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Shah JL, Tandon N, Montrose DM, Mermon D, Eack SM, Miewald J, Keshavan MS. Clinical psychopathology in youth at familial high risk for psychosis. Early Interv Psychiatry 2019; 13:297-303. [PMID: 28880494 PMCID: PMC5897185 DOI: 10.1111/eip.12480] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 05/28/2017] [Accepted: 07/11/2017] [Indexed: 12/16/2022]
Abstract
AIM While the course of psychopathology has been explored from an index mental health diagnosis onwards, there are few detailed, prospective studies of the occurrence of clinical psychopathology in youth with familial risk for severe mental illnesses such as psychosis. We sought to describe the appearance of Axis I psychopathology in a unique sample of adolescents with a family history of schizophrenia (FHR). METHODS One hundred and sixty two first- and second-degree relatives (mean age 15.7 ± 3.6; range 8-25) of probands with schizophrenia or schizoaffective disorder were assessed at baseline and annual intervals for up to 3 years, focusing on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Axis I psychopathology. RESULTS Fourteen individuals (8.6%) developed a psychotic disorder. One hundred and five subjects (65%) met criteria for an Axis I disorder over the course of the study, the most common of which was a depressive episode (40 subjects; 25%). Of the 148 individuals who did not develop psychosis, 91 (61%) had one or more Axis I disorders compared with 10/14 converters who had a comorbid Axis I disorder (71%). Ordered by increasing age of onset, diagnoses included cognitive and externalizing disorders, anxiety disorders, affective disorders, substance use disorders and psychotic disorders. CONCLUSIONS In addition to an elevated risk of psychosis, young FHR relatives manifest a broad range of non-psychotic Axis I psychopathology in childhood and adolescence. This breadth of diagnoses has implications for the structure and function of mental health services for young people.
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Affiliation(s)
- Jai L Shah
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,PEPP-Montréal, Douglas Mental Health University Institute, Montréal, Canada.,Department of Psychiatry, McGill University, Montréal, Canada
| | - Neeraj Tandon
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Baylor College of Medicine, Houston, Texas
| | - Debra M Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diana Mermon
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shaun M Eack
- University of Pittsburgh School of Social Work, Pittsburgh, Pennsylvania
| | - Jean Miewald
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matcheri S Keshavan
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Masucci MD, Lister A, Corcoran CM, Brucato G, Girgis RR. Motor Dysfunction as a Risk Factor for Conversion to Psychosis Independent of Medication Use in a Psychosis-Risk Cohort. J Nerv Ment Dis 2018; 206:356-361. [PMID: 29561299 PMCID: PMC5899031 DOI: 10.1097/nmd.0000000000000806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Structured Interview for Psychosis-Risk Syndromes (SIPS) contains criteria for the Attenuated Positive Symptom Syndrome (APSS), a period of subthreshold positive symptoms that predates full-blown psychosis. Motor abnormalities are often associated with these symptoms but have not been adequately studied. We assessed a diverse sample of 192 APSS participants (27.1% female; 47.9% white; mean age = 20.03 years) for motor dysfunction (SIPS G.3. score) at baseline and conversion to psychosis every 3 months for up to 2 years. Fifty-nine (30.7%) participants converted to psychosis. Baseline G.3. score was significantly higher among converters than nonconverters (mean difference = 0.66; t[95.929] = 2.579, p < 0.05). No significant differences in baseline G.3. were found between demographic groups or those with differential medication use. These results point to the use of G.3. as a potential predictor of psychosis among APSS individuals and potentially implicate the shared biological underpinnings of motor dysfunction in the APSS and full-blown psychotic illnesses.
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Affiliation(s)
- Michael D. Masucci
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA,Corresponding author: Michael Masucci, Mailing Address: 643 West 172nd St., 56, New York, NY 10032., Phone: (315) 281-7205,
| | - Amanda Lister
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Cheryl M. Corcoran
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Gary Brucato
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Ragy R. Girgis
- The Center of Prevention and Evaluation, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY, 10032, USA
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Gill KE, Evans E, Kayser J, Ben-David S, Messinger J, Bruder G, Malaspina D, Corcoran CM. Smell identification in individuals at clinical high risk for schizophrenia. Psychiatry Res 2014; 220:201-4. [PMID: 25066961 PMCID: PMC4252491 DOI: 10.1016/j.psychres.2014.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/13/2014] [Accepted: 07/09/2014] [Indexed: 01/24/2023]
Abstract
Smell identification deficits exist in schizophrenia, and may be associated with its negative symptoms. Less is known about smell identification and its clinical correlates in individuals at clinical high risk (CHR) for schizophrenia and related psychotic disorders. We examined smell identification, symptoms and IQ in 71 clinical high-risk (CHR) subjects and 36 healthy controls. Smell identification was assessed using both the 40-item University of Pennsylvania Smell Identification Test (UPSIT; Doty, R.L., Shaman, P., Kimmelman, C.P., Dann, M.S., 1984. University of Pennsylvania Smell Identification Test: a rapid quantitative olfactory function test for the clinic. Laryngoscope 94, 176-178) and its extracted 12-item Brief Smell Identification Test (Goudsmit, N., Coleman, E., Seckinger, R.A., Wolitzky, R., Stanford, A.D., Corcoran, C., Goetz, R.R., Malaspina, D., 2003. A brief smell identification test discriminates between deficit and non-deficit schizophrenia. Psychiatry Research 120, 155-164). Smell identification did not significantly differ between CHR subjects and controls. Among CHR subjects, smell identification did not predict schizophrenia (N=19; 27%) within 2 years, nor was it associated with negative or positive symptoms. This is the third prospective cohort study to examine smell identification in CHR subjects, and overall, findings are inconclusive, similar to what is found for other disorders in adolescents, such as autism spectrum, attention deficit and anxiety disorders. Smell identification deficit may not have clear utility as a marker of emergent schizophrenia and related psychotic disorders.
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Affiliation(s)
- Kelly Elizabeth Gill
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Elizabeth Evans
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jürgen Kayser
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | | | - Julie Messinger
- Department of Psychiatry, New York University, New York, NY, USA
| | - Gerard Bruder
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | | | - Cheryl Mary Corcoran
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Haglund M, Cabaniss D, Kimhy D, Corcoran CM. A case report of cognitive behavioural therapy for social anxiety in an ultra-high risk patient. Early Interv Psychiatry 2014; 8:176-80. [PMID: 23734668 PMCID: PMC3887124 DOI: 10.1111/eip.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 03/23/2013] [Indexed: 11/30/2022]
Abstract
AIM Psychological treatments such as cognitive behavioural therapy (CBT) may have efficacy in young people at ultra-high risk (UHR) for psychosis. Case reports can illuminate the obstacles and challenges, and potential trajectory of symptom changes, observed with this treatment. METHODS This is a detailed case report of a young adult at UHR for psychosis who received manualized CBT for accompanying social anxiety. RESULTS Cognitive deficits and suspiciousness created initial challenges for successful implementation of CBT. Engagement in treatment occurred with slowing of pace and simplification of material, and modelling of social interaction. Treatment of social anxiety was accompanied by decreases in suspiciousness, conceptual disorganization, and social anhedonia, and increase in range of affect. CONCLUSIONS Adaptation of manualized CBT to accommodate cognitive deficits and suspiciousness in UHR patients may improve engagement. CBT focused on social anxiety can lead to improvement across symptom domains in UHR patients.
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Affiliation(s)
- Margaret Haglund
- Department of Psychiatry, New York State Psychiatric Institute at Columbia University, New York, New York, USA
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Welsh P, Tiffin PA. The 'at-risk mental state' for psychosis in adolescents: clinical presentation, transition and remission. Child Psychiatry Hum Dev 2014; 45:90-8. [PMID: 23584729 DOI: 10.1007/s10578-013-0380-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite increased efforts over the last decade to prospectively identify individuals at ultra-high risk of developing a psychotic illness, limited attention has been specifically directed towards adolescent populations (<18 years). In order to evaluate how those under 18 fulfilling the operationalised criteria for an At-Risk Mental State (ARMS) present and fare over time, we conducted an observational study. Participants (N = 30) generally reported a high degree of functional disability and frequent and distressing perceptual disturbance, mainly in the form of auditory hallucinations. Seventy percent (21/30) were found to fulfil the criteria for a co-morbid ICD-10 listed mental health disorder, with mood (affective; 13/30) disorders being most prevalent. Overall transition rates to psychosis were low at 24 months follow-up (2/28; 7.1 %) whilst many participants demonstrated a significant reduction in psychotic-like symptoms. The generalisation of these findings may be limited due to the small sample size and require replication in a larger sample.
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Affiliation(s)
- Patrick Welsh
- School for Health, The Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, TS17 6BH, UK,
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Tiffin PA, Welsh P. Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches. J Child Psychol Psychiatry 2013; 54:1155-75. [PMID: 24102356 DOI: 10.1111/jcpp.12136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. METHODS This article reviews the literature relating to the assessment and management of 'at-risk mental states' (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970-December 2012. RESULTS Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. CONCLUSIONS A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying those at high risk for a variety of poor outcomes who may benefit most from intervention. There is also an urgent need for age-specific research in the area of psychosocial treatments for children and adolescents with schizophrenia.
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Affiliation(s)
- Paul A Tiffin
- School for Medicine, Pharmacy & Health, The Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, UK
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Yang LH, Anglin DM, Wonpat-Borja AJ, Opler MG, Greenspoon M, Corcoran CM. Public stigma associated with psychosis risk syndrome in a college population: implications for peer intervention. Psychiatr Serv 2013; 64:284-8. [PMID: 23450386 PMCID: PMC3672401 DOI: 10.1176/appi.ps.003782011] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study compared stigma associated with the psychosis risk label and diagnostic labels for nonpsychotic and psychotic mental disorders among young adult peers. METHODS Urban college respondents (N=153) read an experimental vignette describing a young adult experiencing prodromal symptoms who was randomly assigned a diagnostic label (major depression, generalized anxiety disorder, schizophrenia, or psychosis risk with and without accurate information about the psychosis risk label) and answered questions about stigma toward the individual in the vignette. RESULTS Compared with labels for nonpsychotic disorders, schizophrenia elicited more negative stereotyping and the at-risk label invoked greater social distance and less willingness to help. Any increased social distance appeared to be reduced by accurate information about the at-risk state. No differences in stigma were found for the psychosis risk and schizophrenia labels. CONCLUSIONS The psychosis risk label alone appeared to evoke greater status loss and discrimination. Accurate information may minimize some stigmatizing attitudes among college peers.
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Affiliation(s)
- Lawrence H Yang
- Department of Epidemiology, Columbia University, New York, NY 10032, USA.
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Algon S, Yi J, Calkins ME, Kohler C, Borgmann-Winter KE. Evaluation and treatment of children and adolescents with psychotic symptoms. Curr Psychiatry Rep 2012; 14:101-10. [PMID: 22350543 PMCID: PMC3500659 DOI: 10.1007/s11920-012-0258-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In recent years, there have been increasing efforts to develop early detection and prevention strategies for patients at risk of the development of psychotic disorders. These efforts have led to improved recognition and characterization of psychotic symptoms in youth. This review focuses on the evaluation of children and adolescents with psychotic symptoms who are experiencing functional impairment but who do not meet current criteria for schizophrenia. For this article, emphasis is placed on the evaluation of symptoms, differential diagnosis, and consideration of potential interventions.
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Affiliation(s)
- Sibel Algon
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, 2216 TRL, 25 South 31st Street, Philadelphia, PA 19104-3403, USA
| | - James Yi
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, 2216 TRL, 25 South 31st Street, Philadelphia, PA 19104-3403, USA
| | - Monica E. Calkins
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, 2216 TRL, 25 South 31st Street, Philadelphia, PA 19104-3403, USA
| | - Christian Kohler
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, 2216 TRL, 25 South 31st Street, Philadelphia, PA 19104-3403, USA
| | - Karin E. Borgmann-Winter
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania, 2216 TRL, 25 South 31st Street, Philadelphia, PA 19104-3403, USA
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Jandl M, Steyer J, Kaschka WP. Adolescent attention deficit hyperactivity disorder and susceptibility to psychosis in adulthood: a review of the literature and a phenomenological case report. Early Interv Psychiatry 2012; 6:11-20. [PMID: 21895990 DOI: 10.1111/j.1751-7893.2011.00293.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM In contrast to affective disorders, some forms of personality disorders and drug addiction, schizophrenia is commonly not considered to be a sequela of attention deficit hyperactivity disorder. However, attention deficit hyperactivity disorder and the prodromal stages of schizophrenia spectrum disorders do exhibit a number of common central features. To facilitate the early treatment of schizophrenic symptoms, the detection of discrete and subtle alterations in the prodromal stages of incipient psychoses is particularly important. METHODS We review the literature on the prodromal symptoms of psychosis and present a case report, in which a phenomenological approach was used to identify subtle alterations linked to anomalous self-experience. RESULTS Using the Examination of Anomalous Self-Experience symptom checklist, the case report presented here reveals attention deficit hyperactivity disorder symptoms in adolescence as a precursor state of psychosis in adulthood. CONCLUSIONS The characteristics of this schizophrenia spectrum disorder case and its time course are derived from the specific distribution pattern of Examination of Anomalous Self-Experience items. When treating adolescent attention deficit hyperactivity disorder patients, the rare possibility of the development of schizophrenia spectrum disorder from attention deficit hyperactivity disorder like symptoms should be kept in mind.
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Affiliation(s)
- Martin Jandl
- Department of Psychiatry and Psychotherapy I, University Hospital Ulm, Ravensburg, Germany.
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