte L. Vernal
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Eva M. Sheridan
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Yehonathan Borenstein
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Charles Mormando
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Lisa David
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sukhbir Singh
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Andrew J. Seidman
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Miriam Gerstenberg
- University Clinics of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Ema Saito
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
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Bonnín CM, Reinares M, Hidalgo-Mazzei D, Undurraga J, Mur M, Sáez C, Nieto E, Vázquez GH, Balanzá-Martínez V, Tabarés-Seisdedos R, Vieta E. Predictors of functional outcome after a manic episode. J Affect Disord 2015; 182:121-5. [PMID: 25985381 DOI: 10.1016/j.jad.2015.04.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode. METHODS We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable. RESULTS Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode. LIMITATIONS The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness. CONCLUSIONS Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.
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Affiliation(s)
- C Mar Bonnín
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - María Reinares
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain
| | - Juan Undurraga
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain; Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Maria Mur
- Psychiatric Service, Santa Maria Hospital, IRB Lleida (Biomedicine Research, Institute), University of Lleida, Catalonia, Lleida, Spain
| | - Cristina Sáez
- University Psychiatric Hospital, Institut Pere Mata, CIBERSAM, Reus, Catalonia, Spain
| | - Evaristo Nieto
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - Gustavo H Vázquez
- Department of Neuroscience, Palermo University, Buenos Aires, Argentina
| | - Vicent Balanzá-Martínez
- Psychiatric Service, La Fe University and Polytechnic Hospital, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain; Department of Medicine, University of Valencia, CIBERSAM, INCLIVA, Valencia, Spain
| | - Rafael Tabarés-Seisdedos
- Psychiatric Service, La Fe University and Polytechnic Hospital, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Barcelona, Spain.
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Remberk B, Bażyńska AK, Krempa-Kowalewska A, Rybakowski F. Executive impairment predicts schizophrenia diagnosis and treatment status in mid-term follow-up of early-onset psychosis. Neuropsychobiology 2015; 70:181-8. [PMID: 25377241 DOI: 10.1159/000366486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Early-onset psychoses (EOP) vary considerably with regard to diagnostic stability and functional outcome. The aim of this study was the assessment of executive dysfunction as a predictor of outcome in EOP. METHOD This was a retrospective cohort study. Twenty-five hospitalized patients with non-affective EOP were assessed with the Wisconsin Card Sorting Test (WCST) during the index admission. Associations with current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed in 6 years of follow-up. RESULTS The mean age at the index admission and the follow-up was 16.1 ± 1.35 and 22.0 ± 2.1 years, respectively. After discharge, almost all subjects (96%) at least briefly continued psychiatric treatment, and the majority of them (76%) were readmitted. Worse baseline WCST results were associated with a follow-up schizophrenia diagnosis, being a psychiatric in- or outpatient at the moment of follow-up assessment and receiving psychotropic medication. A low number of completed categories correlated with receiving a disability pension at the follow-up. CONCLUSION In patients with EOP, baseline executive function impairment was associated with schizophrenia diagnosis and psychiatric treatment at the follow-up. The association between baseline results and psychiatric treatment may explain the limited effect of baseline impairment on follow-up occupational and relationship status.
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Affiliation(s)
- Barbara Remberk
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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22
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McCarthy JB. The Continuum of Psychosis Proneness and Schizotypal Traits: A Comment on Loas, et al. (2013). Psychol Rep 2015; 116:914-9. [DOI: 10.2466/02.19.pr0.116k30w2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Loas, Dimassi, Monestes, and Yon (2013) studied a version of the Cognitive Slippage Scale and the Schizotypal Ambivalence Scale in support of the view that thought disorder and withdrawal are highly correlated with schizotypy, a central concept in investigations of the vulnerability for schizophrenia. As a brief comment on Loas, et al., I will draw attention to the need for expanding studies of schizotypal traits and the possibility of using these scales with adolescents and young adults who are developing personality disorders as well as with individuals who have experienced prodromal phases of psychosis. Investigations of the Cognitive Slippage Scale and the Schizotypal Ambivalence Scale might be enhanced by conducting studies with individuals at different points on the psychosis continuum, including those who have developed schizophrenia and other psychotic disorders, as well as with their first-degree relatives.
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23
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Pina-Camacho L, Garcia-Prieto J, Parellada M, Castro-Fornieles J, Gonzalez-Pinto AM, Bombin I, Graell M, Paya B, Rapado-Castro M, Janssen J, Baeza I, Del Pozo F, Desco M, Arango C. Predictors of schizophrenia spectrum disorders in early-onset first episodes of psychosis: a support vector machine model. Eur Child Adolesc Psychiatry 2015; 24:427-40. [PMID: 25109600 DOI: 10.1007/s00787-014-0593-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/29/2014] [Indexed: 12/21/2022]
Abstract
Identifying early-onset schizophrenia spectrum disorders (SSD) at a very early stage remains challenging. To assess the diagnostic predictive value of multiple types of data at the emergence of early-onset first-episode psychosis (FEP), various support vector machine (SVM) classifiers were developed. The data were from a 2-year, prospective, longitudinal study of 81 patients (age 9-17 years) with early-onset FEP and a stable diagnosis during follow-up and 42 age- and sex-matched healthy controls (HC). The input was different combinations of baseline clinical, neuropsychological, magnetic resonance imaging brain volumetric and biochemical data, and the output was the diagnosis at follow-up (SSD vs. non-SSD, SSD vs. HC, and non-SSD vs. HC). Enhanced recursive feature elimination was performed for the SSD vs. non-SSD classifier to select and rank the input variables with the highest predictive value for a diagnostic outcome of SSD. After validation with a test set and considering all baseline variables together, the SSD vs. non-SSD, SSD vs. HC and non-SSD vs. HC classifiers achieved an accuracy of 0.81, 0.99 and 0.99, respectively. Regarding the SSD vs. non-SSD classifier, a combination of baseline clinical variables (severity of negative, disorganized symptoms and hallucinations or poor insight) and neuropsychological variables (impaired attention, motor coordination, and global cognition) showed the highest predictive value for a diagnostic outcome of SSD. Neuroimaging and biochemical variables at baseline did not add to the predictive value. Thus, comprehensive clinical/cognitive assessment remains the most reliable approach for differential diagnosis during early-onset FEP. SVMs may constitute promising multivariate tools in the search for predictors of diagnostic outcome in FEP.
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Affiliation(s)
- Laura Pina-Camacho
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón. School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Ibiza 43, 28009, Madrid, Spain,
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24
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Bechdolf A, Ratheesh A, Cotton SM, Nelson B, Chanen AM, Betts J, Bingmann T, Yung AR, Berk M, McGorry PD. The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study. Bipolar Disord 2014; 16:493-504. [PMID: 24797824 DOI: 10.1111/bdi.12205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. METHODS This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. RESULTS A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. CONCLUSIONS These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Academic Hospital of Charite Medicine Berlin, Berlin, Germany; Orygen Youth Health Research Centre; Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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25
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Piras S, Casu G, Casu MA, Orrù A, Ruiu S, Pilleri A, Manca G, Marchese G. Prediction and prevention of the first psychotic episode: new directions and opportunities. Ther Clin Risk Manag 2014; 10:241-53. [PMID: 24729711 PMCID: PMC3974689 DOI: 10.2147/tcrm.s55770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In the last few decades, substantial research has focused on the possibility of early detection and prevention of the first psychotic episode in young individuals at risk of developing this mental disturbance; however, unresolved clinical and ethical issues still call for further investigations. New perspectives and opportunities may come from the identification of selective psychopathological and instrumental markers linking the appearance of subtle psychotic symptoms with the clinical outcome of specific mental pathologies. Furthermore, empirically derived algorithms and risk staging models should facilitate the identification of targeted prevention therapies, possibly improving the efficacy of well-tolerated therapeutic approaches, such as psychological interventions and natural compound supplementations. To date, the collected evidence on the efficacy and tolerability of pharmacological prevention therapies raises more doubts than hopes. A very early detection of risk and appropriate symptomatic pattern classifications may provide a chance to better match prevention strategies with the development of psychosis.
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Affiliation(s)
- Sara Piras
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Gianluca Casu
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Maria Antonietta Casu
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Alessandro Orrù
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Stefania Ruiu
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Antonio Pilleri
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Gabriella Manca
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
| | - Giorgio Marchese
- National Research Council, institute of Translational Pharmacology, Strategic Operating Unit of Cagliari, Cagliari, Italy
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Cuesta MJ, Basterra V, Sanchez-Torres A, Peralta V. Controversies surrounding the diagnosis of schizophrenia and other psychoses. Expert Rev Neurother 2014; 9:1475-86. [DOI: 10.1586/ern.09.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Topor DR, Swenson L, Hunt J, Birmaher B, Strober M, Yen S, Hoeppner B, Case B, Hower H, Weinstock LM, Ryan N, Goldstein B, Goldstein T, Gill MK, Axelson D, Keller M. Manic symptoms in youth with bipolar disorder: factor analysis by age of symptom onset and current age. J Affect Disord 2013; 145:409-12. [PMID: 23021377 PMCID: PMC3535567 DOI: 10.1016/j.jad.2012.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/31/2012] [Accepted: 06/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Factor analysis has been used to identify potential clinical subtypes of mania in pediatric bipolar disorder. Results vary in the number of factors retained. The present study used a formal diagnostic instrument to examine how symptoms of mania in young people are expressed, depending on age of symptom onset and current age. METHODS Trained clinicians completed the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS) Mania Rating Scale (MRS) with parents of 163 children with child-onset of symptoms (before age 12), 94 adolescents with child-onset of symptoms, and 90 adolescents with adolescent-onset of symptoms (after age 12). Factor analysis of symptom ratings during the most severe lifetime manic episode was performed for each age group. RESULTS Symptom factor structures were established for each age group. Two factors were evident for children with child-onset of symptoms ("activated/pleasure seeking" and "labile/disorganized"), one factor was present for adolescents with child-onset of symptoms ("activated/pleasure seeking/disorganized") and two factors were evident for adolescents with adolescent-onset of symptoms ("activated/pleasure seeking" and "disorganized/psychotic"). The factor structures for children with child-onset and adolescents with adolescent-onset of symptoms were highly similar, with the latter factor structure including psychotic symptoms. LIMITATIONS Limitations include reliance on retrospective parent report and potential issues with generalizability. CONCLUSIONS Findings suggest mania symptomatology is largely similar when examined by both age of onset and current age, with some notable differences. Specifically, psychotic symptoms begin emerging as a distinct factor in adolescents with adolescent-onset of symptoms.
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Affiliation(s)
- David R. Topor
- VA Boston Healthcare System, Boston, MA and Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Lance Swenson
- Department of Psychology, Suffolk University, Boston, MA
| | - Jeffrey Hunt
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Shirley Yen
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Bettina Hoeppner
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Brady Case
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Heather Hower
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lauren M. Weinstock
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin Goldstein
- University of Toronto, Faculty of Medicine, Department of Psychiatry, Sunnybrook Health Services Centre, Assistant Professor of Psychiatry
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin Keller
- Department of Psychiatry and Butler and Bradley Hospitals, The Warren Alpert Medical School of Brown University, Providence, RI
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Salokangas RKR, Dingemans P, Heinimaa M, Svirskis T, Luutonen S, Hietala J, Ruhrmann S, Juckel G, Graf von Reventlow H, Linszen D, Birchwood M, Patterson P, Schultze-Lutter F, Klosterkötter J. Prediction of psychosis in clinical high-risk patients by the Schizotypal Personality Questionnaire. Results of the EPOS project. Eur Psychiatry 2013; 28:469-75. [PMID: 23394823 DOI: 10.1016/j.eurpsy.2013.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Schizotypal features indicate proneness to psychosis in the general population. It is also possible that they increase transition to psychosis (TTP) among clinical high-risk patients (CHR). Our aim was to investigate whether schizotypal features predict TTP in CHR patients. METHODS In the EPOS (European Prediction of Psychosis Study) project, 245 young help-seeking CHR patients were prospectively followed for 18 months and their TTP was identified. At baseline, subjects were assessed with the Schizotypal Personality Questionnaire (SPQ). Associations between SPQ items and its subscales with the TTP were analysed in Cox regression analysis. RESULTS The SPQ subscales and items describing ideas of reference and lack of close interpersonal relationships were found to correlate significantly with TTP. The co-occurrence of these features doubled the risk of TTP. CONCLUSIONS Presence of ideas of reference and lack of close interpersonal relations increase the risk of full-blown psychosis among CHR patients. This co-occurrence makes the risk of psychosis very high.
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Affiliation(s)
- R K R Salokangas
- Department of Psychiatry, University of Turku, Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
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Hauser M, Correll CU. The significance of at-risk or prodromal symptoms for bipolar I disorder in children and adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:22-31. [PMID: 23327753 PMCID: PMC4010197 DOI: 10.1177/070674371305800106] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While in the early identification and intervention of psychosis-specific instruments and risk criteria have been generated and validated, research into indicated preventive strategies for bipolar I disorder (BD I) has only recently gained momentum. As the first signs of BD I often start before adulthood, such efforts are especially important in the vulnerable pediatric population. Data are summarized regarding the presence and nature of potentially prodromal, that is, subsyndromal, symptoms prior to BD I, defined by first-episode mania, focusing on pediatric patients. Research indicates the possibility of early identification of youth at clinical high risk for BD. Support for this proposition comes from retrospective studies of BD I patients, as well as prospective studies of community samples, offspring of BD I subjects, youth with depressive disorders, and patients at high risk for psychosis or with bipolar spectrum disorders without lifetime history of mania. These data provide essential insight into potential signs and symptoms that may enable presyndromal identification of BD I in youth. However, except for offspring studies, broader prospective approaches that focus on youth at clinical high risk for BD I and on developing specific interviews and (or) rating scales and risk criteria are mostly missing, or in their early stage. More work is needed to determine valid and sufficiently specific clinical high-risk criteria, to distinguish risk factors, endophenotypes, and comorbidities from prodromal symptomatology, and to develop phase-specific interventions that titrate the risk of intervention to the risk of transition to mania and to functional impairment or distress. Moreover, studies are needed that determine potential differences in prodromal symptoms and trajectories between children, adolescents, and adults, and the best phase-specific interventions.
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Affiliation(s)
- Marta Hauser
- Improve Care, Reduce Costs ICRC Project, The Zucker Hillside Hospital, Division of Psychiatry Research, Glen Oaks, New York, USA
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Schimmelmann BG, Walger P, Schultze-Lutter F. The significance of at-risk symptoms for psychosis in children and adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:32-40. [PMID: 23327754 DOI: 10.1177/070674371305800107] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided.
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Affiliation(s)
- Benno Graf Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.
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Links PS, Eynan R. The relationship between personality disorders and Axis I psychopathology: deconstructing comorbidity. Annu Rev Clin Psychol 2012; 9:529-54. [PMID: 23157449 DOI: 10.1146/annurev-clinpsy-050212-185624] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this review is (a) to study and systematically review the recent literature examining the co-occurrence and relationships between Axis I psychiatric disorders and Axis II personality disorders, specifically the six originally proposed for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, and (b) to consider the clinical utility of the current Axis I and Axis II approach in the DSM-IV-TR and apply findings to state a position on the issue of collapsing together Axis I and Axis II. Community surveys or prospective cohort studies were reviewed as a priority. Our review indicates that the associations between clinical disorders and personality disorders clearly varied within each disorder and across the six personality disorders. Our understanding has advanced, particularly related to the clinical utility of comorbidity, and there may be sufficient evidence to support moving borderline personality disorder to Axis I. However, it seems premature to conclude that comorbidity is best conceptualized by having all disorders in a single category or by deleting disorders so that comorbidity is reduced. Our review suggests some priorities for future research into comorbidity, such as including personality disorders in future multivariate comorbidity models.
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Affiliation(s)
- Paul S Links
- Department of Psychiatry, The University of Western Ontario, London, ON N6A 5W9 Canada.
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Schultze-Lutter F, Schimmelmann BG, Klosterkötter J, Ruhrmann S. Comparing the prodrome of schizophrenia-spectrum psychoses and affective disorders with and without psychotic features. Schizophr Res 2012; 138:218-22. [PMID: 22551680 DOI: 10.1016/j.schres.2012.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 03/21/2012] [Accepted: 04/02/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Following encouraging results in the early detection of psychotic disorders, interest in the early detection of affective, especially bipolar disorders, has recently been renewed. However, the differentiation between affective disorders with and without psychotic features is often missing, although it has been suggested that affective disorders with psychotic features may be distinct from those without psychotic features and closely linked to non-affective psychoses. METHODS We compared the prodromal symptoms of patients who had sought help at an early detection center; had been assessed at baseline with the Structured Interview for Prodromal Syndromes (SIPS); and who, within 53 months on average, developed schizophrenia-spectrum psychosis (pre-SCZ; n=51), affective disorder with psychotic features (pre-AD-P; n=7), or affective disorder without psychotic features (pre-AD-noP; n=16). RESULTS While pre-SCZ scored slightly higher on most positive symptoms than pre-AD, pre-AD-P and pre-SCZ scored comparably across the SIPS; moreover, pre-AD-noP and pre-SCZ differed on most subscales and items, particularly on the positive and negative dimensions. Furthermore, pre-AD-P scored higher on positive symptoms than pre-AD-noP. CONCLUSIONS Our results suggest that, in the early detection of affective disorders, those that might take on a psychotic form and those with a non-psychotic course need to be considered separately. While the current at-risk criteria for psychosis function well in detecting those with a psychotic course, those with a non-psychotic course would benefit from the development and evaluation of new at-risk criteria and new early detection instruments.
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Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland.
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Cognitive changes following antidepressant or antipsychotic treatment in adolescents at clinical risk for psychosis. Schizophr Res 2012; 137:110-7. [PMID: 22377102 PMCID: PMC3752907 DOI: 10.1016/j.schres.2012.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 02/06/2012] [Accepted: 02/08/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improving neurocognitive abilities is a treatment priority in schizophrenia, however, pharmacological efforts to enhance deficits after illness onset have resulted in quite modest results that are of questionable clinical meaningfulness. Individuals at clinical risk for psychosis demonstrate neurocognitive impairments intermediate to the level of deficits observed in schizophrenia and normative performance, suggesting that a similar magnitude of improvement might result in more clinically meaningful change. In this study, we examined neurocognitive changes after six months of treatment in adolescents with clinical signs of risk for psychosis. METHODS Adolescents who were referred to the Recognition and Prevention program, which is focused on treatment and research for individuals at a clinical high risk for psychosis, were followed in a naturalistic treatment design. At study entry and approximately six months after starting treatment, we examined neuropsychological functioning and clinical symptoms for patients who remained off medications (OFF; N=27), started selective serotonin reuptake inhibitor antidepressant medication (AD; N=15), or started a second-generation antipsychotic medication (AP; N=11) within three months of study entry. We also included a locally recruited healthy comparison group (HC; N=17). RESULTS The clinical groups were not significantly different on baseline demographic, neurocognitive, or clinical symptom measures. Linear mixed models were used to examine cognitive changes, with time between assessments, depressive symptom severity, and attenuated positive symptom severity as random effects. Group by time effects were observed in sustained attention and verbal learning, with the AD group showing a more favorable response than the AP group. The AD group's improvements were not significantly different from the HC or OFF group. CONCLUSION Early intervention for those at clinical high risk for psychosis may result in neurocognitive improvements. These improvements were observed for those prescribed antidepressant, but not antipsychotic medications even though the groups did not differ in clinical symptom severity or treatment response.
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González-Isasi A, Echeburúa E, Limiñana JM, González-Pinto A. Predictors of good outcome in patients with refractory bipolar disorder after a drug or a drug and cognitive-behavioral treatment. Compr Psychiatry 2012; 53:224-9. [PMID: 21658693 DOI: 10.1016/j.comppsych.2011.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of the present research study was to analyze the variables involved in the favorable prognosis of patients with refractory bipolar disorder after a drug or a drug and cognitive-behavioral treatment. METHODS A sample of 40 patients was divided into 2 groups: (1) combined drug plus psychoeducational and cognitive-behavioral treatment or (2) drug treatment only (control group). We used a multigroup design with repeated measures at different times (baseline, posttreatment, 6-month follow-up, and 12-month follow-up) to evaluate the following variables: age, sex, number of hospitalizations, type of treatment, mania (Young Mania Rating Scale, or YMRS) and depression (Beck Depression Index, or BDI) symptoms, subsyndromal symptoms (BDI >7; YMRS >6), global suffering index, general index of social ability, self-esteem (Rosenberg scale), inadaptation (inadaptation Scale), anxiety (State-Trait Anxiety Inventory), quality of life (Global Activity Functioning), and health (European Quality of Life Scale). We considered favorable prognosis for subjects without persistent affective symptoms (BDI <7; YMRS <6) and/or without relevant difficulties in adaptation (Inadaptation Scale <14) in a 12-month follow-up. RESULTS A binary logistic regression showed that the type of treatment (combined therapy corresponded to better progression), the number of prior hospitalizations (fewer hospitalizations corresponded to better progression), and self-esteem (higher self-esteem corresponded to better prognosis) were statistically significant. CONCLUSIONS The type of treatment, the number of prior hospitalizations, and the level of self-esteem were the most influencing factors for a favorable progression of refractory bipolar disorder. Differently from other studies, no significant influences of age, sex, subsyndromal symptoms, anxiety, and depression symptoms on the prognosis of refractory bipolar disorder were observed in our study.
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Affiliation(s)
- Ana González-Isasi
- Servicio de Psiquiatría, Complejo Hospitalario Universitario Materno-Infantil de Gran Canaria, Las Palmas, Spain.
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Leopold K, Ritter P, Correll CU, Marx C, Özgürdal S, Juckel G, Bauer M, Pfennig A. Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool. J Affect Disord 2012; 136:1000-10. [PMID: 21802741 DOI: 10.1016/j.jad.2011.06.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/28/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND The precise characterisation of a high risk status for the development of a psychiatric disorder and the question of how well this predicts disease manifestation is of major importance as negative consequences of late diagnosis and treatment have been well demonstrated. In the absence of well defined and disease specific biological markers for bipolar disorder, the recognition of premature stages must rely on combinations of risk factors that have been associated with later disease manifestation. METHODS A review of the literature and our experience from the Early Recognition Centre led us to identify symptom constellations. RESULTS Individual categories defined and grouped included: (I) genetic risk, (II) substance use, misuse or dependence, (III) diagnosis/suspected diagnosis of attention deficit hyperactivity disorder, (IV) pronounced creativity, (V) impairment in psychosocial functioning, (VI) subthreshold affective symptoms, and (VII) early symptomatology including (a) changes in sleep and circadian rhythm, (b) changes in mood, mood swings/affective lability, (c) fearfulness/anxiety, and (d) dissociative symptoms. These risk constellations were operationalised and a new risk assessment instrument, the Early Phase Inventory for Bipolar Disorders (EPIbipolar) was developed. LIMITATIONS Challenges regarding the validity of the data on which the instrument is based, specificity of and correlations between risk categories, and ethical considerations were encountered. CONCLUSIONS Further use of EPIbipolar in research should help to refine prodromal features and narrow these down to a less cumbersome core that can be used to develop a shortened tool for use in clinical care. Prospective longitudinal research is needed to establish the predictive validity of this novel bipolar disorder risk assessment tool.
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Affiliation(s)
- Karolina Leopold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
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Convergent and discriminant validity of attenuated psychosis screening tools. Schizophr Res 2012; 134:49-53. [PMID: 22036199 DOI: 10.1016/j.schres.2011.10.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/29/2011] [Accepted: 10/03/2011] [Indexed: 11/22/2022]
Abstract
Brief self-report questionnaires that assess attenuated psychotic symptoms have the potential to screen many people who may benefit from clinical monitoring, further evaluation, or early intervention. The extent to which recently developed screening instruments demonstrate sound psychometric properties is an important issue toward the implementation of these measures in clinical practice. This study examines the convergent validity, discriminant validity, and test-retest reliability of four recently developed screening instruments. Screening instruments were included in an assessment battery and administered to a sample of 355 college students. Screening scores support the convergent and discriminant validity and the test-retest reliability of these measures.
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Early detection and intervention in bipolar affective disorder: targeting the development of the disorder. Curr Psychiatry Rep 2011; 13:493-9. [PMID: 21850462 PMCID: PMC3836252 DOI: 10.1007/s11920-011-0229-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The diagnosis of bipolar affective disorder (BD) is often delayed, and preceded by incorrect diagnoses and potentially harmful treatment, while the development of the disorder is associated with suicidal behavior and help seeking. Several clinical features have been linked to an increased risk of going on to develop BD, in particular attenuated symptoms of BD, personality traits such as cyclothymia, and general psychopathologic symptoms. Several of these show high specificity, indicating that it may be possible to target detection and intervention in individuals at high risk of BD and perhaps moderate the course of the illness and improve treatment outcome. This article summarizes recent evidence on the characteristics of the prodrome to BD and discusses the potential value and challenges of early detection and intervention in BD.
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Korver-Nieberg N, Quee PJ, Boos HB, Simons CJ. The validity of the DSM-IV diagnostic classification system of non-affective psychoses. Aust N Z J Psychiatry 2011; 45:1061-8. [PMID: 22026404 DOI: 10.3109/00048674.2011.620562] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The schizophrenia and other non-affective disorders categories listed in the DSM-IV, are currently under revision for the development of the fifth edition. The aim of the present study is to demonstrate the validity of these categories by investigating possible differences between diagnostic patient subgroups on various measures. METHODS 1064 patients with a diagnosis of non-affective psychosis (schizophrenia N = 731 (paranoid type 82%), schizoaffective N = 63, schizophreniform N = 120, psychosis not otherwise specified/brief psychotic disorder N = 150) participated in this study. Dependent variables were demographic and clinical characteristics, severity of psychopathology, premorbid and current functioning, and indicators of quality of life. RESULTS Within the diagnostic group of schizophrenia, no significant differences were observed between paranoid schizophrenia, disorganized, and undifferentiated schizophrenia. Patients with schizophrenia experienced more severe psychopathology and had poorer levels of current functioning compared to patients with psychosis not otherwise specified or brief psychotic disorder. Differences between schizophrenia and schizoaffective disorder were less clear. CONCLUSION Our results do not support the validity of schizophrenia subtypes. Schizophrenia can be distinguished from brief psychotic disorder and psychotic disorder not otherwise specified. These findings may fuel the actual DSM-V discussion.
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Affiliation(s)
- Nikie Korver-Nieberg
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
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Taylor M, Bressan RA, Pan PM, Brietzke E. Early intervention for bipolar disorder: current imperatives, future directions. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 33 Suppl 2:s197-212. [DOI: 10.1590/s1516-44462011000600006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES: The objective of this article is to discuss the rationale/background for early intervention in bipolar disorder. METHOD: Narrative review. RESULTS: There are often significant delays before the diagnosis of bipolar disorder is made and effective management initiated. Growing evidence from both preclinical and clinical literature points to a clear need for improved early identification and early intervention in bipolar disorder. Increasing efforts are being applied to the identification of those at high risk of onset of bipolar disorder. It is hoped that identification of an early prodrome of illness will allow preventative measures to be taken. CONCLUSIONS: There is a clear rationale for improved early identification and early intervention in bipolar disorder.
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Affiliation(s)
| | | | | | - Elisa Brietzke
- Universidade Federal de São Paulo, Brazil; Universidade Federal de São Paulo, Brazil
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Howes OD, Lim S, Theologos G, Yung AR, Goodwin GM, McGuire P. A comprehensive review and model of putative prodromal features of bipolar affective disorder. Psychol Med 2011; 41:1567-1577. [PMID: 20836910 PMCID: PMC3687203 DOI: 10.1017/s0033291710001790] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identifying prodromal features that predate the onset of bipolar disorder (BD) may enable the prevention of BD and aid early intervention. This review addresses two key questions: Is there a bipolar prodrome? And, if there is, what are its characteristic features? METHOD A comprehensive search of databases (PubMed, Medline, EMBASE and PsycINFO) supplemented by hand searches was used to identify studies of symptoms preceding the onset of BD. RESULTS Fifty-nine studies were identified, of which 14 met inclusion criteria. Symptoms can predate the onset of BD by months to years and can be categorized as attenuated forms of BD symptoms, general symptoms common to a range of mental disorders, and personality traits, particularly cyclothymia. Two studies provided sufficient data to enable sensitivity and specificity to be calculated. Specificity of several of the features was high (>90%) but sensitivity was generally low (all <60%). We propose a model based on the findings in the studies reviewed to illustrate the potential trajectory to BD and the points at which it may be possible to intervene. CONCLUSIONS Clinical features preceding the onset of BD can be identified. However, conclusions about whether there is a distinct prodrome to BD are restricted by the limitations of current evidence. The high specificity of some features suggests they may be useful in clinical practice. Large-scale longitudinal studies are needed to validate these features and characterize their specificity and sensitivity in independent samples.
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Affiliation(s)
- O D Howes
- Psychiatric Imaging Group, MRC Clinical Sciences Centre, Imperial College Hammersmith Campus, London, UK.
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Salvatore P, Baldessarini RJ, Tohen M, Khalsa HMK, Sanchez-Toledo JP, Zarate CA, Vieta E, Maggini C. McLean-Harvard International First-Episode Project: two-year stability of ICD-10 diagnoses in 500 first-episode psychotic disorder patients. J Clin Psychiatry 2011; 72:183-93. [PMID: 20673546 PMCID: PMC3404810 DOI: 10.4088/jcp.09m05311yel] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 08/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Because clinical and biologic research and optimal clinical practice require stability of diagnoses over time, we determined stability of ICD-10 psychotic disorder diagnoses and sought predictors of diagnostic instability. METHOD Patients from the McLean-Harvard International First-Episode Project, conducted from 1989 to 2003, who were hospitalized for first psychotic illnesses (N = 500) were diagnosed by ICD-10 criteria at baseline and 24 months, on the basis of extensive prospective assessments, to evaluate the longitudinal stability of specific categorical diagnoses and predictors of diagnostic change. RESULTS Diagnostic stability averaged 90.4%, ranking as follows: schizoaffective disorder (100.0%) > mania with psychosis (99.0%) > mixed affective episode (94.9%) > schizophrenia (94.6%) > delusional disorder (88.2%) > severe depressive episode with psychotic symptoms (85.2%) > acute psychosis with/without schizophrenia symptoms = unspecified psychosis (all 66.7%) >> acute schizophrenia-like psychosis (28.6%). Diagnoses changed by 24 months of follow-up to schizoaffective disorder (37.5%), bipolar disorder (25.0%), schizophrenia (16.7%), or unspecified nonorganic psychosis (8.3%), mainly through emerging affective features. By logistic regression, diagnostic change was associated with Schneiderian first-rank psychotic symptoms at intake > lack of premorbid substance use. CONCLUSIONS We found some psychotic disorder diagnoses to be more stable by ICD-10 than DSM-IV criteria in the same patients, with implications for revisions of both diagnostic systems.
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Affiliation(s)
- Paola Salvatore
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, Massachusetts, USA.
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Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2010; 32:515-528. [PMID: 21116455 DOI: 10.1007/s10862-010-9183-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cluster A personality disorders (PD), including schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD, are marked by odd and eccentric behaviors, and are grouped together because of common patterns in symptomatology as well as shared genetic and environmental risk factors. The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits, and much of what is understood about Cluster A personality disorders in particular stems from research with adult populations. Less in known about these disorders in children and adolescents, and controversy remains regarding diagnosis of personality disorders in general in youth. The current paper reviews the available research on Cluster A personality disorders in childhood and adolescence; specifically, we discuss differentiating between the three disorders and distinguishing them from other syndromes, measuring Cluster A disorders in youth, and the nature and course of these disorders throughout childhood and adolescence. We also present recent longitudinal data from a sample of adolescents diagnosed with Cluster A personality disorders from our research laboratory, and suggest directions for future research in this important but understudied area.
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Correll CU, Hauser M, Auther AM, Cornblatt BA. Research in people with psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry 2010; 51:390-431. [PMID: 20214698 PMCID: PMC3085111 DOI: 10.1111/j.1469-7610.2010.02235.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
After decades of research, schizophrenia and related psychotic disorders are still among the most debilitating disorders in medicine. The chronic illness course in most individuals, greater treatment responsiveness during the first episode, progressive gray matter decline during early disease stages, and retrospective accounts of 'prodromal' or early illness signs and symptoms formed the basis for research on the psychosis risk syndrome (PRS), known variably as 'clinical high risk' (CHR), or 'ultra-high risk' (UHR), or 'prodromal'. The pioneering era of research on PRS focused on the development and validation of specific assessment tools and the delineation of high risk criteria. This was followed by the examination of conversion rates in psychosis risk cohorts followed naturalistically, identification of predictors of conversion to psychosis, and investigation of interventions able to abort or delay the development of full psychosis. Despite initially encouraging results concerning the predictive validity of PRS criteria, recent findings of declining conversion rates demonstrate the need for further investigations. Results from intervention studies, mostly involving second-generation antipsychotics and cognitive behavioral therapy, are encouraging, but are currently still insufficient to make treatment recommendations for this early, relatively non-specific illness phase. The next phase of research on PRS, just now beginning, has moved to larger, 'multisite' projects to increase generalizability and to ensure that sufficiently large samples at true risk for psychosis are included. Emphasis in these emerging studies is on: 1) identification of biomarkers for conversion to psychosis; 2) examination of non-antipsychotic, neuroprotective and low-risk pharmacologic and non-pharmacologic interventions; 3) testing of potentially phase-specific interventions; 4) examination of the relationship between treatment response during PRS and prognosis for the course of illness; 5) follow-up of patients who developed schizophrenia despite early interventions and comparison of illness trajectories with patients who did not receive early interventions; 6) characterization of individuals with outcomes other than schizophrenia-spectrum disorders, such as bipolar disorder and remission from PRS, including false positive cases; and 7) assessment of meaningful social and role functioning outcomes. While the research conducted to date has already yielded crucial information, the translation of the concept of a clinically identifiable PRS into clinical practice does not seem justified at this point.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, New York 11004, USA.
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Shrivastava A, Shah N, Johnston M, Stitt L, Thakar M, Chinnasamy G. Effects of duration of untreated psychosis on long-term outcome of people hospitalized with first episode schizophrenia. Indian J Psychiatry 2010; 52:164-7. [PMID: 20838506 PMCID: PMC2927888 DOI: 10.4103/0019-5545.64583] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.
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Affiliation(s)
- Amresh Shrivastava
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada; and Lawson Health Research Institute, London, Ontario, Canada
| | - Nilesh Shah
- LTMG Hospital, University of Mumbai, Sion, Mumbai-400 022, Maharashtra, India
| | - Megan Johnston
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Larry Stitt
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, N6A 5C1, Canada
| | - Meghana Thakar
- Mental Health Foundation of India (PRERANA Charitable Trust) and Silver Mind Hospital, 209 Shivkripa Complex, Gokhale Road, Thane, Mumbai-400 602, Maharashtra, India
| | - Gurusamy Chinnasamy
- novaNAIT - Centre for Applied Research and Technology Transfer, The Northern Alberta Institute of Technology, 10504 Princess Elizabeth Avenue, Edmonton, Alberta, Canada T5G 3K4
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Fakra E, Kaladjian A, Da Fonseca D, Maurel M, Adida M, Besnier N, Pringuey D, Azorin JM. Phase prodromale du trouble bipolaire. Encephale 2010; 36 Suppl 1:S8-12. [DOI: 10.1016/s0013-7006(10)70003-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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