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Bissonnette JN, Anderson TJ, Crocker CE, Tibbo PG, Salisbury DF, Fisher DJ. Examining the Complex Mismatch Negativity in Early Phase Psychosis Using the Dual Rule Paradigm. Clin EEG Neurosci 2024:15500594241273287. [PMID: 39150248 DOI: 10.1177/15500594241273287] [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] [Indexed: 08/17/2024]
Abstract
Using electroencephalography (EEG) to examine the simple mismatch negativity (MMN), a marker of auditory cortex function, has been of great interest in the exploration of biomarkers for psychotic illness. Despite many studies reporting MMN deficits in chronic schizophrenia, there are inconsistent reports of MMN reductions in the early phases of psychotic illness, suggesting the MMN elicited by traditional paradigms may not be a sensitive enough measure of vulnerability to be used as a biomarker. Recently, a more computationally complex measure of auditory cortex function (the complex mismatch negativity; cMMN) has been hypothesized to provide a more sensitive marker of illness vulnerability. The current study employed a novel dual rule paradigm, in which two pattern rules are established and violated, to examine the cMMN in 14 individuals with early phase psychosis (EPP, < 5 years illness) and 15 healthy controls (HC). Relationships between cMMN waveforms, symptom severity, and measures of functioning were explored. We found reductions of cMMN amplitudes at the site of maximal amplitude in EPP (p = .017) with large effect sizes (Hedges' g = 0.96). This study is an early step in the exploration of the cMMN as a biomarker for psychosis. Our results provide evidence that the dual rule cMMN paradigm shows promise as a method for cMMN elicitation that captures more subtle neurofunctional changes in the early stages of illness.
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Affiliation(s)
- Jenna N Bissonnette
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - T-Jay Anderson
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dean F Salisbury
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Derek J Fisher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Cowan HR, Williams TF, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshevan M, Perkins DO, Mathalon DH, Stone W, Woods SW, Walker EF. The Complex Latent Structure of Attenuated Psychotic Symptoms: Hierarchical and Bifactor Models of SIPS Symptoms Replicated in Two Large Samples at Clinical High Risk for Psychosis. Schizophr Bull 2024:sbae042. [PMID: 38728417 DOI: 10.1093/schbul/sbae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms. STUDY DESIGN Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders. STUDY RESULTS Most variance in SIPS items (75%-77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable. CONCLUSIONS Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.
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Affiliation(s)
- Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Departments of Psychiatry and Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Matcheri Keshevan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Zoupou E, Moore TM, Kennedy KP, Calkins ME, Gorgone A, Sandro AD, Rush S, Lopez KC, Ruparel K, Daryoush T, Okoyeh P, Savino A, Troyan S, Wolf DH, Scott JC, Gur RE, Gur RC. Validation of the structured interview section of the penn computerized adaptive test for neurocognitive and clinical psychopathology assessment (CAT GOASSESS). Psychiatry Res 2024; 335:115862. [PMID: 38554493 PMCID: PMC11025108 DOI: 10.1016/j.psychres.2024.115862] [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: 09/18/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 04/01/2024]
Abstract
Large-scale studies and burdened clinical settings require precise, efficient measures that assess multiple domains of psychopathology. Computerized adaptive tests (CATs) can reduce administration time without compromising data quality. We examined feasibility and validity of an adaptive psychopathology measure, GOASSESS, in a clinical community-based sample (N = 315; ages 18-35) comprising three groups: healthy controls, psychosis, mood/anxiety disorders. Assessment duration was compared between the Full and CAT GOASSESS. External validity was tested by comparing how the CAT and Full versions related to demographic variables, study group, and socioeconomic status. The relationships between scale scores and criteria were statistically compared within a mixed-model framework to account for dependency between relationships. Convergent validity was assessed by comparing scores of the CAT and the Full GOASSESS using Pearson correlations. The CAT GOASSESS reduced interview duration by more than 90 % across study groups and preserved relationships to external criteria and demographic variables as the Full GOASSESS. All CAT GOASSESS scales could replace those of the Full instrument. Overall, the CAT GOASSESS showed acceptable psychometric properties and demonstrated feasibility by markedly reducing assessment time compared to the Full GOASSESS. The adaptive version could be used in large-scale studies or clinical settings for intake screening.
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Affiliation(s)
- Eirini Zoupou
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Tyler M Moore
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Kelly P Kennedy
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Monica E Calkins
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Alesandra Gorgone
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Akira Di Sandro
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sage Rush
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Katherine C Lopez
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Tarlan Daryoush
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Paul Okoyeh
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Savino
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Troyan
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel H Wolf
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - J Cobb Scott
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN 4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Lifespan Brain Institute (LiBI), Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA.
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Tarbox-Berry SI, Walsh BC, Pogue-Geile MF, Woods SW. Symptoms of Attenuated Psychosis Syndrome in Relatives of Clinical High-Risk Youth: Preliminary Evidence. Schizophr Bull 2023; 49:1022-1031. [PMID: 36752824 PMCID: PMC10318861 DOI: 10.1093/schbul/sbad001] [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: 02/09/2023]
Abstract
BACKGROUND AND HYPOTHESIS Attenuated Psychosis Syndrome (APS) impacts functioning and predicts increased risk of psychosis. Risk for developing APS itself has received minimal attention. Knowledge of familial and environmental contributions to APS symptoms would advance understanding of APS and risk for psychosis. As an initial step, this report presents the first data on APS symptoms in family members of APS patients. STUDY DESIGN This study utilized a discordant sibling-pair family study design. The Structured Interview for Psychosis-risk Syndromes (SIPS) was administered to 17 APS probands and 26 non-APS biological siblings. Probands and siblings were compared on positive, negative, disorganized, and general SIPS symptom scales and factors derived from those scales. STUDY RESULTS There was significantly greater symptom severity in probands compared to siblings on nine of 19 SIPS scales. Negative/anxiety, functioning, and positive symptom factors were identified. Probands showed significantly greater severity than siblings on the negative/anxiety and positive factors. Elevated pathology on the negative/anxiety factor best differentiated between probands and siblings, over and above the contribution of the positive factor. No difference was found for the functioning factor. CONCLUSIONS Results support the importance of non-familial effects on risk for APS and suggest differences in familial contribution to APS symptoms. Understanding the relative contribution of familial and environmental effects on APS symptoms may reveal important differences among APS patients, with implications for risk characterization, symptom course, and treatment selection.
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Affiliation(s)
- Sarah I Tarbox-Berry
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara C Walsh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Choroidal structural analysis in ultra-high risk and first-episode psychosis. Eur Neuropsychopharmacol 2023; 70:72-80. [PMID: 36931136 DOI: 10.1016/j.euroneuro.2023.02.016] [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: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/19/2023]
Abstract
Both structural and functional alterations in the retina and the choroid of the eye, as parts of the central nervous system, have been shown in psychotic disorders, especially in schizophrenia. In addition, genetic and imaging studies indicate vascular and angiogenesis anomalies in the psychosis spectrum disorders. In this ocular imaging study, choroidal structure and vascularity were investigated using enhanced depth imaging (EDI) optical coherence tomography (OCT) in first-episode psychosis (FEP), ultra-high risk for psychosis (UHR-P), and age- and gender- matched healthy controls (HCs). There were no significant differences between groups in central choroidal thickness, stromal choroidal area (SCA), luminal choroidal area (LCA) and total subfoveal choroidal area. The LCA/SCA ratio (p<0.001) and the choroidal vascularity index (CVI) (p<0.001) were significantly different between FEP, UHR-P and HCs. CVI and LCA/SCA ratio were significantly higher in patients with FEP compared to help-seeking youth at UHR-P. CVI and LCA/SCA ratio were not different between UHR-P and HCs. However, CVI was higher in UHR-P compared to HCs after excluding the outliers for the sensitivity analysis (p = 0.002). Current findings suggest that choroidal thickness is normal, but there are abnormalities in choroidal microvasculature in prodromal and first-episode psychosis. Further longitudinal studies are needed to investigate oculomics, especially CVI, as a promising biomarker for the prediction of conversion to psychosis in individuals at clinical high-risk.
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Kaleda VG, Omelchenko MA, Migalina VV. [Juvenile depression as at-risk state for psychotic disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:38-45. [PMID: 38127699 DOI: 10.17116/jnevro202312311238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To establish the risk of psychotic disorders in juvenile depression and to study the role of negative symptoms in its formation. MATERIAL AND METHODS Seventy-four in-patients (19.6±2.3 years old), who were hospitalized for the first time in the clinic for a depressive episode, were examined. Psychometric scales HDRS, SOPS, SANS were used. The risk of manifestation of psychotic disorders was established in the presence of attenuated positive symptoms (APS) with values of at least one of the points P1, P2, P3 and P4 of the corresponding SOPS subscale more or equal to 3. The overall risk of schizophrenia spectrum disorders was established in the presence of attenuated negative symptoms (ANS) with values of at least one of the points H1-H6 of the negative SOPS subscale is more than or equal to 5. Statistical analysis was carried out using the Statistica 12 program. RESULTS During the psychometric assessment of patients at admission, four groups were identified based on the presence of APS and ANS: group 1 (APS+ANS), group 2 (APS), group 3 (ANS) and a comparison group without APS/ANS. It was found that the presence of APS and ANS in the structure of depression increased its severity (U=109.0; p=0.009). Assessment of the ANS severity on the negative subscale of SOPS and on the SANS demonstrated quantitative differences with the highest representation of negative symptoms in the corresponding groups (APS+ANS and ANS) with significant differences in total scores in the comparison group (U=93.0; p=0.004 and U=85.0; p=0.002). When studying the structure of negative symptoms according to the SANS subscales, patients with APS differed in a lower degree of severity of negative symptoms only according to the «Avolition-Apathy» subscale (U=141.5; p=0.028). Patients from the comparison group, despite significant differences in other psychopathological symptoms, showed lower values only for the SANS subscales «Affective flattening» (U=112.0; p=0.02) and, to a greater extent, «Avolition-Apathy» (U=84.0; p=0.002). CONCLUSION Based on the presence of prodromal symptoms in the structure of juvenile depression and their dynamics during therapy, one can assume not only a different degree of risk of endogenous psychoses, but also their nosological affiliation.
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Affiliation(s)
- V G Kaleda
- Mental Health Research Center, Moscow, Russia
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Palomäki J, Therman S, Kerkelä M, Järvelin MR, Jones P, Murray GK, Nordström T, Heinimaa M, Miettunen J, Veijola J, Riekki T. Specific adolescent prodromal symptoms associated with onset of psychosis in the Northern Finland Birth Cohort 1986. Early Interv Psychiatry 2022. [PMID: 36218312 DOI: 10.1111/eip.13363] [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: 01/24/2022] [Revised: 05/15/2022] [Accepted: 09/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Several psychological symptoms in adolescence associate with later development of psychosis. However, it is unclear which symptoms specifically predict psychotic disorders rather than psychiatric disorders in general. We conducted a prospective study comparing how specific adolescent psychotic-like symptoms, predicted psychotic and non-psychotic hospital-treated psychiatric disorders in the population-based Northern Finland Birth Cohort 1986 (NFBC1986). METHODS At age 15-16 years, 6632 members of the NFBC1986 completed the PROD-screen questionnaire. New hospital-treated mental disorders of the NFBC1986 participants were detected between age 17 and 30 years from the Finnish Care Register for Health Care. Multiple covariates were used in the analysis. RESULTS During the follow-up, 1.1% of the participants developed a psychotic and 3.2% a non-psychotic psychiatric disorder. Three symptoms were specifically associated with onset of psychosis compared to non-psychotic psychiatric disorders: 'Difficulty in controlling one's speech, behaviour or facial expression while communicating' (adjusted OR 4.00; 95% CI 1.66-9.92), 'Difficulties in understanding written text or heard speech' (OR 2.25; 1.12-4.51), and 'Difficulty or uncertainty in making contact with other people' (OR 2.20; 1.03-4.67). Of these, the first one remained statistically significant after Bonferroni correction for multiple comparisons. CONCLUSION To our knowledge, this is the first general-population-based prospective study exploring psychiatric symptoms predicting the onset of hospital-treated first-episode psychosis in comparison to non-psychotic disorders. We found three symptoms related with difficulties in social interaction which predicted onset of psychosis. This is a novel finding and should be replicated.
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Affiliation(s)
- Johanna Palomäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Martta Kerkelä
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | | | - Peter Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tanja Nordström
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tiina Riekki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Ma WF, Yeh TP, Ho YF, Chang SM, Lin YP. The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university. Perspect Psychiatr Care 2022; 58:1372-1380. [PMID: 34462933 DOI: 10.1111/ppc.12939] [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: 11/11/2020] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS This screen model can be used in early detection for undergraduates with HRDP from large general samples.
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Affiliation(s)
- Wei-Fen Ma
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,College of Health Care, Ph.D Program for Health Science and Industry, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Tzu-Pei Yeh
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Ya-Fang Ho
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Shan-Mei Chang
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Yun-Ping Lin
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
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9
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Fekih-Romdhane F, Hallit S, Cheour M, Jahrami H. The nature, consequences, mechanisms, and management of sleep disturbances in individuals at-risk for psychosis. Front Psychiatry 2022; 13:1011963. [PMID: 36203842 PMCID: PMC9530454 DOI: 10.3389/fpsyt.2022.1011963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
There is strong evidence that sleep disturbances are commonly experienced by people with psychosis. Evidence has also shown that sleep disturbances are present since the very early stages of the disease, even during the pre-diagnostic phase. More recently, research involving young individuals at ultra-high risk (UHR) for psychosis documented frequent occurrence of sleep disturbances in this group. The very early onset of sleep disturbances in the course of psychosis has drawn attention to the possible links between sleep parameters and the risk of psychosis. To date, the nature of sleep disturbances characterizing the UHR stage remains unclear, with available studies having yielded mixed findings. In this regard, we performed this review to update the body of literature on the nature of sleep disturbances, their underlying mechanisms, their clinical and functional consequences, the prevention and intervention strategies in the at-risk for psychosis population. Our findings provided further support to the presence of disturbed sleep in UHR individuals as evidenced by subjective and objective sleep measures such as polysomnography, sleep electroencephalograms, and actigraphy. Reviewing the possible mechanisms underlying the relationship between sleep and psychosis emphasized its complex and multifactorial nature which is yet to be determined and understood. Further research is warranted to determine which facets of sleep disturbances are most detrimental to this specific population, and to what extent they can be causal factors or markers of psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Psychiatry, Ministry of Health, Manama, Bahrain
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Bridging the phenomenological gap between predictive basic-symptoms and attenuated positive symptoms: a cross-sectional network analysis. SCHIZOPHRENIA 2022; 8:68. [PMID: 36002447 PMCID: PMC9402628 DOI: 10.1038/s41537-022-00274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
Attenuated positive symptoms (APS), transient psychotic-like symptoms (brief, limited intermittent psychotic symptoms, BLIPS), and predictive cognitive-perceptive basic-symptoms (BS) criteria can help identify a help-seeking population of young people at clinical high-risk of a first episode psychosis (CHRp). Phenomenological, there are substantial differences between BS and APS or BLIPS. BS do not feature psychotic content as delusion or hallucinations, and reality testing is preserved. One fundamental problem in the psychopathology of CHRp is to understand how the non-psychotic BS are related to APS. To explore the interrelationship of APS and predictive BS, we fitted a network analysis to a dataset of 231 patients at CHRp, aged 24.4 years (SD = 5.3) with 65% male. Particular emphasis was placed on points of interaction (bridge symptoms) between the two criteria sets. The BS ‘unstable ideas of reference’ and “inability to discriminate between imagination and reality” interacted with attenuated delusional ideation. Perceptual BS were linked to perceptual APS. Albeit central for the network, predictive cognitive basic BS were relatively isolated from APS. Our analysis provides empirical support for existing theoretical accounts that interaction between the distinct phenomenological domains of BS and APS is characterized by impairments in source monitoring and perspective-taking. Identifying bridge symptoms between the symptom domains holds the potential to empirically advance the etiological understanding of psychosis and pave the way for tailored clinical interventions.
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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12
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TONYALI A, KARAÇETİN G, KANIK A, ERTAŞ E, KARABAĞ U, UMUT Ö, ÇIRAY O, ÖZKAN B, ERMİŞ Ç. Turkish Version of Structured Interview of Psychosis-Risk Syndromes (SIPS) and Proposal of a Brief Version of SIPS as a Pretest Risk Enrichment. Noro Psikiyatr Ars 2022; 59:139-146. [PMID: 35685058 PMCID: PMC9142018 DOI: 10.29399/npa.27793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/15/2021] [Indexed: 06/15/2023] Open
Abstract
Introduction The Structured Interview of Psychosis Risk Syndromes (SIPS) was created to identify patients with Clinical High Risk for psychosis (CHR). This study aimed i) to translate and validate the Scale of Prodromal Syndromes (SOPS) in Turkish adolescents, ii) to explore the factor structure of the SIPS/SOPS in the adolescent population, especially focusing on those under the age of 15, iii) to generate a brief version of SIPS (SIPS-B). Methods A total of 150 adolescents aged between 12 and 18 years, were consecutively interviewed using SIPS/SOPS. Patients with psychotic syndrome (n=20), psychosis risk syndrome (PRS) (n=59), and clinical controls (CC) (n=71) were included in the study. Results Principal component analysis (PCA) yielded three latent factors, explaining 62.7% of the total variance in the whole clinical sample, including positive symptom factor, disorganized symptom factor, and negative symptom factor. The area under curve calculated in ROC analyses involving PRS and CC supported the four-item form of the SIPS-B (optimal cut-off=12.5, sensitivity=87%, specificity=80%). Conclusion Our study results support the notion that the Turkish translation of SIPS/SOPS meets the reliability and validity criteria in Turkish adolescents. The SIPS-B could aid clinicians in their routine clinical practice to expedite referral procedures.
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Affiliation(s)
- Ayşegül TONYALI
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr. Mazhar Osman Mental Health and Disorders Training and Research Hospital, İstanbul, Turkey
| | - Gül KARAÇETİN
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr. Mazhar Osman Mental Health and Disorders Training and Research Hospital, İstanbul, Turkey
| | - Arzu KANIK
- Department of Biostatistics, University of Health Sciences, Mersin, Turkey
| | - Elif ERTAŞ
- Department of Biostatistics, University of Health Sciences, Mersin, Turkey
| | - Uğur KARABAĞ
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr. Mazhar Osman Mental Health and Disorders Training and Research Hospital, İstanbul, Turkey
| | - Öykü UMUT
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğulcan ÇIRAY
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Bedriye ÖZKAN
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Bakirkoy Prof Dr. Mazhar Osman Mental Health and Disorders Training and Research Hospital, İstanbul, Turkey
| | - Çağatay ERMİŞ
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University School of Medicine, İzmir, Turkey
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13
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Giordano GM, Palumbo D, Pontillo M, Mucci A, Galderisi S, Vicari S. Negative Symptom Domains in Children and Adolescents at Ultra-High Risk for Psychosis: Association With Real-Life Functioning. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac025. [PMID: 39144787 PMCID: PMC11205885 DOI: 10.1093/schizbullopen/sgac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background Negative symptoms (NS) appear early in subjects at ultra-high risk (UHR) for psychosis and may increase the risk of conversion to psychotic disorders and poor outcome. Contrary to schizophrenia, there is no consensus on the conceptualization and factor structure of NS in UHR subjects. This study aims to explore NS prevalence, factor structure, and impact on the outcome of UHR state in children and adolescents. Methods 71 UHR were recruited at the Neuropsychiatry Unit of the Hospital Bambino Gesù in Rome. We examined the prevalence of NS of at least moderate severity, the factor structure of NS by Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA), and correlations between extracted factors and functioning. We also evaluated the severity of baseline NS in subjects who converted to psychosis (converters) and in those who did not convert (nonconverters) at 1-year follow-up. Results At baseline, all participants showed at least one NS of at least moderate severity. PCA and CFA yielded a two-factor solution: an ''Expressive" and an "Experiential" factor. Only the Experiential factor was associated with functioning. At baseline, severity of NS did not differ between converters (N = 16) and nonconverters (N = 55). Conclusions In UHR children and adolescents NS have a high prevalence, a significant impact on functioning, and cluster in two-factors. Replications by independent studies, with state-of-the-art instruments and longer duration of follow-up, are needed to improve the characterization of NS in this population, clarify their impact on the outcome and enhance their early identification, prevention, and treatment.
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Affiliation(s)
| | - Davide Palumbo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, IRCSS Bambino Gesù Children’s Hospital of Rome, Rome, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, IRCSS Bambino Gesù Children’s Hospital of Rome, Rome, Italy
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14
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Azis M, Rouhakhtar PR, Schiffman JE, Ellman LM, Strauss GP, Mittal VA. Structure of positive psychotic symptoms in individuals at clinical high risk for psychosis. Early Interv Psychiatry 2021; 15:505-512. [PMID: 32337849 PMCID: PMC8638562 DOI: 10.1111/eip.12969] [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: 11/25/2019] [Revised: 02/28/2020] [Accepted: 04/02/2020] [Indexed: 01/22/2023]
Abstract
AIM Positive symptoms are a critical dimension of psychopathology in psychotic disorders and are used as a criterion for diagnosis across the psychosis continuum. Although initially considered as one dimension, there is evidence for multidimensionality within positive symptoms. The positive symptom structure has not been examined in individuals at clinical high risk (CHR) for psychosis. Knowledge of the dimensional structure of positive symptoms within CHR may contribute to our understanding of the aetiology and trajectory of this key facet of psychosis. METHOD Exploratory factor analysis (EFA) was conducted on the Prodromal Questionnaire-Brief for 183 individuals meeting CHR criteria. Internal consistency was examined to determine the hierarchical structure of the data and alternative models were compared. RESULTS EFA revealed a three factor model, grouping in to: perceptual abnormalities, grandiose/unusual delusions and persecutory/thought delusions, with a general factor accounting for 56% of the variance. Confirmatory factor analysis showed that a hierarchical model was the best fit. One item referring to nihilistic thoughts did not load on any factor. CONCLUSION There is a clear three-dimensional model, distinguishing perceptual abnormalities, and two subgroups of delusions in CHR individuals. The factors are similar to those found in psychotic disorders. The identification and comparison of symptomatic models is useful given the prominent role positive symptoms play in diagnosis, and is crucial to our understanding of the clinical progression of psychosis. This work may provide a useful tool for future studies examining correlations with varying symptom factors and disease progression in CHR.
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Affiliation(s)
- Matilda Azis
- Department of Psychology, Northwestern University, Illinois, USA.,Department of Psychiatry, Northwestern University, Illinois, USA.,Department of Medical Social Sciences, Northwestern University, Illinois, USA.,Institute for Policy Research, Northwestern University, Illinois, USA.,Institute for Innovations in Developmental Sciences, Northwestern University, Illinois, USA
| | | | - Jason E Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Maryland, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Illinois, USA
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15
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Calkins ME, Woods SW, Bearden CE, Liu L, Moore TM, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Mathalon DH, Keshavan M, Stone WS, Addington J. Concordance and factor structure of subthreshold positive symptoms in youth at clinical high risk for psychosis. Schizophr Res 2021; 227:72-77. [PMID: 32943313 DOI: 10.1016/j.schres.2020.08.014] [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: 04/02/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022]
Abstract
Prevailing models of psychosis risk incorporate positive subthreshold symptoms as defining features of risk or transition to psychotic disorders. Despite this, relatively few studies have focused on characterizing longitudinal symptom features, such as prevalence, concordance and structure, which may aid in refining methods and enhancing classification and prediction efforts. The present study aimed to fill these gaps using longitudinal 24-month follow-up data from the well-characterized NAPLS-2 multi-site investigation of youth at clinical high risk (CHR) who had (n = 86) and had not (n = 268) transitioned to a threshold psychotic disorder since baseline. At baseline, among sub-delusional ideas, unusual thought content and suspicious/persecutory thinking were very common in CHR youth, and were highly concordant. Perceptual abnormalities (P4) were also common across youth regardless of symptom course and eventual transition to psychosis. Grandiose ideas were rare. Exploratory factor analysis extracted two constituent factors at multiple follow-up intervals, but there was marked instability in the structure over 24 months, and clear indicators for a single positive symptom factor. Together these findings support suggestions to combine sub-delusional symptoms into a single symptom category for classification purposes, in efforts to reduce clinical heterogeneity and ease measurement burden.
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Affiliation(s)
- Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | - Lu Liu
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States of America
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, La Jolla, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States of America
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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16
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Clarke L, Chisholm K, Cappuccio FP, Tang NKY, Miller MA, Elahi F, Thompson AD. Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis. Schizophr Res 2021; 227:81-91. [PMID: 32646803 DOI: 10.1016/j.schres.2020.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and investigate how sleep disturbances relate to psychotic symptoms, functioning and Quality of Life (QoL) in At Risk Mental State (ARMS) youth. METHOD A comprehensive search of six databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and CENTRAL) was conducted. Eligible studies provided data on sleep disturbances or disorders in ARMS patients. RESULTS Sixteen studies met the inclusion criteria (n = 1962 ARMS patients) including 7 cross-sectional studies, 2 RCT's and 7 cohort studies. Narrative synthesis revealed that self-reported sleep (e.g., general disturbances, fragmented night time sleep and nightmares) was poorer among ARMS patients compared to healthy controls. In the limited studies (n = 4) including objective measurements of sleep disturbances, ARMS patients experienced higher levels of movement during sleep, more daytime naps and increased sleep latency compared to controls. Furthermore, sleep disturbances were associated with attenuated psychotic symptoms and functional outcomes cross-sectionally and longitudinally. Only one study investigated the relationship between sleep and QoL. The exploratory meta-analysis revealed a significant difference in self-reported sleep disturbances measured by the PSQI (mean difference in score: 3.30 (95% CI 1.87, 4.74), p < 0.00001) and SIPS (mean difference in score: 1.58 (95% CI 0.80, 2.35), p < 0.00001) of ARMS patients compared to control groups. CONCLUSIONS ARMS individuals report impaired sleep quality and reduced sleep quantity compared to healthy controls. However, further research is needed to explore the longitudinal relationship between sleep disruptions and QoL in early psychosis. Significant variations in how sleep is measured across studies highlight a need to assess disturbances to sleep using robust and consistent approaches in this patient group.
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Affiliation(s)
- Latoya Clarke
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Francesco P Cappuccio
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Michelle A Miller
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Farah Elahi
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew D Thompson
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
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17
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Jimeno N, Gomez-Pilar J, Poza J, Hornero R, Vogeley K, Meisenzahl E, Haidl T, Rosen M, Klosterkötter J, Schultze-Lutter F. Main Symptomatic Treatment Targets in Suspected and Early Psychosis: New Insights From Network Analysis. Schizophr Bull 2020; 46:884-895. [PMID: 32010940 PMCID: PMC7345824 DOI: 10.1093/schbul/sbz140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The early detection and intervention in psychoses prior to their first episode are presently based on the symptomatic ultra-high-risk and the basic symptom criteria. Current models of symptom development assume that basic symptoms develop first, followed by attenuated and, finally, frank psychotic symptoms, though interrelations of these symptoms are yet unknown. Therefore, we studied for the first time their interrelations using a network approach in 460 patients of an early detection service (mean age = 26.3 y, SD = 6.4; 65% male; n = 203 clinical high-risk [CHR], n = 153 first-episode psychosis, and n = 104 depression). Basic, attenuated, and frank psychotic symptoms were assessed using the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS). Using the R package qgraph, network analysis of the altogether 86 symptoms revealed a single dense network of highly interrelated symptoms with 5 discernible symptom subgroups. Disorganized communication was the most central symptom, followed by delusions and hallucinations. In line with current models of symptom development, the network was distinguished by symptom severity running from SPI-A via SIPS to PANSS assessments. This suggests that positive symptoms developed from cognitive and perceptual disturbances included basic symptom criteria. Possibly conveying important insight for clinical practice, central symptoms, and symptoms "bridging" the association between symptom subgroups may be regarded as the main treatment targets, in order to prevent symptomatology from spreading or increasing across the whole network.
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Affiliation(s)
- Natalia Jimeno
- Department of Psychiatry, School of Medicine University of Valladolid, Valladolid, Spain
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
- GINCS, Research Group on Clinical Neuroscience of Segovia, Segovia, Spain
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Jesus Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- CIBER-BBN, Centro de Investigacion Biomedica en Red-Bioingenieria, Biomateriales y Biomedicina, Valladolid, Spain
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
- INM3, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
| | - Theresa Haidl
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich-Heine University, Düsseldorf, Germany
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18
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Rosen M, Haidl TK, Ruhrmann S, Vogeley K, Schultze-Lutter F. Sex differences in symptomatology of psychosis-risk patients and in prediction of psychosis. Arch Womens Ment Health 2020; 23:339-349. [PMID: 31485796 DOI: 10.1007/s00737-019-01000-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Abstract
Sex differences may be important for understanding underlying pathophysiological mechanisms and developing effective preventions and treatments of mental disorders. Despite sex differences in the onset of psychosis, patients at clinical high risk for psychosis (CHR) are underinvestigated for sex effects, especially with respect to models for prediction of conversion to psychosis. We studied psychopathological sex differences in referrals to a German early detection service and in its subgroup of converters and examined sex-specific psychopathological prediction models. In 152 male and 90 female referrals (88% at CHR; 35% converters), symptoms assessed with the Structured Interview for Psychosis-Risk Syndromes were investigated for sex differences using effect sizes. Sex-specific prediction models of psychosis were separately generated using Cox regressions with a LASSO operator. We found different small sex effects (0.10 < Rosenthal's r < 0.30) in the referral and in the converter sample. In the referral sample, exclusively, males showed more pronounced symptoms (all negative symptoms incl. reduced stress tolerance, grandiosity, and disorganized communication); in converters, females experienced more pronounced perceptual abnormalities, bizarre thinking, and odd behaviors, while males expressed and experienced emotions to a lower degree. Furthermore, sexes differed in psychosis-predictive symptoms: "suspiciousness" and "disorganized communication" were prominent in prediction of psychosis in males, whereas "trouble with focus and attention" was so in females. While most sex differences in patients attending an early detection service seem to reflect general differences that are not specifically related to psychosis, others might be psychosis-specific. These results can inform the development of more individualized and effective interventions for CHR patients based on more precise sex-specific prediction models.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Theresa Katharina Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Vogeley
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany
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19
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Kotov R, Jonas KG, Carpenter WT, Dretsch MN, Eaton NR, Forbes MK, Forbush KT, Hobbs K, Reininghaus U, Slade T, South SC, Sunderland M, Waszczuk MA, Widiger TA, Wright AGC, Zald DH, Krueger RF, Watson D. Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum. World Psychiatry 2020; 19:151-172. [PMID: 32394571 PMCID: PMC7214958 DOI: 10.1002/wps.20730] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis-related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Katherine G Jonas
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | - Michael N Dretsch
- Walter Reed Army Institute of Research, US Army Medical Research Directorate - West, Silver Spring, MD, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Miriam K Forbes
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Kelsey Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance Abuse, University of Sydney, Sydney, NSW, Australia
| | - Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- Matilda Centre for Research in Mental Health and Substance Abuse, University of Sydney, Sydney, NSW, Australia
| | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, South Bend, IN, USA
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20
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Yoviene Sykes LA, Ferrara M, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, McGlashan TH, Woodberry KA, Powers AR, Ponce AN, Cahill JD, Pollard JM, Srihari VH, Woods SW. Predictive validity of conversion from the clinical high risk syndrome to frank psychosis. Schizophr Res 2020; 216:184-191. [PMID: 31864837 PMCID: PMC7239715 DOI: 10.1016/j.schres.2019.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023]
Abstract
Although the clinical high risk for psychosis (CHR) paradigm has become well-established over the past two decades, one key component has received surprisingly little investigative attention: the predictive validity of the criteria for conversion or transition to frank psychosis. The current study evaluates the predictive validity of the transition to psychosis as measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS) in CHR individuals. Participants included 33 SIPS converters and 399 CHR non-converters both from the North American Prodromal Longitudinal Study (NAPLS-2), as well as a sample of 67 separately ascertained first-episode psychosis (FEP) patients from the STEP program. Comparisons were made at baseline and one-year follow-up on demographic, diagnostic stability (SCID), and available measurement domains relating to severity of illness (psychotropic medication, psychosocial treatment, and resource utilization). Principal findings are: 1) a large majority of cases in both SIPS converters (n = 27/33, 81.8%) and FEP (n = 57/67, 85.1%) samples met criteria for continued psychosis at one-year follow-up; 2) follow-up prescription rates for current antipsychotic medication were higher in SIPS converters (n = 17/32, 53.1%) compared to SIPS non-converters (n = 81/397, 20.4%), and similar as compared to FEP cases (n = 39/65, 60%); and 3) at follow-up, SIPS converters had higher rates of resource utilization (psychiatric hospitalizations, day hospital admissions, and ER visits) than SIPS non-converters and were similar to FEP in most categories. The results suggest that the SIPS definition of psychosis onset carries substantial predictive validity. Limitations and future directions are discussed.
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Affiliation(s)
- Laura A Yoviene Sykes
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America; Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Thomas H McGlashan
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Kristen A Woodberry
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Center for Psychiatric Research, Maine Medical Center, Portland, ME, United States of America
| | - Albert R Powers
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Allison N Ponce
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - John D Cahill
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Jessica M Pollard
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
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Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
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Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
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Burton CZ, Tso IF, Carrión RE, Niendam T, Adelsheim S, Auther AM, Cornblatt BA, Carter CS, Melton R, Sale TG, Taylor SF, McFarlane WR. Baseline psychopathology and relationship to longitudinal functional outcome in attenuated and early first episode psychosis. Schizophr Res 2019; 212:157-162. [PMID: 31395490 PMCID: PMC6791749 DOI: 10.1016/j.schres.2019.07.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/28/2019] [Accepted: 07/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND As efforts intensify to intervene early among those at risk for psychosis, examination of the relationship between presenting psychopathology and long-term functional outcome may guide treatment decision-making and offer a means to prevent or reduce chronic disability. METHODS Data were collected through the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a multisite national trial testing the efficacy of an early intervention for youth at risk of developing psychosis. Participants were followed prospectively and completed comprehensive evaluations at 6, 12, and 24 months, including the Structured Interview for Prodromal Syndromes (SIPS) and the Global Social and Role Functioning Scales. The present analyses included 327 participants and examined the relationships between baseline symptoms and longitudinal global social and role functioning using a linear mixed modeling approach. RESULTS Higher baseline negative symptoms and deteriorated thought process predicted worse social and role functioning in the follow-up period. The effect of negative symptoms on social functioning, however, was moderated by positive symptoms, and the relationship between positive symptoms and social functioning changed over time. Baseline positive symptoms, distress, and level of symptom severity were not predictors of either social or role functioning. CONCLUSIONS Baseline negative symptoms and thought disorder appear to predict functional outcome for up to two years among adolescents and young adults at risk for psychosis. Developing effective interventions to target these symptoms may be critical to promote functional recovery among those experiencing attenuated symptoms or a first episode of psychosis.
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Affiliation(s)
- Cynthia Z. Burton
- University of Michigan,Address for correspondence: University of Michigan Neuropsychology Section, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI 48105, , TEL: 1-734-763-9259, FAX: 1-734-936-9262
| | | | | | | | | | | | | | | | - Ryan Melton
- Oregon Health Sciences School of Public Health
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23
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Azis M, Strauss GP, Walker E, Revelle W, Zinbarg R, Mittal V. Factor Analysis of Negative Symptom Items in the Structured Interview for Prodromal Syndromes. Schizophr Bull 2019; 45:1042-1050. [PMID: 30535399 PMCID: PMC6737478 DOI: 10.1093/schbul/sby177] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative symptoms occur early in the clinical high risk (CHR) state and indicate increased risk of conversion to psychotic disorder and poor functional outcome. However, while the negative symptom domain has shown to be parsimoniously explained by a 2-factor construct in schizophrenia, there has yet to be an established factor structure of negative symptoms in CHR. METHODS 214 individuals meeting the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria for CHR were recruited through 3 active research programs in the United States. Exploratory Factor Analysis was conducted on the 6 negative symptom items of the SIPS, and factors were evaluated with respect to functional outcome and depression. RESULTS Factor analysis indicated a 2-factor hierarchical model with 2 negative symptom dimensions reflecting volition (Occupational Functioning and Avolition) and emotion (Expression of Emotion, Experience of Emotion and Social Anhedonia). Linear Regression showed that the emotion factor was associated with poor social function, and the volition factor was associated with poor role function and depression. CONCLUSIONS Similar to factor solutions identified in adults diagnosed with psychotic disorders, results indicated that the SIPS negative symptom subscale is not a unidimensional construct. Rather, the SIPS negative subscale has 2 distinct factors that have different associations with clinical outcome and should be interpreted independently. Results have significant relevance for informing the valid assessment and conceptual interpretation of early clinical phenomenology in the psychosis prodrome.
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Affiliation(s)
- Matilda Azis
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | | | - Elaine Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA
| | - William Revelle
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | - Richard Zinbarg
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | - Vijay Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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Giacon BCC, Vedana KGG, Martin IDS, Zanetti ACG, Fendrich L, Cardoso L, Galera SAF. Family experiences in the identification of the first-episode psychosis in young patients. Arch Psychiatr Nurs 2019; 33:383-388. [PMID: 31280784 DOI: 10.1016/j.apnu.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
The study aimed to understand the family experience in the identification of the first-episode psychosis in young family members. Qualitative research using symbolic interactionism and narrative. Data were collected through depth interview with 13 relatives of 11 young patients treated for the first-episode psychosis. The families showed behavior consistent with the meanings they gave to the disease process of the young relatives, represented by categories: "waiting move: trying to justify the behavior of the adolescent", "not understanding the psychosis", and "seeking help". This research fostered the understanding of how families decided to seek help in the healthcare system. The nursing interventions with these families could contribute to early detection and beginning of treatment.
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Affiliation(s)
- Bianca Cristina Ciccone Giacon
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Kelly Graziani Giacchero Vedana
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Isabela Dos Santos Martin
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Lorena Fendrich
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Lucilene Cardoso
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
| | - Sueli Aparecida Frari Galera
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil.
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25
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Grimm CM, Aksamaz S, Schulz S, Teutsch J, Sicinski P, Liss B, Kätzel D. Schizophrenia-related cognitive dysfunction in the Cyclin-D2 knockout mouse model of ventral hippocampal hyperactivity. Transl Psychiatry 2018; 8:212. [PMID: 30301879 PMCID: PMC6178344 DOI: 10.1038/s41398-018-0268-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
Elevated activity at the output stage of the anterior hippocampus has been described as a physiological endophenotype of schizophrenia, and its development maps onto the transition from the prodromal to the psychotic state. Interventions that halt the spreading glutamatergic over-activity in this region and thereby the development of overt schizophrenia could be promising therapies. However, animal models with high construct validity to support such pre-clinical development are scarce. The Cyclin-D2 knockout (CD2-KO) mouse model shows a hippocampal parvalbumin-interneuron dysfunction, and its pattern of hippocampal over-activity shares similarities with that seen in prodromal patients. Conducting a comprehensive phenotyping of CD2-KO mice, we found that they displayed novelty-induced hyperlocomotion (a rodent correlate of positive symptoms of schizophrenia), that was largely resistant against D1- and D2-dopamine-receptor antagonism, but responsive to the mGluR2/3-agonist LY379268. In the negative symptom domain, CD2-KO mice showed transiently reduced sucrose-preference (anhedonia), but enhanced interaction with novel mice and objects, as well as normal nest building and incentive motivation. Also, unconditioned anxiety, perseveration, and motor-impulsivity were unaltered. However, in the cognitive domain, CD2-knockouts showed reduced executive function in assays of rule-shift and rule-reversal learning, and also an impairment in working memory, that was resistant against LY379268-treatment. In contrast, sustained attention and forms of spatial and object-related memory that are mediated by short-term habituation of stimulus-specific attention were intact. Our results suggest that CD2-KO mice are a valuable model in translational research targeted at the pharmacoresistant cognitive symptom domain in causal relation to hippocampal over-activity in the prodrome-to-psychosis transition.
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Affiliation(s)
- Christina M. Grimm
- 0000 0004 1936 9748grid.6582.9Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Sonat Aksamaz
- 0000 0004 1936 9748grid.6582.9Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Stefanie Schulz
- 0000 0004 1936 9748grid.6582.9Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Jasper Teutsch
- 0000 0004 1936 9748grid.6582.9Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Piotr Sicinski
- 0000 0001 2106 9910grid.65499.37Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA
| | - Birgit Liss
- 0000 0004 1936 9748grid.6582.9Institute for Applied Physiology, Ulm University, Ulm, Germany
| | - Dennis Kätzel
- Institute for Applied Physiology, Ulm University, Ulm, Germany.
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26
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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