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Campo-Arias A, Herazo E, Caballero-Domínguez CC. Prodromal questionnaire (PQ-16) dimensionality among Colombian adolescent school students. Early Interv Psychiatry 2024. [PMID: 38738641 DOI: 10.1111/eip.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
AIMS The study aimed to determine the dimensionality of the Spanish version of the PQ-16 among Colombian adolescent school students. METHODS A validation study was designed with the participation of 334 Colombian adolescent students aged between 13 and 17 (M = 15.2, SD = 1.1); 171 (52.1%) were girls, and 163 (47.9%) were boys, 229 (68.6%) were ninth-grade students and 105 (31.4%) were tenth-grade students. Confirmatory factor analysis was performed, internal consistency was calculated with the Kuder-Richardson and McDonald's omega tests, and correlation with suicide ideation was computed with the Kendall correlation (r). RESULTS The confirmatory factor analysis showed that the PQ-16 adequately fit a unidimensional structure: RMSEA = 0.05 (90%CI 0.04-0.06), CFI = 0.91, TLI = 0.90, SRMR = 0.05, chi-squared = 193.18 (df = 102, p < 0.001) and normalized chi-squared = 1.89. This factor presented high internal consistency: Kuder-Richardson test and McDonald's omega of 0.83. The correlation between the PQ-16 and suicide ideation was r = 0.45 (p < 0.001). CONCLUSION The PQ-16 is a one-dimensional tool with high internal consistency and correlation with suicide ideation among schooled adolescents. Further research should explore the PQ-16 performance against a structured clinical interview.
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Affiliation(s)
| | - Edwin Herazo
- Dirección General, Instituto de Investigación del Comportamiento Humano, Bogotá, Colombia
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Clauss JA, Foo CYS, Leonard CJ, Dokholyan KN, Cather C, Holt DJ. Screening for psychotic experiences and psychotic disorders in general psychiatric settings: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.14.24305796. [PMID: 38699350 PMCID: PMC11065042 DOI: 10.1101/2024.04.14.24305796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background The absence of systematic screening for psychosis within general psychiatric services contribute to substantial treatment delays and poor long-term outcomes. We conducted a meta-analysis to estimate rates of psychotic experiences, clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders identified by screening treatment-seeking individuals to inform implementation recommendations for routine psychosis screening in general psychiatric settings. Methods PubMed and Web of Science databases were searched to identify empirical studies that contained information on the point prevalence of psychotic experiences, CHR-P, or psychotic disorders identified by screening inpatient and outpatient samples aged 12-64 receiving general psychiatric care. Psychotic experiences were identified by meeting threshold scores on validated self-reported questionnaires, and psychotic disorders and CHR-P by gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the Restricted Maximum Likelihood Estimator method of estimating effect sizes in a random effects model. Results 41 independent samples (k=36 outpatient) involving n=25,751 patients (58% female, mean age: 24.1 years) were included. Among a general psychiatric population, prevalence of psychotic experiences was 44.3% (95% CI: 35.8-52.8%; 28 samples, n=21,957); CHR-P was 26.4% (95% CI: 20.0-32.7%; 28 samples, n=14,395); and psychotic disorders was 6.6% (95% CI: 3.3-9.8%; 32 samples, n=20,371). Conclusions High rates of psychotic spectrum illness in general psychiatric settings underscore need for secondary prevention with psychosis screening. These base rates can be used to plan training and resources required to conduct assessments for early detection, as well as build capacity in interventions for CHR-P and early psychosis in non-specialty mental health settings.
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Affiliation(s)
- Jacqueline A. Clauss
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheryl Y. S. Foo
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Katherine N. Dokholyan
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corinne Cather
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daphne J. Holt
- Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Bastiaens L, Cristofano-Casella S, Bastiaens J. Prodromal or Factitious Psychosis: A Cautionary Tale in the Era of Increasing Social Media Use by Vulnerable Individuals. J Psychiatr Pract 2024; 30:162-166. [PMID: 38526405 DOI: 10.1097/pra.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Research on the prodromal phase of schizophrenia has been ongoing for several decades and, more recently, findings from this research are being incorporated into everyday psychiatric practice, such as the use of interviews to evaluate prodromal symptomatology. This evolution is happening in the midst of an explosion of social media use by teenagers and young adults, increasing the exposure of youth to portrayals of psychiatric experiences. For example, reports from around the world of "TIK-TOK tics" emphasize the role of social media in the "creation" of psychiatric symptoms. This case report highlights the importance of a full psychiatric evaluation in acute care settings where quick treatment of psychotic symptoms is the norm. A 15-year-old patient was initially diagnosed with prodromal schizophrenia but, after a more extensive evaluation during a second admission, she was diagnosed with borderline personality disorder. Her antipsychotic treatment regimen was stopped and appropriate education and treatment were started, without the recurrence of "psychotic symptoms" during follow-up. It may be that patients with borderline personality disorder, a frequent condition on inpatient units, are at particular risk of assimilating symptoms as represented on social media.
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Parabiaghi A, Rossi AA, Castelnovo A, Del Fabro L, Mannarini S, Percudani ME. The Italian version of the 16-item Prodromal Questionnaire (PQ-16) and its psychometric features in help-seeking ultra-high-risk subjects and in the general population. Early Interv Psychiatry 2024. [PMID: 38375973 DOI: 10.1111/eip.13516] [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: 08/19/2022] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Increasing attention to the early stages of psychosis and the identification of symptomatic prodromal states have led to the development of a growing number of screening tools. The 16-item version of the Prodromal Questionnaire (PQ-16) is a worldwide used self-administered tool for this purpose. However, to date, fundamental psychometric properties of PQ-16 were not thoroughly investigated. This study aimed to examine the structural validity, measurement invariance, reliability and other psychometrical properties of the Italian version of the PQ-16 (iPQ-16) in help-seeking individuals and in the general population. METHODS The iPQ-16 was administered to 449 young outpatients attending six community mental health services and to 318 control participants enrolled in educational environment. Confirmatory factor analyses (CFAs), measurement invariance (MI) between the help-seeking group and the general population sample, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed. Lastly, the validity of the adopted PQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses was also tested. RESULTS CFAs confirmed the single-factor structure for the iPQ-16 and scalar MI was reached. The iPQ-16 showed high internal consistency, test-retest reliability, convergent validity, and acceptable diagnostic accuracy. ROC analysis suggested a score of ≥4 as best cut-off. CONCLUSIONS The iPQ-16 represents a valid and reliable questionnaire for the assessment of high mental risk in both Italian outpatients and general student population. It has good psychometric properties and is easy to implement as UHR screening for clinical as well as research purposes.
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Affiliation(s)
- Alberto Parabiaghi
- Department of Health Policy, Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lorenzo Del Fabro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Mauro Emilio Percudani
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano "Niguarda", Milan, Italy
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Bernardin F, Gauld C, Martin VP, Laprévote V, Dondé C. The 68 symptoms of the clinical high risk for psychosis: Low similarity among fourteen screening questionnaires. Psychiatry Res 2023; 330:115592. [PMID: 37948888 DOI: 10.1016/j.psychres.2023.115592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
The Clinical High Risk for psychosis (CHR) is a heterogeneous condition with multiple symptoms. CHR screening is challenging in routine care, as a wide variety of questionnaires exists. We propose to explore the extent to which these questionnaires differ or overlap in item content. We performed a systematic and quantitative analysis of item content in a set of widely-used CHR screening questionnaires. Items were extracted from questionnaires and reworded according to the Structured Interview for Psychosis-Risk Syndromes (SIPS). Then, symptoms were generated from individual items. The Jaccard Index was calculated to assess content overlap. The 14 analysed questionnaires were composed of 347 items, from which 198 symptoms were generated and, in turn, collapsed into 68 distinct symptoms. Positive symptoms were the most commonly represented. The overall overlap across questionnaires showed weak similarity (Jaccard = 0.19±0.50). CHR screening questionnaires might evaluate the same broad clinical construct, but have different scopes within that construct, and may be more or less comprehensive than one another. Clinicians and researchers should be mindful of the specific features of each instrument for optimal CHR screening.
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Affiliation(s)
- Florent Bernardin
- Centre Psychothérapique de Nancy, Pôle Transversal Médico-Technique et Clinique, Centre de, Liaison et d'Intervention Précoce, Laxou F-54520, France; Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire, de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Christophe Gauld
- Department of Child Psychiatry, Université de Lyon, 59 Bd Pinel, Lyon F-69000, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de, Lyon CRNL U1028 UMR5292, PSYR2, Bron F-69500, France
| | - Vincent P Martin
- Univ. Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence F-33400, France; Univ. Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Vincent Laprévote
- Centre Psychothérapique de Nancy, Pôle Transversal Médico-Technique et Clinique, Centre de, Liaison et d'Intervention Précoce, Laxou F-54520, France; Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire, de Strasbourg, Université de Strasbourg, Strasbourg, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy F-54500 France
| | - Clément Dondé
- Univ. Grenoble Alpes, Grenoble F-38000, France; INSERM, U1216, Grenoble F-38000, France; Psychiatry Department, CHU Grenoble Alpes, Grenoble F-38000, France.
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Hong W, Wang Q, Hou Q, Zhao N, Wang R, Bai Y, Hu C, Liu W. Home quarantine during COVID-19 blunted childhood trauma-related psychiatric symptoms in Chinese college students. Front Public Health 2023; 11:1073141. [PMID: 37304081 PMCID: PMC10248425 DOI: 10.3389/fpubh.2023.1073141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/27/2023] [Indexed: 06/13/2023] Open
Abstract
Background Childhood trauma confers risks to mental health. However, little is known about whether home quarantine (HQ) during the coronavirus disease 2019 (COVID-19) pandemic exaggerated or mitigated the effect of childhood trauma on mental health. Objective To examine the modulating effects of prior childhood traumas on the longitudinal changes of psychiatric symptoms in college students before and after HQ during the pandemic. Methods This was a two-wave longitudinal study on the mental health of 2,887 college students before and after HQ during the COVID-19 pandemic. The relationships between the changes in the Patient Health Questionnaire-9 (PHQ-9), Symptom Checklist-90 (SCL-90), 16-item Prodromal Questionnaire (PQ-16), Childhood Trauma Questionnaire (CTQ), and Social Support Rating Scale (SSRS) scores were analyzed. Results The students with childhood trauma showed a significantly greater decrement in psychiatric symptoms after HQ (F = 17.21, 14.11, 18.87, and 17.42 for PHQ-9, PQ-16 objective and distress, and SCL-90, respectively). The correlation coefficients between the CTQ and these symptoms scales were significant at baseline (r = 0.42, 0.34, 0.37, and 0.39), and decreased after HQ (r = 0.17, 0.20, 0.18, and 0.19). The decrement of depressive, psychotic, and overall symptoms was positively correlated with the scores of the CTQ (r = 0.08-0.27) but negatively correlated with SSRS (r = -0.08--0.14). Multilinear regression analysis confirmed the results of the CTQ and SSRS regarding the modulation of the dynamic changes in psychiatric symptoms. A constructed structural equation model indicated that the total effects of childhood trauma on decreased psychiatric symptoms were partly mediated by lower baseline social support. Conclusion Home quarantine during the COVID-19 pandemic could blunt the adverse effects of childhood trauma on mental health, especially for prodromal psychotic symptoms in college students. Changes in relative deprivation and social support may be mediating factors.
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Affiliation(s)
- Wenjuan Hong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Qiang Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Qinghong Hou
- Department of Student Mental Health, Dianchi College, Yunnan University, Kunming, China
| | - Nan Zhao
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Ruoling Wang
- Department of Student Mental Health, Dianchi College, Yunnan University, Kunming, China
| | - Yan Bai
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chengping Hu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Weiqing Liu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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Spillebout C, Pelluet A, Bioulac S, Fourneret P, Polosan M, Dondé C. Detection of clinical high risk for psychosis in child and adolescent mental health services: Validation of the first step with the French versions of the Prodromal Questionnaire (fPQ-16) and scale of Perceptual and Cognitive Aberrations (fPCA). Early Interv Psychiatry 2023. [PMID: 36638840 DOI: 10.1111/eip.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/07/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
AIM To validate the French versions of the 16-items Prodromal Questionnaire (PQ-16) and the 9-items scale of Perceptual and Cognitive Aberrations (PCA) to facilitate screening of psychosis risk in native French-speaking young individuals referred to Child and Adolescent Mental Health Services. METHOD Participants (N = 87, age range 10-18 years) were diagnosed with a non-psychotic disorder according to the Diagnostic and Statistical Manual of Mental Disorders. The French versions of the PQ-16 and PCA were developed using a forward-backward translation procedure. Psychometric properties were tested including (i) internal validity with Pearson correlations and Cronbach's coefficients, and (ii) external validity by correlations with each other's. RESULTS (i) Correlations between fPQ-16 and fPCA total scores and individual items were mostly >.4. Cronbach's coefficients were .80 for the fPQ-16 and .61 for the fPCA. (ii) The fPQ-16 and fPCA total scores were significantly correlated with a large effect size (rs = 0.66). CONCLUSION The fPQ-16 and the fPCA are psychometrically acceptable instruments for the screening of potential psychotic symptoms in French-speaking children and young adolescents under 18 years old referred to Child and Adolescent Mental Health Services.
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Affiliation(s)
| | - Albane Pelluet
- Service de Psychopathologie de l'Enfant et du Développement, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Stéphanie Bioulac
- Laboratoire de Psychologie et Neurocognition (CNRS-UMR 5105), Service de Psychiatrie de l'enfant et l'adolescent, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Pierre Fourneret
- Service de Psychopathologie de l'Enfant et du Développement, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Mircea Polosan
- Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.,Adult Psychiatry Department, CHU Grenoble Alpes, Grenoble, France
| | - Clément Dondé
- Université Grenoble Alpes, Grenoble, France.,Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.,Adult Psychiatry Department, CHU Grenoble Alpes, Grenoble, France.,Early Intervention in Psychosis, CH Alpes-Isère, Saint-Egrève, France
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Cao XJ, Liu XQ. Artificial intelligence-assisted psychosis risk screening in adolescents: Practices and challenges. World J Psychiatry 2022; 12:1287-1297. [PMID: 36389087 PMCID: PMC9641379 DOI: 10.5498/wjp.v12.i10.1287] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
Artificial intelligence-based technologies are gradually being applied to psych-iatric research and practice. This paper reviews the primary literature concerning artificial intelligence-assisted psychosis risk screening in adolescents. In terms of the practice of psychosis risk screening, the application of two artificial intelligence-assisted screening methods, chatbot and large-scale social media data analysis, is summarized in detail. Regarding the challenges of psychiatric risk screening, ethical issues constitute the first challenge of psychiatric risk screening through artificial intelligence, which must comply with the four biomedical ethical principles of respect for autonomy, nonmaleficence, beneficence and impartiality such that the development of artificial intelligence can meet the moral and ethical requirements of human beings. By reviewing the pertinent literature concerning current artificial intelligence-assisted adolescent psychosis risk screens, we propose that assuming they meet ethical requirements, there are three directions worth considering in the future development of artificial intelligence-assisted psychosis risk screening in adolescents as follows: nonperceptual real-time artificial intelligence-assisted screening, further reducing the cost of artificial intelligence-assisted screening, and improving the ease of use of artificial intelligence-assisted screening techniques and tools.
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Affiliation(s)
- Xiao-Jie Cao
- Graduate School of Education, Peking University, Beijing 100871, China
| | - Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
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Mamah D, Mutiso VN, Ndetei DM. Longitudinal and cross-sectional validation of the WERCAP screen for assessing psychosis risk and conversion. Schizophr Res 2022; 241:201-209. [PMID: 35144059 PMCID: PMC10448956 DOI: 10.1016/j.schres.2022.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was developed to assess risk for developing psychosis. Its validity has not been investigated in a large population-based study or with longitudinal analyses. METHODS 825 participants, aged 14-25, were recruited from Kenya. Symptoms were assessed using the WERCAP Screen, as experienced over the prior 3-months (3MO), 12-months (12MO) or lifetime (LIF). ROC curve analysis was used to determine the validity of the WERCAP Screen against the Structured Interview of Psychosis-Risk Syndromes. Longitudinal validity was assessed by comparing baseline p-WERCAP scores in psychotic disorder converters and non-converters, and using ROC curve analysis. Relationship of the p-WERCAP was examined against clinical variables. RESULTS ROC curve analyses against SIPS showed an AUC of 0.83 for 3MO, 0.79 for 12MO and 0.65 for LIF psychosis scores. The optimal cut-point on 3MO was a score of >12 (sens: 0.78; spec: 0.77; ppv: 0.41), and >32 for 12MO (sens: 0.71; spec: 0.74; ppv: 0.24). Baseline 3MO scores (but not LIF scores) were higher in converters compared to high-risk non-converters (p = 0.02). 3MO scores against conversion status had an AUC of 0.75, with an optimal cutoff point of >16 (sens: 1.0; spec: 0.53). All p-WERCAP scores significantly correlated with substance use and stress severity. 12 MO scores were most related to cognitive impairment. CONCLUSIONS The WERCAP Screen is a valid instrument for assessing psychosis severity and conversion risk. It can be used in the community to identify those who may require clinical assessment and care, and for recruitment in psychosis-risk research.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
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Starkowska A, Tyburski E, Kucharska-Mazur J, Mak M, Samochowiec J. Assessing self-reported clinical high risk symptoms: The psychometric properties of the polish version of the prodromal questionnaire-brief and a proposal for an alternative approach to scoring. Early Interv Psychiatry 2021; 15:1059-1071. [PMID: 32893465 DOI: 10.1111/eip.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) might occur in the general population as low-risk individual differences or prodromal features, requiring quick detection and early intervention. The aims of this study were to conduct a mini-systematic review of the prognostic abilities of the Prodromal Questionnaire-Brief (PQ-B), describe the PLEs distribution for the first time in a Polish population, assess PQ-B reliability and propose an innovative scoring approach based on cluster analysis. METHODS Five hundred and twenty eight (334 female) adult volunteers underwent screening with the PQ-B, 49% also underwent the early psychosis screening test PRIME, to verify the tests' psychometric properties, to compare the prognostic accuracy of the PQ-B to the more restrictive PRIME, and to the detected types of possible diagnosis in the general population. RESULTS Almost 70% of respondents met the prognostic criteria of the PQ-B while only 30.6% met the PRIME criteria. Both tests proved reliable (α > .835) and valid (rho >.710; P < .001). A cluster analysis identified three different sub-groups detected with the PQ-B: healthy individuals without PLE; healthy with low-distressing PLEs; and possibly prodromal subjects reporting less frequent but more distressing PLEs and no worries about their own mental state. Also in systematic reviews, authors of different adaptations have observed that the PQ-B has too low specificity and postulated the need for higher cut-offs. CONCLUSION Study provides evidence of good reliability and sensitivity of the PQ-B in assessing PLEs among the general population, but emphasizes that straightforward quantitative scoring criteria are still unclear. A more qualitative approach might be useful for differentiating true prodromal subjects from clinically low-risk individual differences.
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Affiliation(s)
- Anna Starkowska
- Independent Clinical Psychology Unit, Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland.,Institute of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Ernest Tyburski
- Institute of Psychology, SWPS University of Social Sciences and Humanities, Poznan, Poland
| | | | - Monika Mak
- Institute of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Adewuya AO, Wright K, Njokanma F. Psychotic like experiences among Nigerian school adolescents: Findings from the Lagos Schools Emotional and Behavioral Health Survey. Early Interv Psychiatry 2021; 15:906-913. [PMID: 32881400 DOI: 10.1111/eip.13032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
AIM This study aimed to explore the presence of psychotic like experience (PLE) symptoms and evaluate for the possible socio-demographic, family, school and mental health variables associated with clinically significant PLE symptoms in Nigeria school adolescent. METHODS A total of 9441 adolescents from 47 secondary schools in Lagos Nigeria completed questionnaire detailing sociodemographic, family and school related variables. Mental health was assessed with the Mini International Diagnostic Interview for children and adolescents (MINI-KID). PLE was assessed using the 16-item version of Prodromal Questionnaire (PQ-16). RESULTS The mean age in years was 15.6 (SD 1.5) and 50.4% were females. The mean PQ-16 score was 2.18 (SD 2.38) with 95% CI 2-15-2.21. A total of 2878 (30.5%) adolescents had no PLE symptoms while 990 (10.5%) had clinically significant PLE symptoms. The most experienced symptoms were "déjà vu" (35.5%) and loss of interest (29.6%). The variables independently associated with clinically significant PLE symptoms were "having no close friend in school" (OR 2.66, 95% CI 2.08-3.41), "often beaten by parents" (OR 1.98, 95% CI 1.67-2.34) "from a polygamous family" (OR 1.80, 95% CI 1.49-2.18), and "diagnosis of depression" (OR 1.33, 95% CI 1.09-1.63). CONCLUSION We have shown that PLE symptoms are relatively common in non-help seeking Nigerian school adolescents and that personal and family factors are significantly associated. Longitudinal studies will be needed to chart the path of symptoms and determinants of distress, help seeking and development of psychosis.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Centre for Mental Health Research and Initiative (CEMHRI), Ikeja, Lagos, Nigeria
| | - Kilelomo Wright
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Fidelis Njokanma
- Department of Pediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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12
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Solmi M, Della Rocca F, Granziol U, Favaro A, Zoleo M, Cremonese C. Increasing referrals to emergency department for psychiatric consultation and treatment among 50,056 adolescents and young adults: Predictors and implications. JCPP ADVANCES 2021. [DOI: 10.1111/jcv2.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marco Solmi
- Neurosciences Department University of Padua Padua Italy
- Padua Neuroscience Center University of Padua Padua Italy
- Psychiatry Unit Padua University Hospital Padua Italy
| | | | - Umberto Granziol
- Department of General Psychology University of Padua Padova Italy
| | - Angela Favaro
- Neurosciences Department University of Padua Padua Italy
- Padua Neuroscience Center University of Padua Padua Italy
- Psychiatry Unit Padua University Hospital Padua Italy
| | - Miranda Zoleo
- Emergency Department Padua University Hospital Padua Italy
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13
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Lejuste F, Pedron L, Bonnard E, Urban M, Morvan Y, Urben S, Gaillard R, Conus P, Krebs MO. [Validation of a French version of the 16-item Prodromal Questionnaire (fPQ16) in adolescents and young adults seeking help]. Encephale 2021; 47:547-553. [PMID: 33867141 DOI: 10.1016/j.encep.2020.11.009] [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: 07/12/2019] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The duration of untreated psychosis has been largely associated with poor outcomes in psychosis. Actual diagnostic tools may be used by very specialized teams and need sustained evaluation. We present a French version of a self-report questionnaire: the 16-item Prodromal Questionnaire (fPQ16). Our objective was to evaluate its predictive value for an ultra-high-risk state (UHR) or psychosis. The population enrolled was consulting in a young adults and adolescents center in Sainte-Anne hospital, Paris, France. METHODS PQ16 had first been translated into French and independently back translated and validated by the original authors. Between November 2016 and May 2018, every C'JAAD consulting patient was proposed to fill in the fPQ16. Each patient was next evaluated with the French version of the comprehensive assessment of at-risk mental state (CAARMS), which detects UHR or psychosis. Statistical analysis of fPQ16 concurrent validity was performed using ROC curves. fPQ16 acceptability was studied by four additional questions especially designed for that purpose. RESULTS One hundred participants were included. Mean age was 19.85years (SD 3.3 y). Fifty-eight percent of patients included were diagnosed with UHR (40%) or psychotic (18%) state after CAARMS evaluation. Mean score at fPQ16 was 5.7 (SD 3.8). Best cut-off score was 4 positive items, with excellent sensibility (91%) and correct specificity (60%). Positive predictive value of fPQ16 was 76%. Area under the curve was 0.85 (P<0.0001). fPQ16 showed good acceptability. DISCUSSION fPQ16 had good screening performances in our population. Cut-off score was lower than in previous studies, but performances were equal or better. As a well-accepted and short questionnaire, the fPQ16 could be a great screening tool in primary care. A version with 18-items, including two items focused on thought content and disorganization that are missing in PQ16, is under evaluation.
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Affiliation(s)
- F Lejuste
- GHU psychiatrie et neuroscience, Sainte-Anne, France
| | - L Pedron
- GHU psychiatrie et neuroscience, Sainte-Anne, France
| | - E Bonnard
- GHU psychiatrie et neuroscience, Sainte-Anne, France; Inserm, laboratoire de physiopathologie des maladies psychiatriques, IPNP, U1266, université de Paris, institut de psychiatrie (CNRS GDR 3557), Paris, France
| | - M Urban
- GHU psychiatrie et neuroscience, Sainte-Anne, France
| | - Y Morvan
- Inserm, laboratoire de physiopathologie des maladies psychiatriques, IPNP, U1266, université de Paris, institut de psychiatrie (CNRS GDR 3557), Paris, France; Laboratoire CLIPSYD, EA4430, UFR SPSE, université Paris Nanterre, 92000 Nanterre, France
| | - S Urben
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, département de psychiatrie, centre hospitalier universitaire vaudois, Lausanne, Suisse
| | - R Gaillard
- GHU psychiatrie et neuroscience, Sainte-Anne, France
| | - P Conus
- Service de psychiatrie générale, département de psychiatrie, centre hospitalier universitaire vaudois, Lausanne, Suisse
| | - M-O Krebs
- GHU psychiatrie et neuroscience, Sainte-Anne, France; Inserm, laboratoire de physiopathologie des maladies psychiatriques, IPNP, U1266, université de Paris, institut de psychiatrie (CNRS GDR 3557), Paris, France.
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14
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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15
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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16
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Broersen M, Frieswijk N, Kroon H, Vermulst AA, Creemers DHM. Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study. Front Psychiatry 2020; 11:609120. [PMID: 33324268 PMCID: PMC7724087 DOI: 10.3389/fpsyt.2020.609120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups. Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups. Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the "internalizing," "externalizing," "non-specific," and the "overly impulsive" subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse. Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, Netherlands.,Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Trimbos Institute, Utrecht, Netherlands
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17
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Brink V, van Driel C, el Bouhaddani S, Wardenaar KJ, van Domburgh L, Schaefer B, van Beilen M, Bartels-Velthuis AA, Veling W. Spontaneous discontinuation of distressing auditory verbal hallucinations in a school-based sample of adolescents: a longitudinal study. Eur Child Adolesc Psychiatry 2020; 29:777-790. [PMID: 31455976 PMCID: PMC7305260 DOI: 10.1007/s00787-019-01393-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
Abstract
Auditory verbal hallucinations (AVH) can be transiently present in both clinical and healthy adolescent populations. It is not yet fully understood why AVH discontinue in some adolescents and persist in others. The aim of this explorative study is to investigate predictors of spontaneous discontinuation of distressing AVH in a school-based sample of adolescents. 1841 adolescents (mean age 12.4 years, 58% female) completed self-report questionnaires at baseline. The current study included 123 adolescents (7%; 63% female) who reported at least mild distressing AVH at baseline and completed follow-up measurements. LASSO analyses were used to uncover predictors of spontaneous discontinuation of distressing AVH. During follow-up, 43 adolescents (35%) reported having experienced distressing AVH during the last 12 months, while 80 adolescents did not. Spontaneous discontinuation of distressing AVH was predicted by never having used cannabis, parents not being divorced in the past year, never having been scared by seeing a deceased body, less prosocial behaviour, school grade repetition, having the feeling that others have it in for you, having anxiety when meeting new people, having lived through events exactly as if they happened before and having the feeling as if parts of the body have changed. No associations between spontaneous discontinuation of distressing AVH and age or ethnicity were found. Distressing AVH in non-clinical adolescents are mostly transient. Discontinuation was predicted up to a certain extent. However, several predictors were difficult to interpret and do not provide leads for preventive measures, except for discouraging cannabis use.
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Affiliation(s)
- Vera Brink
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30.001 (HPC CC60), 9700 RB, Groningen, The Netherlands.
| | - Catheleine van Driel
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | | | - Klaas J. Wardenaar
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, , PO Box 30.001, Groningen, 9700 RB The Netherlands
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, VU University Medical Center, PO Box 303, 1115 ZG Duivendrecht, The Netherlands ,Department of Research and Development, Pluryn-Intermetzo, PO Box 53, 6500 AB Nijmegen, The Netherlands
| | - Barbara Schaefer
- Parnassia Institute, Carnissesingel 51, 3083 JA Rotterdam, The Netherlands
| | - Marije van Beilen
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | - Agna A. Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
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18
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Bouhaddani SE, van Domburgh L, Schaefer B, Doreleijers TAH, Veling W. Psychotic experiences and trauma predict persistence of psychosocial problems in adolescence. Eur Child Adolesc Psychiatry 2019; 28:1597-1606. [PMID: 30972580 DOI: 10.1007/s00787-019-01321-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
Psychosocial problems during adolescence are heterogenic, rather common, and unstable. At the same time, they are associated with an elevated risk of developing psychiatric disorders later in life. We aimed to describe the trajectories of psychosocial problems during adolescence and examine potential markers of persistence as compared to remission of these problems. At baseline, 1841 adolescents (51.4% female) were included. Of these adolescents, 1512 (mean age = 12.6 [range 11-14 years]; 52.8% female) completed the first and second self-report questionnaires on psychosocial problems (measured with the Strengths and Difficulties Questionnaire), psychotic experiences, trauma, self-esteem and somatic symptoms at two time points over a 1-year period. Regression analyses were used to examine the association between potential predictors and the trajectory of psychosocial problems (remitting versus persistent). Four trajectories were distinguished: 75.6% of the sample showed no problems (the 'none' trajectory), 11.9% were in a 'remitting' trajectory, 9.7% were in an 'incident' trajectory and 2.8% were in the 'persistent' trajectory. Hallucinatory experiences and trauma at baseline were significantly associated with persistence of psychosocial problems compared to those with remitting psychosocial problems. Low rather than high self-esteem was associated with lower risk for persistent problems. Risk of persistence of psychosocial problems increased with accumulation of predictors. Psychotic, especially hallucinatory, experiences and trauma predict persistence of psychosocial problems in adolescents. This underlines the need to assess psychotic experiences and trauma in mental health screening programs.
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Affiliation(s)
| | - Lieke van Domburgh
- Department of Research and Development, Pluryn-Intermetzo, Nijmegen, The Netherlands.,Department of Child and Adolescent Psychiatry, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Theo A H Doreleijers
- Department of Research and Development, Pluryn-Intermetzo, Nijmegen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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McDonald M, Christoforidou E, Van Rijsbergen N, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Using Online Screening in the General Population to Detect Participants at Clinical High-Risk for Psychosis. Schizophr Bull 2019; 45:600-609. [PMID: 29889271 PMCID: PMC6483579 DOI: 10.1093/schbul/sby069] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Identification of participants at clinical high-risk (CHR) for the development of psychosis is an important objective of current preventive efforts in mental health research. However, the utility of using web-based screening approaches to detect CHR participants at the population level has not been investigated. METHODS We tested a web-based screening approach to identify CHR individuals. Potential participants were invited to a website via e-mail invitations, flyers, and invitation letters involving both the general population and mental health services. Two thousand two hundred seventy-nine participants completed the 16-item version of the prodromal questionnaire (PQ-16) and a 9-item questionnaire of perceptual and cognitive aberrations (PCA) for the assessment of basic symptoms (BS) online. 52.3% of participants met a priori cut-off criteria for the PQ and 73.6% for PCA items online. One thousand seven hundred eighty-seven participants were invited for a clinical interview and n = 356 interviews were conducted (response rate: 19.9%) using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). n = 101 CHR participants and n = 8 first-episode psychosis (FEP) were detected. ROC curve analysis revealed good to moderate sensitivity and specificity for predicting CHR status based on online results for both UHR and BS criteria (sensitivity/specificity: PQ-16 = 82%/46%; PCA = 94%/12%). Selection of a subset of 10 items from both PQ-16 and PCA lead to an improved of specificity of 57% while only marginally affecting sensitivity (81%). CHR participants were characterized by similar levels of functioning and neurocognitive deficits as clinically identified CHR groups. CONCLUSION These data provide evidence for the possibility to identify CHR participants through population-based web screening. This could be an important strategy for early intervention and diagnosis of psychotic disorders.
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Affiliation(s)
- Mhairi McDonald
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | | | | | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK,Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Germany
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK,To whom correspondence should be addressed; Institute of Neuroscience and Psychology, University of Glasgow, 58 Hillhead Street, Glasgow G12 8QB, UK; tel: 0044-141-330-8730; fax: 0141-330-4606, e-mail:
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20
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Psychotic experiences among ethnic majority and minority adolescents and the role of discrimination and ethnic identity. Soc Psychiatry Psychiatr Epidemiol 2019; 54:343-353. [PMID: 30643926 DOI: 10.1007/s00127-019-01658-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Research shows that the prevalence of psychiatric problems is higher in ethnic minority youth compared to native youth. This school-based screening study of early adolescents' mental health in the Netherlands examined differences in prevalence of psychotic experiences in ethnic minority youth compared to their Dutch peers. Moreover, we investigated the association between psychotic experiences, ethnic identity, and perceived discrimination. METHODS A cohort of 1194 ethnic majority and minority adolescents (mean age 13.72, SD 0.63) filled-out questionnaires on psychotic experiences (including delusional and hallucinatory experiences), perceived group and personal discrimination, and ethnic identity. RESULTS Apart from lower levels of hallucinatory experiences in Turkish-Dutch adolescents, prevalence of psychotic experiences did not differ between ethnic minority and majority adolescents. Perceived personal discrimination was associated with the presence of psychotic experiences (including delusional and hallucinatory experiences) (OR 2.30, 95% CI 1.22-4.34). This association was stronger for delusional experiences (OR 2.94, 95% CI 1.43-6.06) than for hallucinatory experiences (OR 1.65, 95% CI 0.73-3.72). No significant associations were found between perceived group discrimination and psychotic experiences. A weak ethnic identity was associated with higher risk for reporting psychotic experiences (OR 2.04, 95% CI 1.14-3.66), particularly hallucinatory experiences (OR 3.15, 95% CI 1.54-6.44). When looking at specific ethnic identity categories, marginalization, compared to separation, was associated with a threefold risk for reporting psychotic experiences (OR 3.26, 95% CI 1.33-8.03). Both marginalisation (OR 3.17, 95% CI 1.04-9.63) and assimilation (OR 3.25, 95% CI 1.30-8.13) were associated with a higher risk for hallucinatory experiences. CONCLUSIONS These results underline the protective effect of ethnic identity against mental health problems. Future research should focus on interventions that focus on strengthen social identity.
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El Bouhaddani S, van Domburgh L, Schaefer B, Doreleijers TAH, Veling W. Peer status in relation to psychotic experiences and psychosocial problems in adolescents: a longitudinal school-based study. Eur Child Adolesc Psychiatry 2018; 27:701-710. [PMID: 29030694 DOI: 10.1007/s00787-017-1063-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/04/2017] [Indexed: 12/29/2022]
Abstract
Social exclusion is related to many adverse mental health outcomes and may be particularly harmful for mental health in adolescence when peer relations become very important. This study examined associations between low peer status and psychotic experiences, psychosocial problems and short-term courses of these symptoms. A school-based sample of adolescents (N = 1171) was investigated in 2 consecutive years using the 16-item Prodromal Questionnaire and the self-report and teacher-report version of the Strengths and Difficulties Questionnaire (SDQ). Peer status was measured in the second year with positive and negative peer nominations of classmates. Low peer status was, after adjusting for gender, ethnic minority status and level of education, associated with more psychosocial difficulties with a persistent course and a higher level of psychotic experiences. Of all peer status groups, being neglected had the strongest associations with mental health problems. The results of this study show that social exclusion in adolescence is related to psychotic experiences and psychosocial problems, emphasizing the importance of belonging to a social group. Customized prevention programs at individual, family and school level should target causes and consequences of social exclusion.
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Affiliation(s)
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, PO Box 303, 1115 ZG, Duivendrecht, The Netherlands.,Department of Research and Development, Pluryn-Intermetzo, PO Box 53, 6500 AB, Nijmegen, The Netherlands
| | - Barbara Schaefer
- Parnassia Institute, Oude Parklaan 123, 1901 ZZ, Castricum, The Netherlands
| | - Theo A H Doreleijers
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, PO Box 303, 1115 ZG, Duivendrecht, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
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Savill M, D'Ambrosio J, Cannon TD, Loewy RL. Psychosis risk screening in different populations using the Prodromal Questionnaire: A systematic review. Early Interv Psychiatry 2018; 12:3-14. [PMID: 28782283 PMCID: PMC5812357 DOI: 10.1111/eip.12446] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/18/2017] [Accepted: 03/18/2017] [Indexed: 01/31/2023]
Abstract
AIM Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations. METHODS A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis. RESULTS In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants. CONCLUSION The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.
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Affiliation(s)
- Mark Savill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Jennifer D'Ambrosio
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut
| | - Rachel L Loewy
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
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The Italian version of the 92-item Prodromal Questionnaire: Concurrent validity with the SIPS and factor analysis in a sample of 258 outpatients aged 11-36years. Schizophr Res 2017; 189:50-56. [PMID: 28254200 DOI: 10.1016/j.schres.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current early screeners for psychosis-risk states have still to prove ability in identifying at-risk individuals. Among screeners, the 92-item Prodromal Questionnaire (PQ-92) is often used. We aimed to assess the validity of its Italian translation in a large Italian adolescent and young adult help-seeking sample. METHODS We included all individuals aged 12-36years seeking help at psychiatric mental health services in a large semirural Roman area (534,600 population) who accepted to participate. Participants completed the Italian version of the PQ-92 and were subsequently assessed with the Structured Interview of Prodromal/Psychosis-Risk Syndromes (SIPS). We examined diagnostic accuracy (sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) and content, concurrent, and convergent validity between PQ-92 and SIPS using Cronbach's alpha, Cohen's kappa, and Spearman's rho, respectively. We tested the validity of adopted cut-offs through Receiver Operating Characteristic (ROC) curves plotted against SIPS diagnoses and the instrument's factor-structure through Principal Component Analysis. RESULTS PQ-92 showed high internal consistency, acceptable diagnostic accuracy and concurrent validity, and excellent convergent validity. ROC analyses pointed to scores of 18 on the Positive subscale and 36 on the total PQ-92 as best cut-offs. The Scree-test identified a four-factor solution as fitting best. CONCLUSIONS Psychometric properties of Italian PQ-92 were satisfactory. Optimal cut-offs were confirmed at ≥18 on the positive subscale, but at ≥36 on the total scale was able to identify more SIPS-positive cases.
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Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, Emsley R, Luik AI, Foster RG, Wadekar V, Hinds C, Gumley A, Jones R, Lightman S, Jones S, Bentall R, Kinderman P, Rowse G, Brugha T, Blagrove M, Gregory AM, Fleming L, Walklet E, Glazebrook C, Davies EB, Hollis C, Haddock G, John B, Coulson M, Fowler D, Pugh K, Cape J, Moseley P, Brown G, Hughes C, Obonsawin M, Coker S, Watkins E, Schwannauer M, MacMahon K, Siriwardena AN, Espie CA. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry 2017; 4:749-758. [PMID: 28888927 PMCID: PMC5614772 DOI: 10.1016/s2215-0366(17)30328-0] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. INTERPRETATION To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. FUNDING Wellcome Trust.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
| | - Russell G Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
| | - Vanashree Wadekar
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Ray Jones
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
| | - Steve Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Kinderman
- Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Traolach Brugha
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, Centre for Medicine, University of Leicester, Leicester, UK
| | - Mark Blagrove
- Department of Psychology, University of Swansea, Swansea, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Leanne Fleming
- Department of Psychology, University of Strathclyde, Glasgow, UK
| | - Elaine Walklet
- Department of Psychology, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bev John
- School of Psychology and Therapeutic Studies, University of South Wales, Treforest, UK
| | - Mark Coulson
- Department of Psychology, School of Science and Technology, University of Middlesex, London, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - John Cape
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Moseley
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Gary Brown
- Psychology Department, Royal Holloway, Egham, UK
| | - Claire Hughes
- University of Cambridge Centre for Family Research, Cambridge, UK
| | - Marc Obonsawin
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow UK
| | - Sian Coker
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Edward Watkins
- SMART Lab, College of Life and Environmental Sciences, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Matthias Schwannauer
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Kenneth MacMahon
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | | | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
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