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Boldrini T, Lo Buglio G, Cerasti E, Pontillo M, Muzi L, Salcuni S, Polari A, Vicari S, Lingiardi V, Solmi M. Clinical utility of the at-risk for psychosis state beyond transition: A multidimensional network analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02491-x. [PMID: 38896144 DOI: 10.1007/s00787-024-02491-x] [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: 11/15/2023] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
To be relevant to healthcare systems, the clinical high risk for psychosis (CHR-P) concept should denote a specific (i.e., unique) clinical population and provide useful information to guide the choice of intervention. The current study applied network analyses to examine the clinical specificities of CHR-P youths compared to general help-seekers and non-CHR-P youth. 146 CHR-P (mean age = 14.32 years) and 103 non-CHR-P (mean age = 12.58 years) help-seeking youth were recruited from a neuropsychiatric unit and assessed using the Structured Interview for Psychosis-Risk Syndromes, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, Global Functioning: Social, Global Functioning: Role, and Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale. The first network structure comprised the entire help-seeking sample (i.e., help-seekers network), the second only CHR-P patients (i.e., CHR-P network), and the third only non-CHR-P patients (i.e., non-CHR-P network). In the help-seekers network, each variable presented at least one edge. In the CHR-P network, two isolated "archipelagos of symptoms" were identified: (a) a subgraph including functioning, anxiety, depressive, negative, disorganization, and general symptoms; and (b) a subgraph including positive symptoms and the intelligence quotient. In the non-CHR-P network, positive symptoms were negatively connected to functioning, disorganization, and negative symptoms. Positive symptoms were less connected in the CHR-P network, indicating a need for specific interventions alongside those treating comorbid disorders. The findings suggest specific clinical characteristics of CHR-P youth to guide the development of tailored interventions, thereby supporting the clinical utility of the CHR-P concept.
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Affiliation(s)
- Tommaso Boldrini
- Department of Psychology and Educational Science, Pegaso Telematic University, Naples, Italy
| | - Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Erika Cerasti
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Stefano Vicari
- Child Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Lho SK, Kim T, Moon SY, Kim M, Kwon JS. Alteration in left frontoparietal connectivity correlates with impaired cognitive reappraisal in early psychosis. Schizophr Res 2024; 267:130-137. [PMID: 38531160 DOI: 10.1016/j.schres.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Impaired cognitive reappraisal is a notable symptom of early psychosis, but its neurobiological basis remains underexplored. We aimed to identify the underlying neurobiological mechanism of this impairment by using resting-state functional connectivity (FC) analyses focused on brain regions related to cognitive reappraisal. METHODS Resting-state functional magnetic resonance images were collected from 36 first-episode psychosis (FEP) patients, 32 clinical high-risk (CHR) individuals, and 48 healthy controls (HCs). Whole-brain FC maps using seed regions associated with cognitive reappraisal were generated and compared across the FEP, CHR and HC groups. We assessed the correlation between resting-state FC, reappraisal success ratio, positive symptom severity and social functioning controlling for covariates. RESULTS FEP patients showed higher FC between the left superior parietal lobe and left inferior frontal gyrus than HCs. Higher FC between the left superior parietal lobe and left inferior frontal gyrus negatively correlated with the reappraisal success ratio in the FEP group after controlling for covariates. Lower FC correlated with lower positive symptom severity and improved global functioning in the FEP group. CONCLUSIONS Alteration in left frontoparietal connectivity reflects impaired cognitive reappraisal in early psychosis, and such alteration correlates with increased positive symptoms and decreased global functioning. These findings offer a potential path for interventions targeting newly emerging symptoms in the early stages of psychosis.
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Affiliation(s)
- Silvia Kyungjin Lho
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sun-Young Moon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Public Health Service, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jun Soo Kwon
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Livingston NR, Kiemes A, Devenyi GA, Knight S, Lukow PB, Jelen LA, Reilly T, Dima A, Nettis MA, Casetta C, Agyekum T, Zelaya F, Spencer T, De Micheli A, Fusar-Poli P, Grace AA, Williams SCR, McGuire P, Egerton A, Chakravarty MM, Modinos G. Effects of diazepam on hippocampal blood flow in people at clinical high risk for psychosis. Neuropsychopharmacology 2024:10.1038/s41386-024-01864-9. [PMID: 38658738 DOI: 10.1038/s41386-024-01864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/11/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
Elevated hippocampal perfusion has been observed in people at clinical high risk for psychosis (CHR-P). Preclinical evidence suggests that hippocampal hyperactivity is central to the pathophysiology of psychosis, and that peripubertal treatment with diazepam can prevent the development of psychosis-relevant phenotypes. The present experimental medicine study examined whether diazepam can normalize hippocampal perfusion in CHR-P individuals. Using a randomized, double-blind, placebo-controlled, crossover design, 24 CHR-P individuals were assessed with magnetic resonance imaging (MRI) on two occasions, once following a single oral dose of diazepam (5 mg) and once following placebo. Regional cerebral blood flow (rCBF) was measured using 3D pseudo-continuous arterial spin labeling and sampled in native space using participant-specific hippocampus and subfield masks (CA1, subiculum, CA4/dentate gyrus). Twenty-two healthy controls (HC) were scanned using the same MRI acquisition sequence, but without administration of diazepam or placebo. Mixed-design ANCOVAs and linear mixed-effects models were used to examine the effects of group (CHR-P placebo/diazepam vs. HC) and condition (CHR-P diazepam vs. placebo) on rCBF in the hippocampus as a whole and by subfield. Under the placebo condition, CHR-P individuals (mean [±SD] age: 24.1 [±4.8] years, 15 F) showed significantly elevated rCBF compared to HC (mean [±SD] age: 26.5 [±5.1] years, 11 F) in the hippocampus (F(1,41) = 24.7, pFDR < 0.001) and across its subfields (all pFDR < 0.001). Following diazepam, rCBF in the hippocampus (and subfields, all pFDR < 0.001) was significantly reduced (t(69) = -5.1, pFDR < 0.001) and normalized to HC levels (F(1,41) = 0.4, pFDR = 0.204). In conclusion, diazepam normalized hippocampal hyperperfusion in CHR-P individuals, consistent with evidence implicating medial temporal GABAergic dysfunction in increased vulnerability for psychosis.
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Affiliation(s)
- Nicholas R Livingston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Amanda Kiemes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gabriel A Devenyi
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Samuel Knight
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Paulina B Lukow
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Luke A Jelen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Thomas Reilly
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aikaterini Dima
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Maria Antonietta Nettis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Cecilia Casetta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Tyler Agyekum
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Thomas Spencer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Andrea De Micheli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steve C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - M Mallar Chakravarty
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Gemma Modinos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
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Spiteri-Staines AE, Yung AR, Lin A, Hartmann JA, Amminger P, McGorry PD, Thompson A, Wood SJ, Nelson B. Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study. Schizophr Bull 2024:sbae005. [PMID: 38366898 DOI: 10.1093/schbul/sbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline. AIMS This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated. STUDY DESIGN The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline). RESULTS Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up. CONCLUSIONS The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.
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Affiliation(s)
- Anneliese E Spiteri-Staines
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, 161 Barry St, Carlton 3053, Australia
| | - Alison R Yung
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3320, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia
| | - Jessica A Hartmann
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Paul Amminger
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Patrick D McGorry
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Stephen J Wood
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
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5
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Sloan M, Sturner R, Addington J, Cornblatt B, Granholm E, Cadenhead KS. Negative self-reference as a component of subthreshold psychotic symptoms in clinical high-risk youth. Early Interv Psychiatry 2024. [PMID: 38334214 DOI: 10.1111/eip.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
AIM Schizophrenia is a leading cause of disability worldwide; early detection and intervention are critical. Early in their illness, individuals at clinical high-risk (CHR) for psychosis have subthreshold psychotic symptoms that are often derogatory and self-directed. We hypothesized that CHR participants with negative self-reference (NSR) as a component of subthreshold psychosis would also have higher levels of social anxiety and depression, lower self-esteem and lower social/role/global functioning as compared with CHR participants without NSR. METHODS One hundred and sixty-eight participants from the National Institute of Mental Health (NIMH) funded Regroup Cognitive Behavioural Social Skills Training (CBSST) study were included. Clinical vignettes that included the Scale of Psychosis-Risk Symptoms were coded categorically to indicate whether NSR was present. t-tests were used to determine the association between NSR, symptom, and functional measures. RESULTS Participants with NSR demonstrated significantly more social interaction anxiety (p < .001), negative beliefs about the self (p ≤ .001), defeatist beliefs (p < .05), depressive symptoms (p < .05) and positive symptoms (p < .005). There were no significant differences in social self-efficacy, positive or negative beliefs about others, positive beliefs about the self or psychosocial functioning between the two groups. CONCLUSIONS Clinically significant differences were found between CHR participants with and without NSR, suggesting that this may be a useful factor to identify and address. Follow-up studies are needed to determine whether NSR responds to CBSST and whether or not its resolution would be associated with improvement in other symptom domains.
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Affiliation(s)
- Michelle Sloan
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Rebecca Sturner
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
- Department of Child and Adolescent Psychiatry, NYU Langone Hospital, New York City, New York, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Barbara Cornblatt
- Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, New York, USA
| | - Eric Granholm
- San Diego Veterans Affairs Medical Center, Department of Psychiatry, University of California, La Jolla, California, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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Walter N, Wenzel J, Haas SS, Squarcina L, Bonivento C, Ruef A, Dwyer D, Lichtenstein T, Bastrük Ö, Stainton A, Antonucci LA, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Lencer R, Meisenzahl E, Salokangas RKR, Pantelis C, Bertolino A, Koutsouleris N, Kambeitz J, Kambeitz-Ilankovic L. A multivariate cognitive approach to predict social functioning in recent onset psychosis in response to computerized cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110864. [PMID: 37717645 DOI: 10.1016/j.pnpbp.2023.110864] [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: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/19/2023]
Abstract
Clinical and neuroimaging data has been increasingly used in recent years to disentangle heterogeneity of treatment response to cognitive training (CT) and predict which individuals may achieve the highest benefits. CT has small to medium effects on improving cognitive and social functioning in recent onset psychosis (ROP) patients, who show the most profound cognitive and social functioning deficits among psychiatric patients. We employed multivariate pattern analysis (MVPA) to investigate the potential of cognitive data to predict social functioning improvement in response to 10 h of CT in patients with ROP. A support vector machine (SVM) classifier was trained on the naturalistic data of the Personalized Prognostic Tools for Early Psychosis Management (PRONIA) study sample to predict functioning in an independent sample of 70 ROP patients using baseline cognitive data. PRONIA is a part of a FP7 EU grant program that involved 7 sites across 5 European countries, designed and conducted with the main aim of identifying (bio)markers associated with an enhanced risk of developing psychosis in order to improve early detection and prognosis. Social functioning was predicted with a balanced accuracy (BAC) of 66.4% (Sensitivity 78.8%; Specificity 54.1%; PPV 60.5%; NPV 74.1%; AUC 0.64; P = 0.01). The most frequently selected cognitive features (mean feature weights > ± 0.2) included the (1) correct number of symbol matchings within the Digit Symbol Substitution Test, (2) the number of distracting stimuli leading to an error within 300 and 200 trials in the Continuous Performance Test and (3) the dynamics of verbal fluency between 15 and 30 s within the Verbal Fluency Test, phonetic part. Next, the SVM classifier generated on the PRONIA sample was applied to the intervention sample, that obtained 54 ROP patients who were randomly assigned to a social cognitive training (SCT) or treatment as usual (TAU) group and dichotomized into good (GF-S ≥ 7) and poor (GF-S < 7) functioning patients based on their level of Global Functioning-Social (GF-S) score at follow-up (FU). By applying the initial PRONIA classifier, using out-of-sample cross-validation (OOCV) to the sample of ROP patients who have undergone the CT intervention, a BAC of 59.3% (Sensitivity 70.4%; Specificity 48.1%; PPV 57.6%; NPV 61.9%; AUC 0.63) was achieved at T0 and a BAC of 64.8% (Sensitivity 66.7%; Specificity 63.0%; PPV 64.3%; NPV 65.4%; AUC 0.66) at FU. After SCT intervention, a significant improvement in predicted social functioning values was observed in the SCT compared to TAU group (P ≤0.05; ES[Cohens' d] = 0.18). Due to a small sample size and modest variance of social functioning of the intervention sample it was not feasible to predict individual response to SCT in the current study. Our findings suggest that the use of baseline cognitive data could provide a robust individual estimate of future social functioning, while prediction of individual response to SCT using cognitive data that can be generated in the routine patient care remains to be addressed in large-scale cognitive training trials.
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Affiliation(s)
- Nina Walter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America
| | | | | | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Öznur Bastrük
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Alexandra Stainton
- Orygen Youth Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda A Antonucci
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen Youth Health, Melbourne, Australia; School of Psychology, University of Birmingham, United Kingdom; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, United Kingdom; Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Rebekka Lencer
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & NorthWestern Mental Health, Melbourne, Australia
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany; Max Planck Institute for Psychiatry, Munich, Germany; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Kerpenerstr.62, 50931, Cologne, Germany; Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany.
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7
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Lucarini V, Kazes M, Krebs E, Morin V, Godignon M, De Gasquet M, Ton T, Féron M, Tanguy G, Lévi A, Bellot C, Willard D, Auther AM, Cornblatt B, Bralet MC, Krebs MO. Validation of the French version of the Global Functioning: Social and Global Functioning: Role Scales in adolescents and young adults seeking help in early intervention clinics. Early Interv Psychiatry 2024; 18:3-9. [PMID: 37037927 DOI: 10.1111/eip.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
AIM Social and role functioning impairments characterize patients along the schizophrenia spectrum, but the existing evaluations tools do not specifically address younger population issues. The Global Functioning Social (GF:S) and Global Functioning Role (GF:R) scales have been specifically designed for that purpose. The aim of this study is to establish the reliability and concurrent validity of the French version of GF:S and GF:R scales. METHODS The two scales GF: Social (GF:S) and Role (GF:R) have first been translated into French and independently back translated and validated by the original authors. Between March 2021 and March 2022, we enrolled 51 participants (20.3 ± 3.7 years old; female = 22/51) amongst help-seekers referring to two different early mental health services in the Île-de-France. In an ecological design, participants met different diagnoses, 7 (13.7%) met the criteria for Ultra-High Risk of psychosis (UHR) using CAARMS criteria. RESULTS Inter-rater reliability was excellent for scores related to the past month and to the higher levels of functioning over the past year. Both scales showed good to excellent concurrent validity as measured by correlation with the Social and Occupational Functioning Assessment Scale (SOFAS) and the Personal and Social Performance Scale (PSP). CONCLUSION Overall, this study confirms the reliability and validity of the French version of the GF:S and GF:R scales. The use of these scales may improve the evaluation of social and occupational functioning in French-speaking young help-seekers, in a transdiagnostic approach, both in clinical and research settings.
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Affiliation(s)
- Valeria Lucarini
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Mathilde Kazes
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Emma Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Valentine Morin
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Maud Godignon
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Marie De Gasquet
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Trang Ton
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marion Féron
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Guillaume Tanguy
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Agnès Lévi
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Cécile Bellot
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Dominique Willard
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Marie-Cécile Bralet
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
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8
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Bernardin F, Gauld C, Martin VP, Laprévote V, Dondé C. The 68 symptoms of the clinical high risk for psychosis: Low similarity among fourteen screening questionnaires. Psychiatry Res 2023; 330:115592. [PMID: 37948888 DOI: 10.1016/j.psychres.2023.115592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
The Clinical High Risk for psychosis (CHR) is a heterogeneous condition with multiple symptoms. CHR screening is challenging in routine care, as a wide variety of questionnaires exists. We propose to explore the extent to which these questionnaires differ or overlap in item content. We performed a systematic and quantitative analysis of item content in a set of widely-used CHR screening questionnaires. Items were extracted from questionnaires and reworded according to the Structured Interview for Psychosis-Risk Syndromes (SIPS). Then, symptoms were generated from individual items. The Jaccard Index was calculated to assess content overlap. The 14 analysed questionnaires were composed of 347 items, from which 198 symptoms were generated and, in turn, collapsed into 68 distinct symptoms. Positive symptoms were the most commonly represented. The overall overlap across questionnaires showed weak similarity (Jaccard = 0.19±0.50). CHR screening questionnaires might evaluate the same broad clinical construct, but have different scopes within that construct, and may be more or less comprehensive than one another. Clinicians and researchers should be mindful of the specific features of each instrument for optimal CHR screening.
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Affiliation(s)
- Florent Bernardin
- Centre Psychothérapique de Nancy, Pôle Transversal Médico-Technique et Clinique, Centre de, Liaison et d'Intervention Précoce, Laxou F-54520, France; Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire, de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Christophe Gauld
- Department of Child Psychiatry, Université de Lyon, 59 Bd Pinel, Lyon F-69000, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de, Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France
| | - Vincent P Martin
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence F-33400, France; Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Vincent Laprévote
- Centre Psychothérapique de Nancy, Pôle Transversal Médico-Technique et Clinique, Centre de, Liaison et d'Intervention Précoce, Laxou F-54520, France; Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire, de Strasbourg, Université de Strasbourg, Strasbourg, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy F-54500 France
| | - Clément Dondé
- Univ. Grenoble Alpes, Grenoble F-38000, France; INSERM, U1216, Grenoble F-38000, France; Psychiatry Department, CHU Grenoble Alpes, Grenoble F-38000, France.
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9
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Williams TF, Cohen AS, Sanchez-Lopez A, Joormann J, Mittal VA. Attentional biases in facial emotion processing in individuals at clinical high risk for psychosis. Eur Arch Psychiatry Clin Neurosci 2023; 273:1825-1835. [PMID: 36920535 PMCID: PMC10502185 DOI: 10.1007/s00406-023-01582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/26/2023] [Indexed: 03/16/2023]
Abstract
Individuals at clinical high risk (CHR) for psychosis exhibit altered facial emotion processing (FEP) and poor social functioning. It is unclear whether FEP deficits result from attentional biases, and further, how these abnormalities are linked to symptomatology (e.g., negative symptoms) and highly comorbid disorders that are also tied to abnormal FEP (e.g., depression). In the present study, we employed an eye-tracking paradigm to assess attentional biases and clinical interviews to examine differences between CHR (N = 34) individuals and healthy controls (HC; N = 46), as well as how such biases relate to symptoms and functioning in CHR individuals. Although no CHR-HC differences emerged in attentional biases, within the CHR group, symptoms and functioning were related to biases. Depressive symptoms were related to some free-view attention switching biases (e.g., to and from fearful faces, r = .50). Negative symptoms were related to more slowly disengaging from happy faces (r = .44), spending less time looking at neutral faces (r = - .42), and more time looking at no face (Avolition, r = .44). In addition, global social functioning was related to processes that overlapped with both depression and negative symptoms, including time looking at no face (r = - .68) and free-view attention switching with fearful faces (r = - .40). These findings are consistent with previous research, indicating that negative symptoms play a prominent role in the CHR syndrome, with distinct mechanisms relative to depression. Furthermore, the results suggest that attentional bias indices from eye-tracking paradigms may be predictive of social functioning.
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Affiliation(s)
- Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA.
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Alvaro Sanchez-Lopez
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, 28223, Spain
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, 06520, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
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10
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Williams TF, Conley RE, Mittal VA. The relevance of social anxiety for understanding social functioning and facial emotion recognition in individuals at clinical high-risk for psychosis. Early Interv Psychiatry 2023; 17:1021-1027. [PMID: 36641807 PMCID: PMC10349169 DOI: 10.1111/eip.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/07/2022] [Accepted: 01/01/2023] [Indexed: 01/16/2023]
Abstract
AIM Individuals at clinical high risk (CHR) for psychosis often experience poor social functioning and impaired facial emotion recognition (FER); however, the impact of frequently comorbid symptoms upon these processes is underexplored. In particular, social anxiety is characteristic of this population and also related to poor social functioning and FER biases, such as misinterpreting neutral faces as negative or threatening; however, little is known about how social anxiety relates to these processes in CHR individuals. The present study examined the overlap of social anxiety, social functioning, and FER accuracy and bias. METHOD Participants (CHR N = 62, healthy controls N = 52) completed the self-report Social Interaction Anxiety Scale (SIAS), Penn Emotion Recognition-40 (ER-40) behavioural task, and interviewer-rated Global Functioning Scale-Social (GFS-S). The ER-40 was used to assess both FER accuracy (e.g., overall number of correct responses) and bias (e.g., mislabelling neutral faces as angry). RESULTS Consistent with previous research, relative to controls, CHR participants had more social anxiety (d = -1.07), poorer social functioning (d = -1.62), and performed more poorly on the FER task (e.g., d = -.37). Within CHR participants, social anxiety was related to an anger detection bias (r = .28), above and beyond positive symptom severity, which in turn was related to FER accuracy (r = .26) and social functioning (r = -.28). CONCLUSION These findings suggest that ongoing work examining social processes within CHR individuals needs to account for social anxiety and that social anxiety may be a useful preventive intervention target.
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Affiliation(s)
- Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Rachel E Conley
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
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11
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Carrión RE, Auther AM, McLaughlin D, Adelsheim S, Burton CZ, Carter CS, Niendam T, Ragland JD, Sale TG, Taylor SF, Tso IF, McFarlane WR, Cornblatt BA. Recreational cannabis use over time in individuals at clinical high risk for psychosis: Lack of associations with symptom, neurocognitive, functioning, and treatment patterns. Psychiatry Res 2023; 328:115420. [PMID: 37657201 DOI: 10.1016/j.psychres.2023.115420] [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: 03/29/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
Recreational cannabis use has recently gained considerable interest as an environmental risk factor that triggers the onset of psychosis. To date, however, the evidence that cannabis is associated with negative outcomes in individuals at clinical high risk (CHR) for psychosis is inconsistent. The present study tracked cannabis usage over a 2-year period and examined its associations with clinical and neurocognitive outcomes, along with medication rates. CHR youth who continuously used cannabis had higher neurocognition and social functioning over time, and decreased medication usage, relative to non-users. Surprisingly, clinical symptoms improved over time despite the medication decreases.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, United States; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, United States
| | - Steven Adelsheim
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, United States
| | - Cynthia Z Burton
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, United States
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, United States; Department of Psychology, Center for Neuroscience, the University of California at Davis, Davis, CA, United States
| | - Tara Niendam
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, United States; Department of Psychology, Center for Neuroscience, the University of California at Davis, Davis, CA, United States
| | - J Daniel Ragland
- Department of Psychiatry and Behavioral Sciences, Imaging Research Center, the University of California at Davis, Sacramento, CA, United States
| | - Tamara G Sale
- EASA Center for Excellence at Oregon Health & Science University, PSU School of Public Health, Portland, Oregon, United States
| | - Stephan F Taylor
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, United States
| | - Ivy F Tso
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, United States
| | - William R McFarlane
- Tufts University School of Medicine, Boston, MA, United States; Maine Medical Center Research Institute, Portland, ME, United States
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, United States; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
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12
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Strauss GP, Raugh IM, Luther L, Walker EF, Mittal VA. Temporal Interactions Between Social Motivation and Behavior In Daily Life Among Individuals at Clinical High-Risk for Psychosis. Schizophr Bull 2023; 49:1150-1160. [PMID: 37467481 PMCID: PMC10483454 DOI: 10.1093/schbul/sbad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND HYPOTHESES Poor social functioning is common among individuals at clinical high-risk (CHR) for psychosis and is associated with greater likelihood of conversion. Unfortunately, processes contributing to social impairment are unclear, making social functioning difficult to improve via treatment. The current study examined whether abnormalities in social functioning result from aberrant temporal interactions between social motivation and behavior. STUDY DESIGN Participants included 105 individuals at CHR and 62 healthy controls (CN) who completed 6 days of ecological momentary assessment. Multilevel models examined time-lagged interactions between social behavior and motivation. STUDY RESULTS CHR and CN did not differ in social motivation; however, CHR were less likely to interact with family and coworkers and more likely to engage in interactions via phone and text/social media. Autocorrelations indicated that social behavior and motivation were generally consistent across time in CHR and CN groups. Time-lagged analyses indicated that both groups had an increase in social motivation across time when they were alone and a decrease in social motivation across time when they were with others. However, the relative decrease when with others and increase when alone were less robust in CHR than CN, particularly for in-person interactions. Social motivation at time t did not differentially impact social partner or modality at time t+1 in the groups. CONCLUSIONS Findings suggest that social behavior and motivation have different temporal interactions in CHR and CN. Psychosocial interventions may benefit from targeting the frequency of social behavior with specific partners and modalities to change social motivation.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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13
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Powell SB, Swerdlow NR. The Relevance of Animal Models of Social Isolation and Social Motivation for Understanding Schizophrenia: Review and Future Directions. Schizophr Bull 2023; 49:1112-1126. [PMID: 37527471 PMCID: PMC10483472 DOI: 10.1093/schbul/sbad098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND HYPOTHESES Social dysfunction in schizophrenia includes symptoms of withdrawal and deficits in social skills, social cognition, and social motivation. Based on the course of illness, with social withdrawal occurring prior to psychosis onset, it is likely that the severity of social withdrawal/isolation contributes to schizophrenia neuropathology. STUDY DESIGN We review the current literature on social isolation in rodent models and provide a conceptual framework for its relationship to social withdrawal and neural circuit dysfunction in schizophrenia. We next review preclinical tasks of social behavior used in schizophrenia-relevant models and discuss strengths and limitations of existing approaches. Lastly, we consider new effort-based tasks of social motivation and their potential for translational studies in schizophrenia. STUDY RESULTS Social isolation rearing in rats produces profound differences in behavior, pharmacologic sensitivity, and neurochemistry compared to socially reared rats. Rodent models relevant to schizophrenia exhibit deficits in social behavior as measured by social interaction and social preference tests. Newer tasks of effort-based social motivation are being developed in rodents to better model social motivation deficits in neuropsychiatric disorders. CONCLUSIONS While experimenter-imposed social isolation provides a viable experimental model for understanding some biological mechanisms linking social dysfunction to clinical and neural pathology in schizophrenia, it bypasses critical antecedents to social isolation in schizophrenia, notably deficits in social reward and social motivation. Recent efforts at modeling social motivation using effort-based tasks in rodents have the potential to quantify these antecedents, identify models (eg, developmental, genetic) that produce deficits, and advance pharmacological treatments for social motivation.
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Affiliation(s)
- Susan B Powell
- Research Service, VA San Diego Healthcare System, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs VISN22 Mental Illness Research, Education and Clinical Center, La Jolla, CA, USA
| | - Neal R Swerdlow
- Research Service, VA San Diego Healthcare System, La Jolla, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs VISN22 Mental Illness Research, Education and Clinical Center, La Jolla, CA, USA
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14
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Theisen C, Rosen M, Meisenzahl E, Koutsouleris N, Lichtenstein T, Ruhrmann S, Kambeitz J, Kambeitz-Ilankovic L, Riecher-Rössler A, Chisholm K, Upthegrove R, Antonucci LA, Bertolino A, Pigoni A, Salokangas RKR, Pantelis C, Wood SJ, Lencer R, Falkai P, Hietala J, Brambilla P, Schmidt A, Andreou C, Borgwardt S, Osman N, Schultze-Lutter F. The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning. Front Psychiatry 2023; 14:1209485. [PMID: 37484669 PMCID: PMC10361815 DOI: 10.3389/fpsyt.2023.1209485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. Method A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. Result We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Conclusion Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.
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Affiliation(s)
- Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Research Center Jülich, Institute for Cognitive Neuroscience (INM-3), Jülich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Linda A. Antonucci
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J. Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
| | - Jarmo Hietala
- Department of Psychiatry, Medical Faculty, University of Turku, Turku, Finland
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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15
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Williams TF, Walker EF, Strauss GP, Woods SW, Powers AR, Corlett PR, Schiffman J, Waltz JA, Gold JM, Silverstein SM, Ellman LM, Zinbarg RE, Mittal VA. The reliability and validity of the revised Green et al. paranoid thoughts scale in individuals at clinical high-risk for psychosis. Acta Psychiatr Scand 2023; 147:623-633. [PMID: 36905387 PMCID: PMC10463775 DOI: 10.1111/acps.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Paranoia is a common and impairing psychosis symptom, which exists along a severity continuum that extends into the general population. Individuals at clinical high-risk for psychosis (CHR) frequently experience paranoia and this may elevate their risk for developing full psychosis. Nonetheless, limited work has examined the efficient measurement of paranoia in CHR individuals. The present study aimed to validate an often-used self-report measure, the revised green paranoid thoughts scale (RGPTS), in this critical population. METHOD Participants were CHR individuals (n = 103), mixed clinical controls (n = 80), and healthy controls (n = 71) who completed self-report and interview measures. Confirmatory factor analysis (CFA), psychometric indices, group differences, and relations to external measures were used to evaluate the reliability and validity of the RGPTS. RESULTS CFA replicated a two-factor structure for the RGPTS and the associated reference and persecution scales were reliable. CHR individuals scored significantly higher on both reference and persecution, relative to both healthy (ds = 1.03, 0.86) and clinical controls (ds = 0.64, 0.73). In CHR participants, correlations between reference and persecution and external measures were smaller than expected, though showed evidence of discriminant validity (e.g., interviewer-rated paranoia, r = 0.24). When examined in the full sample, correlation magnitude was larger and follow-up analyses indicated that reference related most specifically to paranoia (β = 0.32), whereas persecution uniquely related to poor social functioning (β = -0.29). CONCLUSION These results demonstrate the reliability and validity of the RGPTS, though its scales related more weakly to severity in CHR individuals. The RGPTS may be useful in future work aiming to develop symptom-specific models of emerging paranoia in CHR individuals.
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Affiliation(s)
- Trevor F. Williams
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, 30322, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, 30602, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Philip R. Corlett
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA, 92697, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - Steven M. Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Lauren M. Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, 19122, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, 60208, USA
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Pratt DN, Bridgwater M, Schiffman J, Ellman LM, Mittal VA. Do the Components of Attenuated Positive Symptoms Truly Represent One Construct? Schizophr Bull 2023; 49:788-798. [PMID: 36454660 PMCID: PMC10154719 DOI: 10.1093/schbul/sbac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND HYPOTHESES Psychosis-risk inventories, like the Structured Interview for Psychosis-Risk Syndromes (SIPS), utilize symptom components and coalesce the information into a single-severity rating. These components include frequency, duration, in-the-moment conviction, retrospective insight, distress, and effect on social/role functioning. While combining components distills a great deal of important information into one practical symptom rating, this approach may mask important details of the greater clinical picture. STUDY DESIGN Individuals at clinical high risk for psychosis (n = 115) were assessed with the SIPS Score Separable Components (SSSC) scale, created to accompany the SIPS positive items by dividing each item into the 7 components identified above. The latent structure of the SSSC was identified with an exploratory factor analysis (EFA). The factors were followed up with validation analyses including hypothesized cognitive, functioning, and symptom measures. Finally, clinical utility analyses were conducted to understand relationships between psychosis risk and common comorbidities. STUDY RESULTS EFA revealed that the SSSC had 3 interpretable factors with the appropriate fit (rmsr = 0.018, TLI = 0.921): Conviction (in-the-moment conviction, retrospective insight), Distress-Impairment (distress, social/role functioning), and Frequency/Duration (frequency, duration). Conviction was minimally valid, Distress-Impairment had excellent validity, and Frequency/Duration was not related to any of the candidate validators. Conviction significantly predicted elevated psychosis risk. Distress-Impairment was related to common comorbid symptoms. Notably, the factors associated more strongly with clinical features than the traditional SIPS scores. CONCLUSIONS The SSSC offers a supplemental approach to single-severity ratings, providing useful clinical insight, mechanistic understanding, and the potential for better capturing heterogeneity in this population.
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Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Miranda Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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17
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Li S, Chan SY, Higgins A, Hall MH. Sensory gating, neurocognition, social cognition and real-life functioning: a 2-year follow-up of early psychosis. Psychol Med 2023; 53:2540-2552. [PMID: 37310299 DOI: 10.1017/s0033291721004463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diminished sensory gating (SG) is a robust finding in psychotic disorders, but studies of early psychosis (EP) are rare. It is unknown whether SG deficit leads to poor neurocognitive, social, and/or real-world functioning. This study aimed to explore the longitudinal relationships between SG and these variables. METHODS Seventy-nine EP patients and 88 healthy controls (HCs) were recruited at baseline. Thirty-three and 20 EP patients completed 12-month and 24-month follow-up, respectively. SG was measured using the auditory dual-click (S1 & S2) paradigm and quantified as P50 ratio (S2/S1) and difference (S1-S2). Cognition, real-life functioning, and symptoms were assessed using the MATRICS Consensus Cognitive Battery, Global Functioning: Social (GFS) and Role (GFR), Multnomah Community Ability Scale (MCAS), Awareness of Social Inference Test (TASIT), and the Positive and Negative Syndrome Scale (PANSS). Analysis of variance (ANOVA), chi-square, mixed model, correlation and regression analyses were used for group comparisons and relationships among variables controlling for potential confounding variables. RESULTS In EP patients, P50 ratio (p < 0.05) and difference (p < 0.001) at 24-month showed significant differences compared with that at baseline. At baseline, P50 indices (ratio, S1-S2 difference, S1) were independently associated with GFR in HCs (all p < 0.05); in EP patients, S2 amplitude was independently associated with GFS (p = 0.037). At 12-month and 24-month, P50 indices (ratio, S1, S2) was independently associated with MCAS (all p < 0.05). S1-S2 difference was a trending predictor of future function (GFS or MCAS). CONCLUSIONS SG showed progressive reduction in EP patients. P50 indices were related to real-life functioning.
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Affiliation(s)
- Shen Li
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Department of Psychiatry, College of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Shi Yu Chan
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Translational Neurosciences, Singapore Institute for Clinical Sciences 117609, Singapore
| | - Amy Higgins
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Mei-Hua Hall
- Schizophrenia and Bipolar Disorders Program, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Psychosis Neurobiology Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
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18
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Mensi MM, Orlandi M, Casini E, Catalan A, de Pablo GS, Fusar-Poli P, Borgatti R. Neurocognition and functioning in adolescents at clinical high risk for psychosis. Child Adolesc Psychiatry Ment Health 2023; 17:22. [PMID: 36755293 PMCID: PMC9909975 DOI: 10.1186/s13034-023-00567-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Once psychosis has set in, it is difficult for patients to achieve full recovery. Prevention of psychosis and early intervention are promising for improving the outcomes of this disorder. In the last two decades, neurocognition has been studied as a biomarker for clinical-high risk for psychosis (CHR-P). However, neurocognitive functioning has been under-investigated in adolescents. METHODS We enrolled 116 adolescents from 12 to 17 years old (mean = 15.27, SD = 1.56; 76 females). This 3-year cohort study aimed to identify differences in neurocognitive and overall functioning in three groups of adolescent patients divided according to the semi-structured interview Comprehensive Assessment of At-Risk Mental States (CAARMS): adolescents with established psychosis, adolescents with CHR-P, and adolescents not meeting either criteria (non-CHR-P). To differentiate the profiles, clinicians administered cognitive evaluation and neuropsychological tasks. Moreover, they filled in scales to assess their global, social, and role functioning and a questionnaire to assess the severity of the disease. RESULTS We made a between-group comparison on neurocognitive measures and found that the CHR-P and the psychosis groups differed in processing speed (TMT-A; p = .002 in BVN categorial fluency (p = .018), and Rey-Osterrieth complex figure drawing from memory task (p = .014), with psychosis group showing worse performance. No differences emerged between non-CHR-P and CHR-P (p = .014) individuals. CHR-P had better functioning than the psychosis group but worse than the non-CHR-P one. CONCLUSIONS These results confirm that neurocognition can be a helpful biomarker in identifying specific subgroups of adolescents with emerging psychopathology and help clinicians develop stratified preventive approaches.
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Affiliation(s)
- Martina Maria Mensi
- grid.419416.f0000 0004 1760 3107Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Marika Orlandi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Erica Casini
- grid.419416.f0000 0004 1760 3107Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Ana Catalan
- grid.452310.1Psychiatry Department, Facultad de Medicina y Odontología, Centro de Investigación en Red de Salud Menta (CIBERSAM), Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto, University of the Basque Country UPV/EHU, Instituto de Salud Carlos III, Barakaldo, Bizkaia Spain ,grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College London, Psychology & Neuroscience, London, UK ,grid.37640.360000 0000 9439 0839Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK ,grid.4795.f0000 0001 2157 7667Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Paolo Fusar-Poli
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK ,grid.37640.360000 0000 9439 0839OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK ,grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Renato Borgatti
- grid.419416.f0000 0004 1760 3107Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy ,grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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19
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Herrera SN, Sarac C, Phili A, Gorman J, Martin L, Lyallpuri R, Dobbs MF, DeLuca JS, Mueser KT, Wyka KE, Yang LH, Landa Y, Corcoran CM. Psychoeducation for individuals at clinical high risk for psychosis: A scoping review. Schizophr Res 2023; 252:148-158. [PMID: 36652831 PMCID: PMC9974813 DOI: 10.1016/j.schres.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Psychoeducation is recommended in the treatment of patients with schizophrenia and has been shown to improve satisfaction with mental health service and treatment adherence, reduce relapse and hospital readmission rates, and enhance functioning and quality of life. Youth at clinical high risk for psychosis (CHR) may also benefit from receiving psychoeducation as part of their treatment. The goal of this study was to conduct a scoping review to map out the existing literature on psychoeducation for CHR individuals, including content, utilization, and benefits, in order to identify areas for future research and clinical care. Following PRISMA guidelines, we conducted a systematic search of electronic databases (MEDLINE, Embase, PsycINFO, Scopus, and Web of Science Core Collection) to identify literature through 02/25/2022 that provided data or significant commentary about the provision of psychoeducation to CHR individuals. After screening titles and abstracts, four co-authors assessed full-text articles for eligibility. Thirty-three studies were included in the review. Psychoeducation is recommended in the treatment of CHR individuals, is a preferred treatment option among CHR individuals, and many CHR programs report offering psychoeducation. However, details about the psychoeducational content and method of delivery are notably absent from recommendations and reports on the provision of CHR psychoeducation in real-world settings. We identified two brief and structured CHR psychoeducation interventions and one longer-term psychoeducational multifamily group model for CHR that show feasibility and promise, though they have not yet undergone randomized trials to evaluate effectiveness of the psychoeducation. We also identified several comprehensive CHR interventions that included an explicit psychoeducation module, though the unique role of the psychoeducational component is unknown. Despite being recommended as a critical component of treatment for CHR individuals and preferred by CHR individuals, the ways in which psychoeducation are being delivered to CHR individuals in real-world practice is still largely ambiguous. Rigorous evaluations of psychoeducation treatment models are needed, as well as investment from clinical programs to facilitate the implementation and dissemination of standardized psychoeducation for CHR individuals.
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Affiliation(s)
- Shaynna N Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Cansu Sarac
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antigone Phili
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Gorman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romi Lyallpuri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | - Matthew F Dobbs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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20
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Addington J, Liu L, Braun A, Brummitt K, Cadenhead KS, Cornblatt BA, Holden JL, Granholm E. Cognitive-Behavioral Social Skills Training: Outcome of a Randomized Controlled Trial for Youth at Risk of Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad020. [PMID: 37601286 PMCID: PMC10439516 DOI: 10.1093/schizbullopen/sgad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Aim Difficulties in social functioning have been observed in youth at clinical high-risk (CHR) of psychosis even in those who do not go on to develop a psychotic illness. Few treatment studies have attempted to improve social functioning in this population. The aim of this study was to conduct a randomized trial comparing the effects of Cognitive-Behavioral Social Skills Training (CBSST) with a supportive therapy (ST). Methods Both CBSST and ST were weekly group therapies, delivered over 18 weeks. This was a 2-arm trial with single-blinded ratings and intention-to-treat analyses. Assessments occurred at baseline, end-of-treatment, and 12 months after the baseline assessment. The primary outcome was social and role functioning and defeatist performance attitudes were the secondary outcome. Attenuated positive and negative symptoms, anxiety, depression, self-efficacy, and beliefs about self and others were examined as exploratory outcomes. Results There were no significant differences between the 2 groups at baseline or either of the 2 follow-ups. However, at follow-ups, in each group there were significant improvements in clinical symptoms. These could not be attributed to group treatment since there was no control or wait-list group. Conclusions Since poor social functioning is one of the most observed difficulties in CHR individuals, and a decline in social functioning may be a significant predictor of later transition to psychosis, future work will be needed to find effective treatments for this decline in functioning for CHR youth.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kali Brummitt
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | | | - Jason L Holden
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Frosch IR, Damme KSF, Bernard JA, Mittal VA. Cerebellar correlates of social dysfunction among individuals at clinical high risk for psychosis. Front Psychiatry 2022; 13:1027470. [PMID: 36532176 PMCID: PMC9752902 DOI: 10.3389/fpsyt.2022.1027470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Social deficits are a significant feature among both individuals with psychosis and those at clinical high-risk (CHR) for developing psychosis. Critically, the psychosis risk syndrome emerges in adolescence and young adulthood, when social skill development is being fine-tuned. Yet, the underlying pathophysiology of social deficits in individuals at CHR for psychosis remains unclear. Literature suggests the cerebellum plays a critical role in social functioning. Cerebellar dysfunction in psychosis and CHR individuals is well-established, yet limited research has examined links between the cerebellum and social functioning deficits in this critical population. Method In the current study, 68 individuals at CHR for developing psychosis and 66 healthy controls (HCs) completed social processing measures (examining social interaction, social cognition, and global social functioning) and resting-state MRI scans. Seed-to-voxel resting-state connectivity analyses were employed to examine the relationship between social deficits and lobular cerebellar network connectivity. Results Analyses indicated that within the CHR group, each social domain variable was linked to reduced connectivity between social cerebellar subregions (e.g., Crus II, lobules VIIIa and VIIIb) and cortical regions (e.g., frontal pole and frontal gyrus), but a control cerebellar subregion (e.g., lobule X) and was unrelated to these social variables. Discussion These results indicate an association between several cerebellar lobules and specific deficits in social processing. The cerebellum, therefore, may be particularly salient to the social domain and future research is need to examine the role of the cerebellum in psychosis.
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Affiliation(s)
- Isabelle R. Frosch
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Katherine S. F. Damme
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
| | - Jessica A. Bernard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, United States
- Department of Psychiatry, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Institute for Policy Research, Northwestern University, Chicago, IL, United States
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22
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Barbato M, Liu L, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone W, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J. Migrant status, clinical symptoms and functional outcome in youth at clinical high risk for psychosis: findings from the NAPLS-3 study. Soc Psychiatry Psychiatr Epidemiol 2022; 58:559-568. [PMID: 36348056 DOI: 10.1007/s00127-022-02383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Migrant status is a known risk factor for psychosis, but the underlying causes of this vulnerability are poorly understood. Recently, studies have begun to explore whether migrant status predicts transition to psychosis in individuals at clinical high risk (CHR) for psychosis. Results, however, have been inconclusive. The present study assessed the impact of migrant status on clinical symptoms and functional outcome in individuals at CHR for psychosis who took part in the NAPLS-3 study. METHODS Participants' migrant status was classified as native-born, first-generation, or second-generation migrant. Clinical symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes (SIPS); functional outcome was measured using the Global Functioning Scales:Social and Role (GF:S; GF:R). Assessments were conducted at baseline, 12-months, 18-months, and 24-months follow-up. Generalized linear mixed models for repeated measures were used to examine changes over time and differences between groups. RESULTS The overall sample included 710 individuals at CHR for psychosis (54.2% males; Age: M = 18.19; SD = 4.04). A mixed model analysis was conducted, and no significant differences between groups in symptoms or functioning were observed at any time point. Over time, significant improvement in symptoms and functioning was observed within each group. Transition rates did not differ across groups. CONCLUSION We discuss potential factors that might explain the lack of group differences. Overall, migrants are a heterogeneous population. Discerning the impact of migration from that of neighborhood ethnic density, social disadvantage or socio-economic status of different ethnic groups could help better understand vulnerability and resilience to psychosis.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, UAE
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA
- Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Kuhney FS, Damme KSF, Ellman LM, Schiffman J, Mittal VA. Evaluating the Social Functioning Scale modified for use in individuals at clinical high-risk for psychosis. Schizophr Res 2022; 248:246-253. [PMID: 36115189 PMCID: PMC9912743 DOI: 10.1016/j.schres.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Social functioning deficits occur prior to the onset of psychosis and predict conversion to psychosis in clinical high-risk (CHR) populations. The Social Functioning Scale (SFS), a self-report measure of social functioning, is widely used in adults with psychosis but has not been tailored to CHR individuals. CHR syndromes overlap with the adolescent/young-adult developmental period, a time with unique social demands and contexts. The current study evaluates a modified version of the SFS in CHR individuals. METHODS Two independent samples of CHR participants (n = 84 and n = 45) and non-CHR participants (n = 312 and n = 42) completed the SFS and a psychosis-risk interview. Resulting factors were compared across diagnostic categories (CHR, Major Depressive Disorder, Generalized Anxiety Disorder) and community controls (CC) who were not excluded for any psychopathology except psychosis, depression, and anxiety. CHR participants completed scales of negative symptoms, global social and role functioning, cognition, and finger tapping as measures of convergent and divergent validity. RESULTS Exploratory factor analysis identified three SFS factors (RMSEA = 0.05) which demonstrated reliability in a confirmatory analysis in an independent sample: Recreation (α = 0.82), Nightlife (α = 0.85), and Interpersonal (α = 0.69). Factors and their composite score demonstrated increased social deficits in CHR compared to CC and depression groups and showed expected convergent (r's = 0.30-0.54) and divergent (r's = -0.004-0.26) validity with appropriate measures. CONCLUSIONS These findings suggest that there are reliable, valid, and developmentally relevant categories of social behavior within the SFS that differentiate between CHR and MDD or CC individuals. Recommendations for future work with CHR populations are included.
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Affiliation(s)
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA; Department of Psychology, University of California at Irvine, Irvine, CA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA; Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA; Department of Psychiatry, Northwestern University, Chicago, IL, USA; Medical Social Sciences, Northwestern University, Chicago, IL, USA; Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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24
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Lindhardt L, Storebø OJ, Bruun LS, Simonsen E, Mortensen OS. “ Psychosis among the disconnected youth: a systematic review.”. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2056306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Line Lindhardt
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Laura Staxen Bruun
- Early Psychosis Intervention Center, Mental Health Services East, Region Zealand Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbaek Hospital, Denmark
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25
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Lepock JR, Mizrahi R, Gerritsen CJ, Bagby RM, Maheandiran M, Ahmed S, Korostil M, Kiang M. N400 event-related brain potential and functional outcome in persons at clinical high risk for psychosis: A longitudinal study. Psychiatry Clin Neurosci 2022; 76:114-121. [PMID: 35037344 DOI: 10.1111/pcn.13330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The N400 event-related brain potential (ERP) semantic priming effect is thought to reflect activation by meaningful stimuli of related concepts in semantic memory and has been found to be deficient in schizophrenia. We tested the hypothesis that, among individuals at clinical high risk (CHR) for psychosis, N400 semantic priming deficits predict worse symptomatic and functional outcomes after one year. METHODS We measured N400 semantic priming at baseline in CHR patients (n = 47) and healthy control participants (n = 25) who viewed prime words each followed by a related or unrelated target word, at stimulus-onset asynchronies (SOAs) of 300 or 750 ms. We measured patients' psychosis-like symptoms with the Scale of Prodromal Symptoms (SOPS) Positive subscale, and academic/occupational and social functioning with the Global Functioning (GF):Role and Social scales, respectively, at baseline and one-year follow-up (n = 29). RESULTS CHR patients exhibited less N400 semantic priming than controls across SOAs; planned contrasts indicated this difference was significant at the 750-ms but not the 300-ms SOA. In patients, reduced N400 semantic priming at the 750-ms SOA was associated with lower GF:Social scores at follow-up, and greater GF:Social decrements from baseline to follow-up. Patients' N400 semantic priming was not associated with SOPS Positive or GF:Role scores at follow-up, or change in these from baseline to follow-up. CONCLUSIONS In CHR patients, reduced N400 semantic priming at baseline predicted worse social functioning after one year, and greater decline in social functioning over this period. Thus, the N400 may be a useful prognostic biomarker of real-world functional outcome in CHR patients.
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Affiliation(s)
- Jennifer R Lepock
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Romina Mizrahi
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Cory J Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - R Michael Bagby
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Sarah Ahmed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michele Korostil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Michael Kiang
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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26
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Antonucci LA, Fazio L, Pergola G, Blasi G, Stolfa G, Di Palo P, Mucci A, Rocca P, Brasso C, di Giannantonio M, Maria Giordano G, Monteleone P, Pompili M, Siracusano A, Bertolino A, Galderisi S, Maj M. Joint structural-functional magnetic resonance imaging features are associated with diagnosis and real-world functioning in patients with schizophrenia. Schizophr Res 2022; 240:193-203. [PMID: 35032904 DOI: 10.1016/j.schres.2021.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/20/2021] [Accepted: 12/22/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Earlier evidence suggested that structural-functional covariation in schizophrenia patients (SCZ) is associated with cognition, a predictor of functioning. Moreover, studies suggested that functional brain abnormalities of schizophrenia may be related with structural network features. However, only few studies have investigated the relationship between structural-functional covariation and both diagnosis and functioning in SCZ. We hypothesized that structural-functional covariation networks associated with diagnosis are related to real-world functioning in SCZ. METHODS We performed joint Independent Component Analysis on T1 images and resting-state fMRI-based Degree Centrality (DC) maps from 89 SCZ and 285 controls. Structural-functional covariation networks in which we found a main effect of diagnosis underwent correlation analysis to investigate their relationship with functioning. Covariation networks showing a significant association with both diagnosis and functioning underwent univariate analysis to better characterize group-level differences at the spatial level. RESULTS A structural-functional covariation network characterized by frontal, temporal, parietal and thalamic structural estimates significantly covaried with temporo-parietal resting-state DC. Compared with controls, SCZ had reduced structural-functional covariation within this network (pFDR = 0.005). The same measure correlated positively with both social and occupational functioning (both pFDR = 0.042). Univariate analyses revealed grey matter deviations in SCZ compared with controls within this structural-functional network in hippocampus, cerebellum, thalamus, orbito-frontal cortex, and insula. No group differences were found in DC. CONCLUSIONS Findings support the existence of a phenotypical association between group-level differences and inter-individual heterogeneity of functional deficits in SCZ. Given that only the joint structural/functional analysis revealed this association, structural-functional covariation may be a potentially relevant schizophrenia phenotype.
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Affiliation(s)
- Linda A Antonucci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Leonardo Fazio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giulio Pergola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Blasi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Stolfa
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Piergiuseppe Di Palo
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Claudio Brasso
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | | | | | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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27
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Phalen P, Millman Z, Rouhakhtar PR, Andorko N, Reeves G, Schiffman J. Categorical versus dimensional models of early psychosis. Early Interv Psychiatry 2022; 16:42-50. [PMID: 33559329 PMCID: PMC8349380 DOI: 10.1111/eip.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
AIM Early psychosis is typically operationalized as a categorical construct by dividing people into one of three diagnostic statuses: low-risk, clinical high-risk, and first episode psychosis. We empirically assess whether an alternative dimensional approach focused on observed symptom severity may be more desirable for clinical and research purposes. METHODS Participants were 152 help-seeking youths ages 12-22 years old. Structured interview for psychosis risk syndromes interviews were used to obtain dimensional psychosis symptom severity ratings, and to classify participants by categorical psychosis risk status. Twenty-five participants were classified as having a diagnosable psychotic disorder, 52 participants as clinical high-risk, and 75 participants as help-seeking controls. We assessed the relation between categorical and dimensional measurements of psychosis severity, and then compared categorical versus dimensional psychosis severity in their ability to predict social and role functioning. RESULTS On average, dimensional psychosis symptom severity increased along with categorical risk status (help-seeking control < clinical high-risk < diagnosable psychotic disorder). There was, however, considerable overlap between categories, with people at clinical high-risk being particularly hard to distinguish from people with diagnosable psychotic disorders on the basis of symptom severity. Dimensional symptom severity was more predictive of functioning than categorical risk status. CONCLUSIONS Categorical risk status and psychosis symptom severity are related but not interchangeable, and dimensional models of psychosis may be more predictive of functional outcomes. Adopting a dimensional rather than categorical approach to the psychosis risk spectrum may facilitate better predictive models and a richer theoretical understanding of early psychosis.
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Affiliation(s)
- Peter Phalen
- VA Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.,Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zachary Millman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Center of Excellence in Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicole Andorko
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Gloria Reeves
- Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Psychological Science, University of California, Irvine, California, USA
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28
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Addington J, Liu L, Santesteban-Echarri O, Brummitt K, Braun A, Cadenhead KS, Cornblatt BA, Holden JL, Granholm E. Cognitive behavioural social skills training: Methods of a randomized controlled trial for youth at risk of psychosis. Early Interv Psychiatry 2021; 15:1626-1636. [PMID: 33398922 DOI: 10.1111/eip.13102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/16/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
AIM Poor functioning has become a hallmark of many youth at clinical high-risk (CHR) of psychosis. Even for those who do not make the transition to psychosis remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address social and role functioning in CHR. METHODS This was a randomized controlled trial of cognitive-behavioural social skills training (CBSST) versus a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence-based treatments for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. RESULTS Two hundred and three participants were recruited for this study. Results include initial baseline data. CONCLUSION This article describes the baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this significant problem.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Olga Santesteban-Echarri
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kali Brummitt
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, New York, USA
| | - Jason L Holden
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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29
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Yoo DW, Ernala SK, Saket B, Weir D, Arenare E, Ali AF, Van Meter AR, Birnbaum ML, Abowd GD, De Choudhury M. Clinician Perspectives on Using Computational Mental Health Insights From Patients' Social Media Activities: Design and Qualitative Evaluation of a Prototype. JMIR Ment Health 2021; 8:e25455. [PMID: 34783667 PMCID: PMC8663497 DOI: 10.2196/25455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/11/2021] [Accepted: 06/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Previous studies have suggested that social media data, along with machine learning algorithms, can be used to generate computational mental health insights. These computational insights have the potential to support clinician-patient communication during psychotherapy consultations. However, how clinicians perceive and envision using computational insights during consultations has been underexplored. OBJECTIVE The aim of this study is to understand clinician perspectives regarding computational mental health insights from patients' social media activities. We focus on the opportunities and challenges of using these insights during psychotherapy consultations. METHODS We developed a prototype that can analyze consented patients' Facebook data and visually represent these computational insights. We incorporated the insights into existing clinician-facing assessment tools, the Hamilton Depression Rating Scale and Global Functioning: Social Scale. The design intent is that a clinician will verbally interview a patient (eg, How was your mood in the past week?) while they reviewed relevant insights from the patient's social media activities (eg, number of depression-indicative posts). Using the prototype, we conducted interviews (n=15) and 3 focus groups (n=13) with mental health clinicians: psychiatrists, clinical psychologists, and licensed clinical social workers. The transcribed qualitative data were analyzed using thematic analysis. RESULTS Clinicians reported that the prototype can support clinician-patient collaboration in agenda-setting, communicating symptoms, and navigating patients' verbal reports. They suggested potential use scenarios, such as reviewing the prototype before consultations and using the prototype when patients missed their consultations. They also speculated potential negative consequences: patients may feel like they are being monitored, which may yield negative effects, and the use of the prototype may increase the workload of clinicians, which is already difficult to manage. Finally, our participants expressed concerns regarding the prototype: they were unsure whether patients' social media accounts represented their actual behaviors; they wanted to learn how and when the machine learning algorithm can fail to meet their expectations of trust; and they were worried about situations where they could not properly respond to the insights, especially emergency situations outside of clinical settings. CONCLUSIONS Our findings support the touted potential of computational mental health insights from patients' social media account data, especially in the context of psychotherapy consultations. However, sociotechnical issues, such as transparent algorithmic information and institutional support, should be addressed in future endeavors to design implementable and sustainable technology.
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Affiliation(s)
- Dong Whi Yoo
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sindhu Kiranmai Ernala
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Bahador Saket
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Domino Weir
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Elizabeth Arenare
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Asra F Ali
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Anna R Van Meter
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Michael L Birnbaum
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Gregory D Abowd
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
- College of Engineering, Northeastern University, Boston, MA, United States
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
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30
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Carrión RE, Auther AM, McLaughlin D, Cornblatt BA. The immediate impact of the COVID-19 pandemic on attenuated positive symptoms and functioning in individuals at clinical high risk for psychosis: A pilot study. Schizophr Res 2021; 236:9-11. [PMID: 34364033 PMCID: PMC8452606 DOI: 10.1016/j.schres.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/25/2021] [Accepted: 07/10/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Ricardo E. Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA,Corresponding author at: Zucker Hillside Hospital, Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
| | - Andrea M. Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA,Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA,Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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31
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Akouri-Shan L, Schiffman J, Millman ZB, Demro C, Fitzgerald J, Rakhshan Rouhakhtar PJ, Redman S, Reeves GM, Chen S, Gold JM, Martin EA, Corcoran C, Roiser JP, Buchanan RW, Rowland LM, Waltz JA. Relations Among Anhedonia, Reinforcement Learning, and Global Functioning in Help-seeking Youth. Schizophr Bull 2021; 47:1534-1543. [PMID: 34240217 PMCID: PMC8530392 DOI: 10.1093/schbul/sbab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dysfunction in the neural circuits underlying salience signaling is implicated in symptoms of psychosis and may predict conversion to a psychotic disorder in youth at clinical high risk (CHR) for psychosis. Additionally, negative symptom severity, including consummatory and anticipatory aspects of anhedonia, may predict functional outcome in individuals with schizophrenia-spectrum disorders. However, it is unclear whether anhedonia is related to the ability to attribute incentive salience to stimuli (through reinforcement learning [RL]) and whether measures of anhedonia and RL predict functional outcome in a younger, help-seeking population. We administered the Salience Attribution Test (SAT) to 33 participants who met criteria for either CHR or a recent-onset psychotic disorder and 29 help-seeking youth with nonpsychotic disorders. In the SAT, participants must identify relevant and irrelevant stimulus dimensions and be sensitive to different reinforcement probabilities for the 2 levels of the relevant dimension ("adaptive salience"). Adaptive salience attribution was positively related to both consummatory pleasure and functioning in the full sample. Analyses also revealed an indirect effect of adaptive salience on the relation between consummatory pleasure and both role (αβ = .22, 95% CI = 0.02, 0.48) and social functioning (αβ = .14, 95% CI = 0.02, 0.30). These findings suggest a distinct pathway to poor global functioning in help-seeking youth, via impaired reward sensitivity and RL.
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Affiliation(s)
- LeeAnn Akouri-Shan
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA,Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, USA
| | - Zachary B Millman
- Center of Excellence in Psychotic Disorders, McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Caroline Demro
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John Fitzgerald
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA
| | | | - Samantha Redman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA
| | - Gloria M Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA,Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, USA
| | - Cheryl Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, 1 Gustave L. Levy Place, New York, NY4, USA
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, England, UK
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura M Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA,To whom correspondence should be addressed; Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA; tel: 410-402-6044, fax: 410-402-7198, e-mail:
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32
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Chang WC, Ng CM, Chan KN, Lee HC, Chan SI, Chiu SS, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Chan CWH, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Psychiatric comorbidity in individuals at-risk for psychosis: Relationships with symptoms, cognition and psychosocial functioning. Early Interv Psychiatry 2021; 15:616-623. [PMID: 32441490 DOI: 10.1111/eip.12992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/01/2020] [Accepted: 04/28/2020] [Indexed: 02/04/2023]
Abstract
AIM Psychiatric comorbidity frequently occurs with at-risk mental state (ARMS) for psychosis. Its relationships with psychopathology, cognition and functioning, however, remain to be further clarified. We aimed to examine prevalence and correlates of psychiatric comorbidity, and its associations with psychosocial functioning and subjective quality-of-life (QoL) in a representative sample of Chinese ARMS individuals. METHODS One hundred ten help-seeking participants aged 15 to 40 years with ARMS were recruited from a specialized early psychosis service in Hong Kong. ARMS status was verified by comprehensive assessment of at-risk mental state (CAARMS). Comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition non-psychotic psychiatric disorders at baseline were ascertained using diagnostic interview and medical record review. Assessments encompassing symptom profiles, psychosocial functioning, subjective QoL and a brief cognitive battery were conducted. RESULTS Forty-nine (44.5%) ARMS participants were diagnosed as having comorbid non-psychotic psychiatric disorders at baseline, primarily depressive and anxiety disorders. Binary multiple logistic regression analysis revealed that female gender, more severe depressive symptoms, higher suicidality and poorer global cognitive functioning were independently associated with comorbid diagnosis status. ARMS participants with psychiatric comorbidity displayed significantly more limited extended social networks and poorer subjective QoL than those without psychiatric comorbidity. CONCLUSION Comorbid disorders were frequently observed in Chinese ARMS individuals, and were linked to poorer cognition and higher suicide risk. Our findings underscore a potential critical role of psychiatric comorbidity in determining social functioning and subjective QoL in at-risk individuals. Further longitudinal research is required to clarify trajectories of comorbid disorder status and its prospective impact on clinical and functional outcomes in ARMS populations.
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Affiliation(s)
- Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Chung Mun Ng
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kwun Nam Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hoi Ching Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Suet In Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Shirley Sanyin Chiu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | | | - Kwok Ling Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Wai Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Lam Wai Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Shiu Yin Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Man Wa Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Tak Lam Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Man Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - Lap Tak Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Wai Chung Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Yip Chau Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Wai Sau Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Yi Man Mo
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Woodberry KA, Chokran C, Johnson KA, Nuechterlein KH, Miklowitz DJ, Faraone SV, Seidman LJ. Computer-aided learning for managing stress: A feasibility trial with clinical high risk adolescents and young adults. Early Interv Psychiatry 2021; 15:471-479. [PMID: 32237208 PMCID: PMC8175018 DOI: 10.1111/eip.12958] [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: 12/03/2019] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 12/01/2022]
Abstract
AIM The peak onset of psychotic disorders occurs during adolescence and early adulthood, yet treatments for youth at clinical high risk (CHR) for psychosis are generally designed for adults. CHR youth, despite poor academic and social engagement, spend hours each day playing complicated videogames. The aim of this study was to test the feasibility of integrating biofeedback and cooperative videogame play within family therapy as a means of engaging and enhancing this population's resilience. METHODS We conducted a feasibility trial of an innovative 12-week family therapy for CHR ages 12-30 (clinicaltrials.gov NCT02531243). We report feasibility outcomes and preliminary effect sizes for pre-post changes and youth-parent differences. RESULTS Of 88 individuals referred to the centre who met age and CHR criteria, 11 (13%) youth-parent pairs met full criteria and engaged in treatment. Ten (91%) completed at least six sessions. Youth found CALMS initially credible, but parents tended to find it more credible and to be more satisfied over time. Surprisingly, parents reported a better game experience than youth. As a group, youth and parent participants reported experiencing reduced stress and perceiving each other as less critical by the end of treatment. Youth were rated as having significantly improved social, but not role or global functioning by the end of treatment. CONCLUSIONS Multiuser videogames may have a role to play in engaging youth at risk for psychosis in therapy and reducing stress and familial risk factors. A number of key developments are needed to enhance the appeal, effectiveness and practicality of this approach.
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Affiliation(s)
- Kristen A Woodberry
- Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Psychiatry Department, Harvard Medical School, Boston, Massachusetts, USA.,Psychiatry Department, Maine Medical Center, Portland, Maine, USA
| | - Cole Chokran
- Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kelsey A Johnson
- Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California, Los Angeles, California, USA
| | - David J Miklowitz
- Departments of Psychiatry and Psychology, University of California, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Larry J Seidman
- Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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34
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Mensi MM, Molteni S, Iorio M, Filosi E, Ballante E, Balottin U, Fusar-Poli P, Borgatti R. Prognostic Accuracy of DSM-5 Attenuated Psychosis Syndrome in Adolescents: Prospective Real-World 5-Year Cohort Study. Schizophr Bull 2021; 47:1663-1673. [PMID: 33939829 PMCID: PMC8530398 DOI: 10.1093/schbul/sbab041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 ± 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell's C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.
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Affiliation(s)
- Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neuropsychiatry Unit, ASST Lariana, Como, Italy
| | - Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia,Italy,BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; via Mondino 2, 27100 Pavia, Italy; tel: +390382430211, fax: +390382430236, e-mail:
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy,Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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35
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Pelletier-Baldelli A, Strauss GP, Kuhney FS, Chun C, Gupta T, Ellman LM, Schiffman J, Mittal VA. Perceived stress influences anhedonia and social functioning in a community sample enriched for psychosis-risk. J Psychiatr Res 2021; 135:96-103. [PMID: 33460840 PMCID: PMC7914219 DOI: 10.1016/j.jpsychires.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Existing animal and human research support the causal role of stress in the emergence of anhedonia, and in turn, the influence of anhedonia in social functioning. However, this model has not been tested in relation to psychosis-risk; this literature gap is notable given that both anhedonia and declining social functioning represent key markers of risk of developing a psychotic disorder such as schizophrenia. The current research tested the evidence for this model using structural equation modeling in 240 individuals selected based on a range of psychosis-risk symptomatology from the general community. Results supported this model in comparison with alternative models, and additionally emphasized the direct role of perceived stress in social functioning outcomes. Findings suggest the clinical relevance of targeting early perceptions of stress in individuals meeting psychosis-risk self-report criteria in an effort to prevent subsequent anhedonia and declines in social functioning.
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Affiliation(s)
| | | | - Franchesca S Kuhney
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA
| | - Charlotte Chun
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | - Tina Gupta
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | - Lauren M Ellman
- Temple University, Department of Psychology, Philadelphia, PA, USA
| | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry, Evanston, IL, USA; Northwestern University, Institute for Policy Research, Evanston, IL, USA; Northwestern University, Department of Medical Social Science, Evanston, IL, USA
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36
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Simon AE, Keller P, Cattapan K. Commentary about social avoidance and its significance in adolescents and young adults. Psychiatry Res 2021; 297:113718. [PMID: 33465524 DOI: 10.1016/j.psychres.2021.113718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
Social avoidance in young patients is a clinically worrisome phenomenon that characterizes impending schizophrenia, but that also constitutes a core phenomenon in avoidant personality disorder (AvPD), schizoid personality disorder (ScPD), and in autism spectrum disorder (ASD). Especially in the absence of any other clinically relevant phenomena, understanding the origins of social avoidance may be one the most challenging tasks in assessing whether adolescents and young adults are at risk for developing schizophrenia. Descriptive and psychometric assessments only allow to comment on the absence or the presence of this phenomenon, but do not capture the origins and the meaning of social avoidance. Based on a narrative review, we highlight the importance of a phenomenological approach to unveil the Gestalt of social avoidance in these mental disorders, including and appraisal of the underlying mental structures and attachment styles. The phenomenological approach allows to distinguish the Gestalt of social avoidance between AvPD, ScPD, ASD, and beginning schizophrenia, to ensure correct diagnostic labelling and optimal treatment, and to avoid unwarranted stigmatization.
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Affiliation(s)
- Andor E Simon
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Binningen, Switzerland.
| | - Petra Keller
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Katja Cattapan
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Sanatorium Kilchberg/Zuerich, Private Hospital of Psychiatry, Kilchberg, Switzerland
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37
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Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Predictors of remission from the ultra-high risk state for psychosis. Early Interv Psychiatry 2021; 15:104-112. [PMID: 31910496 DOI: 10.1111/eip.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 12/14/2019] [Indexed: 02/07/2023]
Abstract
AIM A significant proportion of individuals at Ultra-High Risk (UHR) for psychosis do not transition to manifest psychosis. Many non-transitioning UHR individuals do, however, display poor long-term outcomes such as persistence of attenuated psychotic symptoms. Evidence is scarce on which variables may predict a better clinical and functional prognosis such as remission from the UHR state. METHODS A total of 146 UHR individuals were enrolled in a randomized clinical trial (RCT), with this being analyses secondary to the RCT. Participants were assessed on multiple domains of symptoms, functioning, neuro- and social cognition. Regression analyses elucidated on the predictive power of these measures to remission from the UHR status (ie, not meeting UHR criteria) at 12-month follow-up. RESULTS Of the 91 UHR individuals attending 12-month follow-up, 33 (36%) exhibited remission from the UHR state. Regression analyses revealed baseline functioning to be a significant predictor of risk remission, and this was maintained when controlling for the effect of antipsychotic medication, gender and estimated IQ. The individuals with remission from the UHR state showed lower attenuated psychotic- and depressive symptoms along with better functioning at 12-month follow-up. CONCLUSION Our findings indicate functioning to be a contributor to the symptomatic recovery of UHR individuals, but a large amount of the variance on risk remission is, however, explained by other factors. Additionally, our findings suggest that UHR individuals with better functioning at ascertainment may present with a better clinical and functional prognosis, which may inform on the need for monitoring and intervention in this subgroup.
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Affiliation(s)
- Louise B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Tina D Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
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38
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Addington J, Santesteban-Echarri O, Braun A, Lecomte T. Assessing social functioning in youth at clinical high-risk for psychosis. Schizophr Res 2021; 228:188-189. [PMID: 33444935 DOI: 10.1016/j.schres.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Olga Santesteban-Echarri
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, Québec, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Québec, Canada
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39
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Lepock JR, Ahmed S, Mizrahi R, Gerritsen CJ, Maheandiran M, Bagby RM, Korostil M, Kiang M. N400 event-related brain potential as an index of real-world and neurocognitive function in patients at clinical high risk for schizophrenia. Early Interv Psychiatry 2021; 15:68-75. [PMID: 31883227 DOI: 10.1111/eip.12911] [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: 08/26/2019] [Revised: 11/27/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
AIM The N400 event-related potential is a neurophysiological index of cognitive processing of real-world knowledge. In healthy populations, N400 amplitude is smaller in response to stimuli that are more related to preceding context. This 'N400 semantic priming effect' is thought to reflect activation of contextually related information in semantic memory (SM). N400 semantic priming deficits have been found in schizophrenia, and in patients at clinical high risk (CHR) for this disorder. Because this abnormality in processing relationships between meaningful stimuli could affect ability to navigate everyday situations, we hypothesized it would be associated with real-world functional impairment in CHR patients. Second, we hypothesized it would correlate with global neurocognitive impairment in this group. METHODS We measured N400 semantic priming in 35 CHR patients who viewed prime words each followed by a related or unrelated target word, at stimulus-onset asynchrony (SOA) of 300 or 750 ms. We measured academic/occupational and social function with the global function (GF): Role and Social scales, and cognitive function with the MATRICS Consensus Cognitive Battery (MCCB). RESULTS Decreased N400 semantic priming at the 300-ms SOA correlated with lower GF:Role scores. Decreased N400 semantic priming at the 750-ms SOA correlated with lower MCCB composite scores. CONCLUSIONS Deficits in activating contextually related concepts in SM over short time intervals may contribute to functional impairment in CHR patients. Furthermore, N400 priming deficits over longer intervals may be a biomarker of global cognitive dysfunction in this population. Longitudinal studies are needed to determine whether these deficits are associated with schizophrenia risk within this population.
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Affiliation(s)
- Jennifer R Lepock
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Ahmed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Romina Mizrahi
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cory J Gerritsen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | | | - R Michael Bagby
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michele Korostil
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Michael Kiang
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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40
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Strauss GP, Pelletier-Baldelli A, Visser KF, Walker EF, Mittal VA. Reprint of: A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis. Schizophr Res 2021; 227:63-71. [PMID: 33526203 DOI: 10.1016/j.schres.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/04/2023]
Abstract
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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Affiliation(s)
| | | | | | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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41
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Carrión RE, Auther AM, McLaughlin D, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman L, Stone W, Tsuang M, Walker EF, Woods SW, Torous J, Cornblatt BA. Social decline in the psychosis prodrome: Predictor potential and heterogeneity of outcome. Schizophr Res 2021; 227:44-51. [PMID: 33131983 DOI: 10.1016/j.schres.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND While an established clinical outcome of high importance, social functioning has been emerging as possibly having a broader significance to the evolution of psychosis and long term disability. In the current study we explored the association between social decline, conversion to psychosis, and functional outcome in individuals at clinical high risk (CHR) for psychosis. METHODS 585 subjects collected in the North American Prodrome Longitudinal Study (NAPLS2) were divided into 236 Healthy Controls (HCs), and CHR subjects that developed psychosis (CHR + C, N = 79), or those that did not (Non-Converters, CHR-NC, N = 270). CHR + C subjects were further divided into those that experienced an atypical decline in social functioning prior to baseline (beyond typical impairment levels) when in min-to-late adolescence (CHR + C-SD, N = 39) or those that did not undergoing a decline (CHR + C-NSD, N = 40). RESULTS Patterns of poor functional outcomes varied across the CHR subgroups: CHR-NC (Poor Social 36.3%, Role 42.2%) through CHR + C-NSD (Poor Social 50%, Poor Role 67.5%) to CHR + C-SD (Poor Social 76.9%, Poor Role 89.7%) functioning. The two Converter subgroups had comparable positive symptoms at baseline. At 12 months, the CHR + C-SD group stabilized, but social functioning levels remained significantly lower than the other two subgroups. CONCLUSIONS The current study demonstrates that pre-baseline social decline in mid-to-late adolescence predicts psychosis. In addition, we found that this social decline in converters is strongly associated with especially poor functional outcome and overall poorer prognosis. Role functioning, in contrast, has not shown similar predictor potential, and rather appears to be an illness indicator that worsens over time.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, United States
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Ming Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - John Torous
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
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Kafadar E, Mittal VA, Strauss GP, Chapman HC, Ellman LM, Bansal S, Gold JM, Alderson-Day B, Evans S, Moffatt J, Silverstein SM, Walker EF, Woods SW, Corlett PR, Powers AR. Modeling perception and behavior in individuals at clinical high risk for psychosis: Support for the predictive processing framework. Schizophr Res 2020; 226:167-175. [PMID: 32593735 PMCID: PMC7774587 DOI: 10.1016/j.schres.2020.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022]
Abstract
Early intervention in psychotic spectrum disorders is critical for maximizing key clinical outcomes. While there is some evidence for the utility of intervention during the prodromal phase of the illness, efficacy of interventions is difficult to assess without appropriate risk stratification. This will require biomarkers that robustly help to identify risk level and are also relatively easy to obtain. Recent work highlights the utility of computer-based behavioral tasks for understanding the pathophysiology of psychotic symptoms. Computational modeling of performance on such tasks may be particularly useful because they explicitly and formally link performance and symptom expression. Several recent studies have successfully applied principles of Bayesian inference to understanding the computational underpinnings of hallucinations. Within this framework, hallucinations are seen as arising from an over-weighting of prior beliefs relative to sensory evidence. This view is supported by recently-published data from two tasks: the Conditioned Hallucinations (CH) task, which determines the degree to which participants use expectations in detecting a target tone; and a Sine-Vocoded Speech (SVS) task, in which participants can use prior exposure to speech samples to inform their understanding of degraded speech stimuli. We administered both of these tasks to two samples of participants at clinical high risk for psychosis (CHR; N = 19) and healthy controls (HC; N = 17). CHR participants reported both more conditioned hallucinations and more pre-training SVS detection. In addition, relationships were found between participants' performance on both tasks. On computational modeling of behavior on the CH task, CHR participants demonstrate significantly poorer recognition of task volatility as well as a trend toward higher weighting of priors. A relationship was found between this latter effect and performance on both tasks. Taken together, these results support the assertion that these two tasks may be driven by similar latent factors in perceptual inference, and highlight the potential utility of computationally-based tasks in identifying risk.
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Affiliation(s)
- Eren Kafadar
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Vijay A Mittal
- Northwestern University, Evanston, IL, United States of America
| | | | | | - Lauren M Ellman
- Temple University, Philadelphia, PA, United States of America
| | - Sonia Bansal
- Maryland Psychiatric Research Center, Catonsville, MD, United States of America
| | - James M Gold
- Maryland Psychiatric Research Center, Catonsville, MD, United States of America
| | | | | | | | | | | | - Scott W Woods
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Philip R Corlett
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, United States of America.
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43
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Progression from being at-risk to psychosis: next steps. NPJ SCHIZOPHRENIA 2020; 6:27. [PMID: 33020486 PMCID: PMC7536226 DOI: 10.1038/s41537-020-00117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
Over the past 20 years there has been a great deal of research into those considered to be at risk for developing psychosis. Much has been learned and studies have been encouraging. The aim of this paper is to offer an update of the current status of research on risk for psychosis, and what the next steps might be in examining the progression from CHR to psychosis. Advances have been made in accurate prediction, yet there are some methodological issues in ascertainment, diagnosis, the use of data-driven selection methods and lack of external validation. Although there have been several high-quality treatment trials the heterogeneity of this clinical high-risk population has to be addressed so that their treatment needs can be properly met. Recommendations for the future include more collaborative research programmes, and ensuring they are accessible and harmonized with respect to criteria and outcomes so that the field can continue to move forward with the development of large collaborative consortiums as well as increased funding for multisite projects.
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Strauss GP, Pelletier-Baldelli A, Visser KF, Walker EF, Mittal VA. A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis. Schizophr Res 2020; 222:104-112. [PMID: 32522469 PMCID: PMC7572550 DOI: 10.1016/j.schres.2020.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022]
Abstract
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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Affiliation(s)
- Gregory P. Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-706-542-0307. Fax: +1-706-542-3275. University of Georgia, Department of Psychology, 125 Baldwin St., Athens, GA 30602
| | | | | | | | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Kim M, Hwang WJ, Park J, Kim T, Oh S, Kwon JS. Neurophysiological Correlate of Emotion Regulation by Cognitive Reappraisal and Its Association With Psychotic Symptoms in Early Psychosis. Schizophr Bull 2020; 47:87-96. [PMID: 32609340 PMCID: PMC7825098 DOI: 10.1093/schbul/sbaa080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emotion dysregulation is crucial to both poor social functioning and psychotic symptom formation in patients with schizophrenia. The efficient use of emotion regulation strategies, such as cognitive reappraisal, has been less frequently observed in the early phases of psychotic disorder. It is unknown whether neurophysiological responses related to emotion regulation by cognitive reappraisal are altered in early psychosis. METHODS Fifty-four patients with first-episode psychosis (FEP), 34 subjects at clinical high risk (CHR) for psychosis, and 30 healthy controls (HCs) participated in event-related potential recordings during a validated emotion regulation paradigm to measure the effect of cognitive reappraisal on emotion regulation. Late positive potentials (LPPs), which reflect emotional arousal, were compared across the groups and the 3 conditions (negative, cognitive reappraisal, and neutral). The relationship among LPP modulation by cognitive reappraisal and social/role functioning and severity of psychotic symptoms was investigated in the early psychosis group. RESULTS The FEP and CHR participants showed comparably larger LPP amplitudes in the negative and cognitive reappraisal conditions than in the neutral condition, whereas the HCs presented larger LPPs in the negative condition than in the cognitive reappraisal and neutral conditions. LPP modulation by cognitive reappraisal was negatively correlated with positive symptom severity in the FEP patients and with disorganization severity in the CHR subjects. CONCLUSIONS Inefficient use of cognitive reappraisal may be related to the impaired emotion regulation and psychotic symptoms from the very beginning of psychotic disorder. This study provides the first neurophysiological evidence regarding current concepts of emotion regulation in early psychosis.
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Affiliation(s)
- Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Jihye Park
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea,To whom correspondence should be addressed; Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, Republic of Korea, 03080; tel: +82-2-2072-2972, fax: +82-2-747-9063, e-mail:
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46
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Harvey PD, Isner EC. Cognition, Social Cognition, and Functional Capacity in Early-Onset Schizophrenia. Child Adolesc Psychiatr Clin N Am 2020; 29:171-182. [PMID: 31708046 DOI: 10.1016/j.chc.2019.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cognitive impairments are a central feature of schizophrenia. These impairments are present across the course of the illness, from prodromal to more chronic patients. Social cognitive deficits, now known to be related to social outcomes in the real world, are also impaired in cases with early-onset psychosis. Similarly, disability in everyday functions is present and is correlated with impairments in performance on measures of the ability to perform everyday functional and social skills. This constellation of impairments leads to wide-ranging social and functional deficits. Treatments offered for adult-onset cases should be offered to early-onset cases as well."
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Research Service, Bruce W. Carter VA Medical Center, 1120 Northwest 14th Street, Suite 1450, Miami, FL 33136, USA.
| | - Elizabeth C Isner
- University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Suite 1450, Miami, FL 33136, USA
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Salazar de Pablo G, Guinart D, Cornblatt BA, Auther AM, Carrión RE, Carbon M, Jiménez-Fernández S, Vernal DL, Walitza S, Gerstenberg M, Saba R, Lo Cascio N, Brandizzi M, Arango C, Moreno C, Van Meter A, Fusar-Poli P, Correll CU. DSM-5 Attenuated Psychosis Syndrome in Adolescents Hospitalized With Non-psychotic Psychiatric Disorders. Front Psychiatry 2020; 11:568982. [PMID: 33192693 PMCID: PMC7609900 DOI: 10.3389/fpsyt.2020.568982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/14/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Although attenuated psychotic symptoms often occur for the first time during adolescence, studies focusing on adolescents are scarce. Attenuated psychotic symptoms form the criteria to identify individuals at increased clinical risk of developing psychosis. The study of individuals with these symptoms has led to the release of the DSM-5 diagnosis of Attenuated Psychosis Syndrome (APS) as a condition for further research. We aimed to characterize and compare hospitalized adolescents with DSM-5-APS diagnosis vs. hospitalized adolescents without a DSM-5-APS diagnosis. Methods: Interviewing help-seeking, hospitalized adolescents (aged 12-18 years) and their caregivers independently with established research instruments, we (1) evaluated the presence of APS among non-psychotic adolescents, (2) characterized and compared APS and non-APS individuals regarding sociodemographic, illness and intervention characteristics, (3) correlated psychopathology with levels of functioning and severity of illness and (4) investigated the influence of individual clinical, functional and comorbidity variables on the likelihood of participants to be diagnosed with APS. Results: Among 248 consecutively recruited adolescents (age=15.4 ± 1.5 years, females = 69.6%) with non-psychotic psychiatric disorders, 65 (26.2%) fulfilled APS criteria and 183 (73.8%) did not fulfill them. Adolescents with APS had higher number of psychiatric disorders than non-APS adolescents (3.5 vs. 2.4, p < 0.001; Cohen's d = 0.77), particularly, disruptive behavior disorders (Cramer's V = 0.16), personality disorder traits (Cramer's V = 0.26), anxiety disorders (Cramer's V = 0.15), and eating disorders (Cramer's V = 0.16). Adolescents with APS scored higher on positive (Cohen's d = 1.5), negative (Cohen's d = 0.55), disorganized (Cohen's d = 0.51), and general symptoms (Cohen's d = 0.84), and were more severely ill (Cohen's d = 1.0) and functionally impaired (Cohen's d = 0.31). Negative symptoms were associated with lower functional levels (Pearson ρ = -0.17 to -0.20; p = 0.014 to 0.031). Global illness severity was associated with higher positive, negative, and general symptoms (Pearson ρ = 0.22 to 0.46; p = 0.04 to p < 0.001). APS status was independently associated with perceptual abnormalities (OR = 2.0; 95% CI = 1.6-2.5, p < 0.001), number of psychiatric diagnoses (OR = 1.5; 95% CI = 1.2-2.0, p = 0.002), and impaired stress tolerance (OR = 1.4; 95% CI = 1.1-1.7, p = 0.002) (r 2 = 0.315, p < 0.001). Conclusions: A considerable number of adolescents hospitalized with non-psychotic psychiatric disorders meet DSM-5-APS criteria. These help-seeking adolescents have more comorbid disorders and more severe symptoms, functional impairment, and severity of illness than non-APS adolescents. Thus, they warrant high intensity clinical care.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Andrea M Auther
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Ricardo E Carrión
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Maren Carbon
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Unit, Jaén Medical Center, Jaén, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Ditte L Vernal
- Research Unit for Child- and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Walitza
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | - Miriam Gerstenberg
- Psychiatric University Hospital Zurich, Department of Child and Adolescent Psychiatry and Psychotherapy, Zurich, Switzerland
| | | | - Nella Lo Cascio
- Prevention and Early Intervention Service, Department of Mental Health, Rome, Italy
| | - Martina Brandizzi
- Local Health Agency Rome 1, Santo Spirito in Sassia Hospital, Department of Mental Health, Inpatient Psychiatric Unit, Rome, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, General Universitario Gregorio Marañón School of Medicine, Institute of Psychiatry and Mental Health, Hospital Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, Madrid, Spain
| | - Anna Van Meter
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Outreach and Support in South London Service, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.,Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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48
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Osborne KJ, Mittal VA. External validation and extension of the NAPLS-2 and SIPS-RC personalized risk calculators in an independent clinical high-risk sample. Psychiatry Res 2019; 279:9-14. [PMID: 31279247 PMCID: PMC6713610 DOI: 10.1016/j.psychres.2019.06.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022]
Abstract
Early identification of individuals likely to develop psychosis is a priority for the field, resulting in the development of risk calculators that provide personalized estimates that an individual at clinical high-risk (CHR) will develop psychosis. The North American Prodrome Longitudinal Study (NAPLS) consortium and Shanghai At-Risk for Psychosis program have recently developed such calculators (NAPLS-2/SIPS-RC, respectively), but their discrimination performance has never been examined within the same sample. Moreover, validation studies of NAPLS-2 are limited in number and the SIPS-RC has not been cross-validated in a North American sample. The present research (N = 68) used the area under the receiver operating characteristic curve (AUC) to examine the accuracy of the NAPLS-2 and SIPS-RC calculators for discriminating CHR converters and non-converters, as well as extend their use by examining their ability to predict illness progression over a two-year period. For conversion, the NAPLS-2 and SIPS-RC risk calculators demonstrated moderate (AUC = 0.71) and fair (AUC = 0.65) discrimination performance, respectively. Both calculators provided moderate accuracy for discriminating illness progression over two-years (NAPLS-2 AUC = 0.71/ SIPS-RC AUC = 0.76). We discuss implications for researchers and practitioners interested in using the NAPLS-2 and/or SIPS-RC and identify important steps for future research.
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Affiliation(s)
- K Juston Osborne
- Northwestern University, Department of Psychology, Evanston, IL, USA.
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston, Chicago, IL, USA
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49
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Harvey PD, Jones MT. Functional deficits in attenuated psychosis syndrome and related conditions: Current and future treatment options. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 17:100152. [PMID: 31193274 PMCID: PMC6522774 DOI: 10.1016/j.scog.2019.100152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Research Service, Miami VA Healthcare System, Miami, FL 33125, USA
- Corresponding author at: Leonard M. Miller Professor of Psychiatry and Behavioral Science, Division of Psychology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1450, Miami, FL 33136, USA.
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