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Spiteri-Staines AE, Yung AR, Lin A, Hartmann JA, Amminger P, McGorry PD, Thompson A, Wood SJ, Nelson B. Non-psychotic Outcomes in Young People at Ultra-High Risk of Developing a Psychotic Disorder: A Long-Term Follow-up Study. Schizophr Bull 2024:sbae005. [PMID: 38366898 DOI: 10.1093/schbul/sbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline. AIMS This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated. STUDY DESIGN The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline). RESULTS Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up. CONCLUSIONS The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.
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Affiliation(s)
- Anneliese E Spiteri-Staines
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, 161 Barry St, Carlton 3053, Australia
| | - Alison R Yung
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC 3320, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia
| | - Jessica A Hartmann
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Paul Amminger
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Patrick D McGorry
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - Stephen J Wood
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville 3052, Victoria, Australia
- The Centre for Youth Mental Health, University of Melbourne, Parkville 3052, Australia
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Adewuya AO, Oladipo OE, Imarah T, Asmal L, Emsley R. The 3-year progression of clinically significant psychotic-like experiences in a general adult population in Lagos, Nigeria. Soc Psychiatry Psychiatr Epidemiol 2023; 58:91-103. [PMID: 36098756 DOI: 10.1007/s00127-022-02358-z] [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: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The study assessed the 3-year progression of clinically significant psychotic-like experience (CS-PLE) symptoms in an adult general population in terms of stability or remission of symptoms and transition to psychosis. METHODS Participants (n = 1292) aged 18-65 years with CS-PLE were assessed at baseline for sociodemographic details, family history of mental illness, functioning status, common mental disorders, alcohol, and substance use disorders. Three years later they were reassessed for diagnosis of psychosis, presence or remission of PLE symptoms, and contact with mental health services. RESULTS The mean age of the participants at baseline in years was 36.56 (SD = 11.66) and there were 855 (66.2%) females. By the 3rd year follow-up, 95 (7.3%) had transited to psychosis, while 850 (65.5%) had persistent CS-PLE symptoms and the rest 347 (27.2%) were in remission. Only history of mental illness in the immediate family (HR 4.81, 95% CI 1.40-16.47, P = 0.013) and regular use of cannabis at less than 18 years of age (HR 0.65, 95% CI 0.55-0.77, P < 0.001) were the independent predictors of conversion to psychosis at 3 years. CONCLUSION The rate of TTP in the non-clinical population with elevated risk may be lower than that earlier reported in the western literature. Interventions aimed at preventing transition to psychosis in high risk groups must pay attention to early onset users of cannabis and those with family history of mental illness.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Behavioral Medicine, Lagos State University College of Medicine, 1-5, Oba Akinjobi Way, GRA, Ikeja, Lagos, Nigeria.
- Centre for Mental Health Research and Initiative, Lagos, Nigeria.
| | | | - Tomilola Imarah
- Centre for Mental Health Research and Initiative, Lagos, Nigeria
| | - Laila Asmal
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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Tran T, Spilka MJ, Raugh IM, Strauss GP, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone WS, Tsuang MT, Walker EF, Woods SW, Addington JM. Negative Symptom Trajectories in Individuals at Clinical High Risk for Psychosis: Differences Based on Deficit Syndrome, Persistence, and Transition Status. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad014. [PMID: 37362552 PMCID: PMC10287168 DOI: 10.1093/schizbullopen/sgad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background and Hypothesis Negative symptom trajectory in clinical high risk (CHR) for psychosis is ill defined. This study aimed to better characterize longitudinal patterns of change in negative symptoms, moderators of change, and differences in trajectories according to clinical subgroups. We hypothesized that negative symptom course will be nonlinear in CHR. Clinical subgroups known to be more severe variants of psychotic illness-deficit syndrome (DS), persistent negative syndrome (PNS), and acute psychosis onset-were expected to show more severe baseline symptoms, slower rates of change, and less stable rates of symptom resolution. Study Design Linear, curvilinear, and stepwise growth curve models, with and without moderators, were fitted to negative symptom ratings from the NAPLS-3 CHR dataset (N = 699) and within clinical subgroups. Study Results Negative symptoms followed a downward curvilinear trend, with marked improvement 0-6 months that subsequently stabilized (6-24 months), particularly among those with lower IQ and functioning. Clinical subgroups had higher baseline ratings, but distinct symptom courses; DS vs non-DS: more rapid initial improvement, similar stability of improvements; PNS vs non-PNS: similar rates of initial improvement and stability; transition vs no transition: slower rate of initial improvement, with greater stability of this rate. Conclusions Continuous, frequent monitoring of negative symptoms in CHR is justified by 2 important study implications: (1) The initial 6 months of CHR program enrollment may be a key window for improving negative symptoms as less improvement is likely afterwards, (2) Early identification of clinical subgroups may inform distinct negative symptom trajectories and treatment needs.
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Affiliation(s)
- Tanya Tran
- Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Michael J Spilka
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA
- Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Jean M Addington
- To whom correspondence should be addressed; Department of Psychiatry, Hotchkiss Brain Institute, Mathison Centre for Mental Health Research & Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; fax: (403) 210-9114; e-mail:
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Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e9. [PMID: 35042573 PMCID: PMC8786617 DOI: 10.1017/s2045796021000639] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. METHODS "Preferred Reporting Items for Systematic reviews and Meta-Analyses" and "Meta-analysis Of Observational Studies in Epidemiology"-compliant meta-analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs. those who did transition to psychosis at follow-up. We conducted random-effects model meta-analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). RESULTS Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β = -0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β = -0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. CONCLUSIONS Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.
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Janssen H, Maat A, Slot MIE, Scheepers F. Efficacy of psychological interventions in young individuals at ultra-high risk for psychosis: A naturalistic study. Early Interv Psychiatry 2021; 15:1019-1027. [PMID: 32945145 DOI: 10.1111/eip.13048] [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: 10/27/2019] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
AIM Early detection and intervention in individuals at risk for developing psychosis have become a priority for many clinical services around the world. Limited naturalistic evidence is available on whether detection and intervention for ultra-high risk (UHR) is effective by means of reducing psychosis risk and improving functioning. METHODS We compared functioning scores over 5.9 (±7.7) months of time between UHR individuals (n = 61) and help-seeking adolescents without a specific UHR profile (general adolescent help-seeking population [HSP]; n = 82) aged 12 to 25 years receiving psychological interventions at a specialized UHR service in the Netherlands. Attenuated psychotic symptoms (APS) were evaluated over time within the UHR group. In addition, the impact of duration of treatment, <7 sessions, 8 to 21 sessions and >20 sessions, as well as treatment type, that is, cognitive behavioural therapy (CBT) and CBT + add on treatment, were evaluated. RESULTS Both UHR and HSP showed an increase in functioning over time (P < .001), with no difference between these groups. The UHR group showed a reduction of APS over time (P < .001). More than 20 treatment sessions was more effective than 1 to 6 treatment sessions (P < .01, partial eta squared = .08) and CBT was equally effective as CBT-add on in improving functioning. CONCLUSIONS The findings of this study suggest that psychological treatment is just as effective in improving functioning in UHR as in HSP. Moreover, it decreases APS in UHR. Improvement in functioning is not affected by treatment type, but positively affected by the duration of treatment.
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Affiliation(s)
- Hella Janssen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Arija Maat
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margot I E Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floortje Scheepers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Devoe DJ, Lu L, Cannon TD, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Woods SW, Walker EF, Mathalon DH, Bearden CE, Addington J. Persistent negative symptoms in youth at clinical high risk for psychosis: A longitudinal study. Schizophr Res 2021; 227:28-37. [PMID: 32362460 PMCID: PMC7606256 DOI: 10.1016/j.schres.2020.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Severity of negative symptoms has been associated with poor functioning, cognitive deficits, and defeatist beliefs in schizophrenia patients. However, one area that remains understudied is persistent negative symptoms (PNS). Negative symptoms, including PNS, have been observed in those at clinical high-risk (CHR) for psychosis. The aim of this study was to determine if PNS were associated with functioning, neurocognition, and defeatist beliefs in a CHR sample. METHOD CHR participants (n = 764) were recruited for the North American Prodrome Longitudinal Study. Negative symptoms were rated on the Scale of Psychosis-risk Symptoms. Generalized linear mixed models for repeated measures were used to examine changes over time between and within groups (PNS vs non-PNS). RESULTS The PNS group (n = 67) had significant deficits in functioning at baseline, 6, 12, 18, and 24-months compared to the non-PNS group (n = 673). Functioning improved over time in the non-PNS group, while functioning in the PNS group remained relatively stable and poor over a two-year period. A consistent trend emerged demonstrating higher defeatist beliefs in the PNS group; however, this result was lost when controlling for persistent depressive symptoms. There were no significant differences between the groups on neurocognition, social cognition, and transition to psychosis. CONCLUSIONS PNS exist in youth at CHR for psychosis, resulting in significant and persistent functional impairment, which remains when controlling for persistent depressive symptoms. PNS remain even in CHR youth who do not transition to psychosis. Thus, PNS may represent an unmet therapeutic need in CHR populations for which there are currently no effective treatments.
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Affiliation(s)
- D J Devoe
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - L Lu
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - T D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | - K S Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - B A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Queens, NY, United States
| | - T H McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - D O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - L J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - M T Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Institute of Genomic Medicine, University of California, La Jolla, CA, United States
| | - S W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - E F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - D H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, United States; Psychiatry Service, San Francisco, CA, United States
| | - C E Bearden
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States; Department Biobehavioral Sciences and Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - J Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Predicting the individual risk of psychosis conversion in at-risk mental state (ARMS): a multivariate model reveals the influence of nonpsychotic prodromal symptoms. Eur Child Adolesc Psychiatry 2020; 29:1525-1535. [PMID: 31872289 DOI: 10.1007/s00787-019-01461-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/16/2019] [Indexed: 01/11/2023]
Abstract
To improve the prediction of the individual risk of conversion to psychosis in UHR subjects, by considering all CAARMS' symptoms at first presentation and using a multivariate machine learning method known as logistic regression with Elastic-net shrinkage. 46 young individuals who sought help from the specialized outpatient unit at Sainte-Anne hospital and who met CAARMS criteria for UHR were assessed, among whom 27 were reassessed at follow-up (22.4 ± 6.54 months) and included in the analysis. Elastic net logistic regression was trained, using CAARMS items at baseline to predict individual evolution between converters (UHR-P) and non-converters (UHR-NP). Elastic-net was used to select the few CAARMS items that best predict the clinical evolution. All validations and significances of predictive models were computed with non-parametric re-sampling strategies that provide robust estimators even when the distributional assumption cannot be guaranteed. Among the 25 CAARMS items, the Elastic net selected 'obsessive-compulsive symptoms' and 'aggression/dangerous behavior' as risk factors for conversion while 'anhedonia' and 'mood swings/lability' were associated with non-conversion at follow-up. In the ten-fold stratified cross-validation, the classification achieved 81.8% of sensitivity (P = 0.035) and 93.7% of specificity (P = 0.0016). Non-psychotic prodromal symptoms bring valuable information to improve the prediction of conversion to psychosis. Elastic net logistic regression applied to clinical data is a promising way to switch from group prediction to an individualized prediction.
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Course of clinical high-risk states for psychosis beyond conversion. Eur Arch Psychiatry Clin Neurosci 2018; 268:39-48. [PMID: 28054132 DOI: 10.1007/s00406-016-0764-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The main focus of research on clinical high-risk states for psychosis (CHR) has been the development of algorithms to predict psychosis. Consequently, other outcomes have been neglected, and little is known about the long-term diagnostic and functional outcome among those not converting to psychosis. METHODS In a naturalistic study, incidence, persistence, and remission rates of CHR states according to symptomatic ultra-high risk or cognitive disturbances criteria were investigated in 160 of 246 outpatients of an early detection of psychoses service (21.1% CHR negative and 78.9% CHR positive at baseline) who had not converted to psychosis within follow-up (median 53.7 months, range 13.9-123.7 months). RESULTS Remission rate of CHR status was 43.3% of all 194 CHR-positive cases, including converters, or 72.4% if only the 116 non-converters were considered, persistence rate was 27.6%, and new occurrence rate in initially CHR-negative patients was 9.1%. At follow-up, 54.5% of the non-converters met criteria of at least one Axis-I diagnosis, mainly affective and anxiety disorders, and had functional problems. The severity of risk at baseline was not associated with a higher presence of Axis-I diagnosis at follow-up. CONCLUSIONS During follow-up, CHR symptoms remitted in one-third of initially CHR-positive patients, while almost 10% met CHR criteria newly in CHR-negative adults presenting at early detection services. The presence of CHR criteria seems to maintain the risk for lower functioning and mental disorders, particularly for affective disorders. Thus, therapeutic efforts targeting CHR patients should also focus on the current mental disorders as well as social and role functions to improve the long-term outcome.
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Booij SH, Wichers M, de Jonge P, Sytema S, van Os J, Wunderink L, Wigman JTW. Study protocol for a prospective cohort study examining the predictive potential of dynamic symptom networks for the onset and progression of psychosis: the Mapping Individual Routes of Risk and Resilience (Mirorr) study. BMJ Open 2018; 8:e019059. [PMID: 29358438 PMCID: PMC5781162 DOI: 10.1136/bmjopen-2017-019059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/25/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Our current ability to predict the course and outcome of early psychotic symptoms is limited, hampering timely treatment. To improve our understanding of the development of psychosis, a different approach to psychopathology may be productive. We propose to reconceptualise psychopathology from a network perspective, according to which symptoms act as a dynamic, interconnected system, impacting on each other over time and across diagnostic boundaries to form symptom networks. Adopting this network approach, the Mapping Individual Routes of Risk and Resilience study aims to determine whether characteristics of symptom networks can predict illness course and outcome of early psychotic symptoms. METHODS AND ANALYSIS The sample consists of n=100 participants aged 18-35 years, divided into four subgroups (n=4×25) with increasing levels of severity of psychopathology, representing successive stages of clinical progression. Individuals representing the initial stage have a relatively low expression of psychotic experiences (general population), whereas individuals representing the end stage are help seeking and display a psychometric expression of psychosis, putting them at ultra-high risk for transition to psychotic disorder. At baseline and 1-year follow-up, participants report their symptoms, affective states and experiences for three consecutive months in short, daily questionnaires on their smartphone, which will be used to map individual networks. Network parameters, including the strength and directionality of symptom connections and centrality indices, will be estimated and associated to individual differences in and within-individual progression through stages of clinical severity and functioning over the next 3 years. ETHICS AND DISSEMINATION The study has been approved by the local medical ethical committee (ABR no. NL52974.042.15). The results of the study will be published in (inter)national peer-reviewed journals, presented at research, clinical and general public conferences. The results will assist in improving and fine-tuning dynamic models of psychopathology, stimulating both clinical and scientific progress. TRIAL REGISTRATION NUMBER NTR6205 ; Pre-results.
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Affiliation(s)
- Sanne H Booij
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Developmental Psychology, Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Sjoerd Sytema
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
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Hengartner MP, Heekeren K, Dvorsky D, Walitza S, Rössler W, Theodoridou A. Course of psychotic symptoms, depression and global functioning in persons at clinical high risk of psychosis: Results of a longitudinal observation study over three years focusing on both converters and non-converters. Schizophr Res 2017; 189:19-26. [PMID: 28139360 DOI: 10.1016/j.schres.2017.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/27/2022]
Abstract
The aim of this study was to test the validity of the CHR state by focusing on the course of psychosis spectrum symptoms, depression and global functioning in converters and non-converters. A total of 188 CHR-positive subjects (60.2% men) aged between 13 and 35years (mean=20.5) at study outset were assessed five times (t0-t4) over a total observation period of 36months. Conversion to manifest psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23). Measures of positive and negative symptoms were assessed with the Structured Interview for Prodromal Syndromes (SIPS), depression with the Calgary Depression Scale (CDS), and global functioning with the Global Assessment of Functioning Scale (GAF). Converters scored higher over time on all SIPS scales apart from grandiosity (Cohen's d: 0.5-0.7; all p<0.001), higher on the CDS (d=0.43, p=0.001) and lower on the GAF (d=0.69, p<0.001) than did non-converters. Positive and negative symptoms as well as depression were most severe at study outset (t0) and then declined sharply following a linear function over the three-year observation period (t1-t4) across groups (all linear contrasts p<0.001). In conclusion, converters showed significantly more psychopathological symptoms and poorer functioning before crossing the diagnostic threshold for manifest psychosis. CHR-subjects who convert to manifest psychosis during follow-up appear to be recovering from illness rather than becoming ill. Major issues involve the poor discrimination of CHR state and psychosis as well as the dichotomous definition of both at-risk and disease states. Further examination in other CHR-samples is warranted.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland.
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Diane Dvorsky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland
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11
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Long-term employment among people at ultra-high risk for psychosis. Schizophr Res 2017; 184:26-31. [PMID: 27903412 DOI: 10.1016/j.schres.2016.11.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultra-high risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. METHOD 268 UHR patients recruited from the Personal Assessment and Crisis Evaluation clinic in Melbourne, Australia were followed-up over 2-14years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. RESULTS A high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses. CONCLUSIONS Nearly a quarter of this UHR sample was unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.
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12
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Rutigliano G, Valmaggia L, Landi P, Frascarelli M, Cappucciati M, Sear V, Rocchetti M, De Micheli A, Jones C, Palombini E, McGuire P, Fusar-Poli P. Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis. J Affect Disord 2016; 203:101-110. [PMID: 27285723 DOI: 10.1016/j.jad.2016.05.053] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/11/2016] [Accepted: 05/22/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients at ultra-high risk for psychosis (UHR) are a highly heterogeneous group in terms of clinical and functional outcomes. Several non-psychotic mental disorders co-occur together with the UHR state. Little is known about the impact of non-psychotic comorbid mental disorders on clinical and functional outcomes of UHR patients. METHODS The sample included 154 UHR help-seeking patients (identified with the CAARMS, comprehensive assessment of the at-risk mental state), evaluated at baseline on the Ham-D, Ham-A (Hamilton depression/anxiety rating scale), and PANSS (positive and negative syndrome scale). 74 patients completed the 6-year follow-up assessment (mean=6.19, SD=1.87). Comorbid disorders at follow-up were assessed with the SCID I and II. Global functioning was rated on the global assessment of functioning (GAF) scale. RESULTS In the present sample, 6-year risk of psychosis transition was 28.4%. Among non-transitioned UHR patients, 28.3% reported attenuated psychotic symptoms (APS) and 45.3% remained functionally impaired at follow-up (GAF<60). 56.8% patients were affected by at least one comorbid disorder at follow-up. Among UHR patients who presented with some comorbid disorder at baseline, 61.5% had persistent or recurrent course. Incident comorbid disorders emerged in 45.4% of baseline UHR patients. The persistence or recurrence of non-psychotic comorbid mental disorders was associated with poorer global functional outcomes at follow-up. LIMITATIONS A substantial proportion of the initial sample was not available for follow-up interviews and some groups in the analyses had small sample size. Predictors of longitudinal outcomes were not explored. CONCLUSIONS Among UHR patients, persistence or recurrence of non-psychotic comorbid mental disorders, mostly affective disorders, is associated with 6-year poor functional outcomes.
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Affiliation(s)
- Grazia Rutigliano
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Valmaggia
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paola Landi
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Frascarelli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Marco Cappucciati
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Victoria Sear
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matteo Rocchetti
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Andrea De Micheli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ceri Jones
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom
| | - Erika Palombini
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, United Kingdom; OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
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13
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Ising HK, Ruhrmann S, Burger NAFM, Rietdijk J, Dragt S, Klaassen RMC, van den Berg DPG, Nieman DH, Boonstra N, Linszen DH, Wunderink L, Smit F, Veling W, van der Gaag M. Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders. Psychol Med 2016; 46:1839-1851. [PMID: 26979398 DOI: 10.1017/s0033291716000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders. METHOD Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14-35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses. RESULTS At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class. CONCLUSIONS Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
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Affiliation(s)
- H K Ising
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - N A F M Burger
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - J Rietdijk
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - S Dragt
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - R M C Klaassen
- Child and Adolescent Department,University Medical Centre,Utrecht,The Netherlands
| | - D P G van den Berg
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D H Nieman
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - N Boonstra
- Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands
| | - D H Linszen
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - L Wunderink
- Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands
| | - F Smit
- VU University and EMGO+, Institute of Health and Care Research,Amsterdam,The Netherlands
| | - W Veling
- Department of Psychiatry,University Medical Center Groningen and University of Groningen,Groningen,The Netherlands
| | - M van der Gaag
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
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14
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Cropley VL, Lin A, Nelson B, Reniers RLEP, Yung AR, Bartholomeusz CF, Klauser P, Velakoulis D, McGorry P, Wood SJ, Pantelis C. Baseline grey matter volume of non-transitioned "ultra high risk" for psychosis individuals with and without attenuated psychotic symptoms at long-term follow-up. Schizophr Res 2016; 173:152-158. [PMID: 26032566 DOI: 10.1016/j.schres.2015.05.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Two thirds of individuals identified as ultra-high risk (UHR) for psychosis do not transition to psychosis over the medium to long-term (non-transition; UHR-NT). Nevertheless, many of these individuals have persistent attenuated psychotic symptoms (APS). The current study examined whether there were differences in baseline grey matter volume (i.e. at initial identification as UHR) in UHR-NT individuals whom had APS compared to those without APS (No-APS) at medium to long-term follow-up. METHODS Participants were help-seeking individuals who were identified as being at UHR for psychosis between 2 and 12years previously (mean=7.5). The sample consisted of 109 participants who underwent a Magnetic Resonance Imaging scan at baseline and who had not been observed to develop a psychotic disorder over the follow-up period (UHR-NT). Using voxel-based morphometry, baseline grey matter volume (GMV) was compared between participants with (N=30) and without (N=79) APS at follow-up. RESULTS At baseline, the APS and No-APS groups were clinically indistinguishable. At follow-up, the APS group had significantly worse symptoms and impaired functioning. Individuals with APS had reduced baseline GMV in frontal, temporal, posterior and cingulate regions compared to those without APS at follow-up. Reduced GMV was associated with more severe positive, negative and depressive symptoms and lower global functioning in the combined UHR-NT cohort. These associations were independent of later APS outcome. DISCUSSION This study found that differences in regional GMV are discernible at an early stage of UHR and may be specific to individuals who have APS and psychopathology at follow-up. Our findings suggest that lower GMV at baseline may confer neurobiological risk for later APS and/or increased psychopathology while the absence of these structural abnormalities might be protective.
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Affiliation(s)
- Vanessa L Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia 6008, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, Victoria 3052, Australia
| | - Renate L E P Reniers
- School of Psychology,-University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Cali F Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, Victoria 3052, Australia
| | - Paul Klauser
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Monash Clinical and Imaging Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, Victoria 3052, Australia
| | - Stephen J Wood
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; School of Psychology,-University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia; Department of Psychiatry, The University of Melbourne, Parkville, Victoria 3052, Australia
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15
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Chen FZ, Wang Y, Sun XR, Yao YH, Zhang N, Qiao HF, Zhang L, Li ZJ, Lin H, Lu Z, Li J, Chan RCK, Zhao XD. Emotional Experiences Predict the Conversion of Individuals with Attenuated Psychosis Syndrome to Psychosis: A 6-Month Follow up Study. Front Psychol 2016; 7:818. [PMID: 27313553 PMCID: PMC4888623 DOI: 10.3389/fpsyg.2016.00818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/17/2016] [Indexed: 02/05/2023] Open
Abstract
The present study explored the conversion rate in individuals with Attenuated Psychosis Syndrome (APS) and potential predictor for transition in mainland China. Sixty-three participants identified as APS were followed up 6 months later. The results showed that 17% of individuals with APS converted to full-blown psychosis. The converters exhibited significantly poorer emotional experience and expression than the non-converters at baseline. A further binary logistic regression analysis showed that emotional experience could predict the transition (Wald = 4.18, p = 0.041, 95% CI = 1.04~6.82). The present study suggests an important role of emotional processing in the prediction of the development of full-blown psychosis.
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Affiliation(s)
- Fa Zhan Chen
- Pudong New Area Mental Health Center, Tongji University School of MedicineShanghai, China; Department of Psychosomatic Medicine, East Hospital, Tongji University School of MedicineShanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Xi Rong Sun
- Pudong New Area Mental Health Center, Tongji University School of Medicine Shanghai, China
| | - Yu Hong Yao
- Psychological Health Education and Counseling Center, Tongji University Shanghai, China
| | - Ning Zhang
- Department of Clinical Psychology, Nanjing Brain Hospital, Nanjing Medical University Nanjing, China
| | - Hui Fen Qiao
- Department of Clinical Psychology, Nanjing Brain Hospital, Nanjing Medical University Nanjing, China
| | - Lan Zhang
- Mental Health Center, West China Hospital, Sichuan University Chengdu, China
| | - Zhan Jiang Li
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University Beijing, China
| | - Hong Lin
- Department of Clinical Psychology, Peking University Sixth Hospital Beijing, China
| | - Zheng Lu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine Shanghai, China
| | - Jing Li
- Department of Psychiatry, First Affiliated Hospital of Chongqing Medical University Chongqing, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing, China
| | - Xu Dong Zhao
- Pudong New Area Mental Health Center, Tongji University School of MedicineShanghai, China; Department of Psychosomatic Medicine, East Hospital, Tongji University School of MedicineShanghai, China
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16
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Comparelli A, Corigliano V, De Carolis A, Pucci D, Angelone M, Di Pietro S, Kotzalidis GD, Terzariol L, Manni L, Trisolini A, Girardi P. Anomalous self-experiences and their relationship with symptoms, neuro-cognition, and functioning in at-risk adolescents and young adults. Compr Psychiatry 2016; 65:44-9. [PMID: 26773989 DOI: 10.1016/j.comppsych.2015.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 01/21/2023] Open
Abstract
Empirical and theoretical studies support the notion that anomalous self-experience (ASE) may constitute a phenotypic aspect of vulnerability to schizophrenia, but there are no studies examining the relationship of ASE with other clinical risk factors in a sample of ultra-high risk (UHR) subjects. The aim of the present study was to explore the relationship between ASE, prodromal symptoms, neurocognition, and global functioning in a sample of 45 UHR adolescents and young adults (age range 15-25years) at first contact with Public Mental Health Services. Prodromal symptoms and global functioning were assessed through the SIPS interview. ASE was evaluated through the Examination of Anomalous Self-Experience (EASE); for neurocognition, we utilized a battery of tests examining seven cognitive domains as recommended by the Measurement And Treatment Research to Improve Cognition in Schizophrenia. In the UHR group, higher levels in two domains of the EASE (stream of consciousness and self-awareness) were found in comparison with help-seeking subjects. Correlational analysis corrected for possible confounding variables showed a strong association (p>0.001) between higher EASE scores and global functioning. A principal factor analysis with Varimax rotation yielded a two-factor solution, jointly accounting for 70.58% of the total variance in the UHR sample. The first factor was comprised of SOPS domains, while the second was comprised of EASE-total, EASE-10, and GAF variables. Our findings provide support for the notion that disorders of self-experience are present early in schizophrenia and are related to global functioning. As such, they may constitute a potential marker of risk supplementing the UHR approach.
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Affiliation(s)
- Anna Comparelli
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy.
| | - Valentina Corigliano
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Antonella De Carolis
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Neurology, Sant'Andrea Hospital, Rome, Italy
| | - Daniela Pucci
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | | | - Simone Di Pietro
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Giorgio D Kotzalidis
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | | | - Luigi Manni
- Department of Mental Health, ASL of Viterbo, Italy
| | | | - Paolo Girardi
- Sapienza University-Rome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
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17
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Armando M, Pontillo M, De Crescenzo F, Mazzone L, Monducci E, Lo Cascio N, Santonastaso O, Pucciarini ML, Vicari S, Schimmelmann BG, Schultze-Lutter F. Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophr Res 2015; 169:186-192. [PMID: 26526751 DOI: 10.1016/j.schres.2015.10.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status. METHOD Thirty-five children and adolescents (age 9-17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion). RESULTS At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified. CONCLUSIONS Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted.
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Affiliation(s)
- Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Franco De Crescenzo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Luigi Mazzone
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Elena Monducci
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Nella Lo Cascio
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ornella Santonastaso
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Maria Laura Pucciarini
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland
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18
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Kim M, Lee TY, Lee S, Kim SN, Kwon JS. Auditory P300 as a predictor of short-term prognosis in subjects at clinical high risk for psychosis. Schizophr Res 2015; 165:138-44. [PMID: 25956629 DOI: 10.1016/j.schres.2015.04.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/30/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether P300 could predict the short-term prognosis of subjects at clinical high risk (CHR) for psychosis who do not convert to psychotic disorder (non-converters). METHOD CHR subjects were examined with auditory P300 at baseline, and their clinical state was regularly assessed up to 2 years. 45 CHR non-converters were divided into remitter and non-remitter groups. Repeated-measures analysis of variance (ANOVA) was performed to compare baseline P300 between the two groups. Multiple regression analysis was used to identify factors predicting symptomatic or functional improvement in CHR subjects during the follow-up period. RESULTS There were no group differences in P300 amplitude or latency between CHR remitters and non-remitters. In the multiple regression analysis, P300 amplitude at Pz (β=0.206, 95% confidence interval [95CI]=0.035 to 0.567, p=0.028) significantly predicted later amelioration of the Scale of Prodromal Symptoms (SOPS) negative symptoms. Improvement in SOPS general symptoms was significantly predicted by P300 amplitude at Pz (β=0.255, 95CI=0.065 to 0.455, p=0.010) and mood stabilizer use (β=0.199, 95CI=0.081 to 4.154, p=0.042). CONCLUSIONS These results indicate that P300 may be a possible predictor of improvement in negative and general symptoms in CHR non-converters. Our findings support the recommendation that a broader concept of assessment guidelines is needed to forecast clinical outcome and provide appropriate interventions for CHR non-converters.
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Affiliation(s)
- Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Institute of Human Behavioral Sciences, Seoul National University-Medical Research Center, Seoul, Republic of Korea
| | - Suji Lee
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Sciences, Seoul National University-Medical Research Center, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Sciences, Seoul National University-Medical Research Center, Seoul, Republic of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea.
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van Tricht MJ, Bour LJ, Koelman JHTM, Derks EM, Braff DL, de Wilde OM, Boerée T, Linszen DH, de Haan L, Nieman DH. Qualitative and quantitative aspects of information processing in first psychosis: latent class analyses in patients, at-risk subjects, and controls. Psychophysiology 2014; 52:585-93. [PMID: 25376718 DOI: 10.1111/psyp.12379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Abstract
We aimed to determine profiles of information processing deficits in the pathway to first psychosis. Sixty-one subjects at ultrahigh risk (UHR) for psychosis were assessed, of whom 18 converted to a first episode of psychosis (FEP) within the follow-up period. Additionally, 47 FEP and 30 control subjects were included. Using 10 neurophysiological parameters associated with information processing, latent class analyses yielded three classes at baseline. Class membership was related to group status. Within the UHR sample, two classes were found. Transition to psychosis was nominally associated with class membership. Neurophysiological profiles were unstable over time, but associations between specific neurophysiological components at baseline and follow-up were found. We conclude that certain constellations of neurophysiological variables aid in the differentiation between controls and patients in the prodrome and after first psychosis.
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Affiliation(s)
- Mirjam J van Tricht
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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20
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Woods SW, Walsh BC, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Perkins DO, Seidman LJ, Tarbox SI, Tsuang MT, Walker EF, McGlashan TH. Current status specifiers for patients at clinical high risk for psychosis. Schizophr Res 2014; 158:69-75. [PMID: 25012147 PMCID: PMC4152558 DOI: 10.1016/j.schres.2014.06.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Longitudinal studies of the clinical high risk (CHR) syndrome for psychosis have emphasized the conversion vs non-conversion distinction and thus far have not focused intensively on classification among non-converters. The present study proposes a system for classifying CHR outcomes over time when using the Structured Interview for Psychosis-risk Syndromes and evaluates its validity. METHOD The system for classifying CHR outcomes is referred to as "current status specifiers," with "current" meaning over the month prior to the present evaluation and "specifiers" indicating a set of labels and descriptions of the statuses. Specifiers for four current statuses are described: progression, persistence, partial remission, and full remission. Data from the North American Prodromal Longitudinal Study were employed to test convergent, discriminant, and predictive validity of the current status distinctions. RESULTS Validity analyses partly supported current status distinctions. Social and role functioning were more impaired in progressive and persistent than in remitted patients, suggesting a degree of convergent validity. Agreement between CHR current statuses and current statuses for a different diagnostic construct (DSM-IV Major Depression) was poor, suggesting discriminant validity. The proportion converting to psychosis within a year was significantly higher in cases meeting progression criteria than in those meeting persistence criteria and tended to be higher than in those meeting full remission criteria, consistent with a degree of predictive validity. DISCUSSION CHR syndrome current status specifiers could offer a potentially valid and useful description of current clinical status among non-converters. Study in additional samples is needed.
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Affiliation(s)
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Robert Heinssen
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda MD
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill NC
| | | | | | - Ming T. Tsuang
- Department of Psychiatry, UCSD, San Diego CA,Department of Psychiatry, Harvard Medical School, Boston MA
| | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta GA
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21
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Bora E, Lin A, Wood SJ, Yung AR, McGorry PD, Pantelis C. Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis. Acta Psychiatr Scand 2014; 130:1-15. [PMID: 24611632 DOI: 10.1111/acps.12261] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE It is likely that cognitive deficits are vulnerability markers for developing schizophrenia, as these deficits are already well-established findings in first-episode psychosis. Studies at-risk adolescents and young adults are likely to provide information about cognitive deficits that predate the onset of the illness. METHOD We conducted meta-analyses of studies comparing familial-high risk (FHR) or ultra-high risk (UHR; n = 2113) and healthy controls (n = 1748) in youth studies in which the mean age was between 15 and 29. RESULTS Compared with controls, high risk subjects were impaired in each domain in both UHR (d = 0.34-0.71) and FHR (d = 0.24-0.81). Heterogeneity of effect sizes across studies was modest, increasing confidence to the findings of the current meta-analysis (I(2) = 0-0.18%). In both risk paradigms, co-occurrence of genetic risk with attenuated symptoms was associated with more severe cognitive dysfunction. In UHR, later transition to psychosis was associated with more severe cognitive deficits in all domains (d = 0.31-0.49) except sustained attention. However, cognitive impairment has a limited capacity to predict the outcome of high-risk patients. CONCLUSION Cognitive deficits are already evident in adolescents and young adults who have familial or clinical risk for psychosis. Longitudinal developmental studies are important to reveal timing and trajectory of emergence of such deficits.
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Affiliation(s)
- E Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic., Australia
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22
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de Wit S, Schothorst PF, Oranje B, Ziermans TB, Durston S, Kahn RS. Adolescents at ultra-high risk for psychosis: long-term outcome of individuals who recover from their at-risk state. Eur Neuropsychopharmacol 2014; 24:865-73. [PMID: 24636460 DOI: 10.1016/j.euroneuro.2014.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/19/2022]
Abstract
Studies of individuals at ultra-high risk (UHR) for psychosis have mostly reported on long-term outcome of those individuals who develop psychosis compared to those who do not. However, these studies show that a large number of UHR individuals no longer meet criteria for UHR at follow-up. Therefore, this study aimed to investigate functioning at 6-year follow-up in remitted individuals, and to explore the course of their clinical symptoms. Forty-four UHR adolescents completed extensive clinical assessments at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had either converted to psychosis or who still met UHR criteria (n=26) at follow-up were compared to individuals who had remitted from their UHR status (n=18) on clinical and psychosocial variables. Results show that more than 40% of UHR individuals had fully remitted from their UHR status. At six-year follow-up, remitted individuals had improved clinically on most symptoms. The course of their symptoms showed that the most substantial reduction in positive symptoms occurred within the first two years, while improvements in general, mood and anxiety symptoms occurred at a later stage. Baseline socio-demographic characteristics and clinical symptoms did not distinguish between remitters and non-remitters. Although remitters no longer met criteria for UHR, they did meet diagnostic criteria for a wide range of psychiatric disorders. Our findings suggest that, when related to long-term outcome, UHR criteria capture non-specific psychotic symptoms rather than risk for psychosis per se and relate more to general psychopathology.
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Affiliation(s)
- S de Wit
- Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands.
| | - P F Schothorst
- Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - B Oranje
- Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - T B Ziermans
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands
| | - S Durston
- Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - R S Kahn
- Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
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Fusar-Poli P, Yung AR, McGorry P, van Os J. Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med 2014; 44:17-24. [PMID: 23414600 DOI: 10.1017/s0033291713000184] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The past two decades have seen exponential clinical and research interest in help-seeking individuals presenting with potentially prodromal symptoms for psychosis. However, the epidemiological validity of this paradigm has been neglected, limiting future advancements in the field. METHOD We undertook a critical review of core epidemiological issues underlying the clinical high-risk (HR) state for psychosis and which model of prodromal intervention is best suited for mental health. RESULTS The HR state for psychosis model needs refining, to bring together population-based findings of high levels of psychotic experiences (PEs) and clinical expression of risk. Traditionally, outcome has been attributed to 'HR criteria' alone rather than taking into account sampling strategies. Furthermore, the exclusive focus on variably defined 'transition' obscures true variation in the slow and non-linear progression across stages of psychopathology. Finally, the outcome from HR states is variable, indicating that the underlying paradigm of 'schizophrenia light progressing to schizophrenia' is inadequate. CONCLUSIONS In the general population, mixed and non-specific expression of psychosis, depression, anxiety and subthreshold mania is common and mostly transitory. When combined with distress, it may be considered as the first, diagnostically neutral stage of potentially more severe psychopathology, which only later may acquire a degree of diagnostic specificity and possible relative resistance to treatment. Therefore, rather than creating silos of per-disorder ultra-HR syndromes, an early intervention focus on the broad syndrome of early mental distress, requiring phase-specific interventions, may be more profitable.
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Affiliation(s)
- P Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS Team, South London and the Maudsley NHS Foundation Trust, London, UK
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24
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Velthorst E, Derks EM, Schothorst P, Becker H, Durston S, Ziermans T, Nieman DH, de Haan L. Quantitative and qualitative symptomatic differences in individuals at Ultra-High Risk for psychosis and healthy controls. Psychiatry Res 2013; 210:432-7. [PMID: 23938166 DOI: 10.1016/j.psychres.2013.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/24/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
Patients at Ultra-High Risk (UHR) for developing a first psychosis vary widely in their symptom presentation and illness course. An important aim in UHR research concerns the characterization of the clinical heterogeneity in this population. We aimed to identify qualitatively and quantitatively different clinical symptom profiles at baseline and at 2-year follow-up in a group of UHR subjects and healthy controls. We employed a Latent Class Factor Analysis (LCFA) to the 19 items of the Structured Interview for Prodromal Syndromes (SIPS) ratings at baseline and at 2-year follow-up in a sample of 147 UHR subjects and 141 controls from the Dutch Prediction of Psychosis Study (DUPS) in the Netherlands. Additionally, a stepwise logistic regression analysis was performed with transition to psychosis as a dependent variable and baseline latent variable scores as predictors. Variation in symptomatology at baseline was explained by both quantitative and qualitative differences; at 2-year follow-up qualitative differences between individuals were no longer observed. Quantitative differences showed moderate stability over time (range=0.109-0.42). Within the UHR sample, transition to psychosis was significantly associated with quantitative differences in baseline SIPS scores. The results of our study suggest a 'quasi'-continuous extended psychosis phenotype, a finding that merits replication in other samples.
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Affiliation(s)
- Eva Velthorst
- Academic Medical Center, Department of Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands.
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25
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Valmaggia LR, Stahl D, Yung AR, Nelson B, Fusar-Poli P, McGorry PD, McGuire PK. Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study. Psychol Med 2013; 43:2311-2325. [PMID: 23442767 DOI: 10.1017/s0033291713000251] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Many research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores. METHOD Data from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes. RESULTS LCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate-severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning. CONCLUSIONS The different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms.
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Affiliation(s)
- L R Valmaggia
- King's College London, Institute of Psychiatry, London, UK
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26
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Simon AE, Borgwardt S, Riecher-Rössler A, Velthorst E, de Haan L, Fusar-Poli P. Moving beyond transition outcomes: meta-analysis of remission rates in individuals at high clinical risk for psychosis. Psychiatry Res 2013; 209:266-72. [PMID: 23871169 DOI: 10.1016/j.psychres.2013.03.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 02/24/2013] [Accepted: 03/03/2013] [Indexed: 01/28/2023]
Abstract
Recent evidence suggests that transition risks from initial clinical high risk (CHR) status to psychosis are decreasing. The role played by remission in this context is mostly unknown. The present study addresses this issue by means of a meta-analysis including eight relevant studies published up to January 2012 that reported remission rates from an initial CHR status. The primary effect size measure was the longitudinal proportion of remissions compared to non-remission in subjects with a baseline CHR state. Random effect models were employed to address the high heterogeneity across studies included. To assess the robustness of the results, we performed sensitivity analyses by sequentially removing each study and rerunning the analysis. Of 773 subjects who met initial CHR criteria, 73% did not convert to psychosis along a 2-year follow. Of these, about 46% fully remitted from the baseline attenuated psychotic symptoms, as evaluated on the psychometric measures usually employed by prodromal services. The corresponding clinical remission was estimated as high as 35% of the baseline CHR sample. The CHR state is associated with a significant proportion of remitting subjects that can be accounted by the effective treatments received, a lead time bias, a dilution effect, a comorbid effect of other psychiatric diagnoses.
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Affiliation(s)
- Andor E Simon
- University Psychiatry Clinics, University of Basel, 4031 Basel, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland; University Hospital of Psychiatry, University of Bern, 3010 Bern, Switzerland
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27
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Fusar-Poli P, Bechdolf A, Taylor MJ, Bonoldi I, Carpenter WT, Yung AR, McGuire P. At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk. Schizophr Bull 2013; 39:923-32. [PMID: 22589370 PMCID: PMC3686446 DOI: 10.1093/schbul/sbs060] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical high-risk state for psychosis (HRP) is associated with an enhanced probability of developing a psychotic episode over a relatively short period of time. However, the extent to which different diagnostic types of illness develop remains unclear. METHODS A systematic review was performed to identify studies of HRP participants reporting International Classfication of Diseases/Diagnostic and Statistical Manual of Mental Disorders diagnostic outcomes at follow-up. Demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. A meta-analysis was performed of transition to schizophrenic (SP) or affective psychoses (AP) and to specific diagnostic categories. Statistical heterogeneity and small study bias were assessed, and meta-regressions were performed. RESULTS Twenty-three studies were retrieved, including a total of 2182 HRP participants, 560 (26%) of them developed a frank psychotic disorder over the follow-up time (mean = 2.35 y). Among HRP participants who developed psychosis, 73% were diagnosed with SP and only 11% with AP (Risk Ratio, RR = 5.43, 95% CI from 3.35 to 8.83). The specific transition risk to ICD/DSM schizophrenia was of 15.7% (over 2.35y). Heterogeneity was statistically significant and moderate in magnitude. Use of basic symptoms criteria in the baseline clinical assessment was associated with a further increase in the proportion progressing to SP vs AP (RR = 17.1). There was no evidence of publication bias and the sensitivity analysis confirmed robustness of the above results. CONCLUSIONS The HRP state is heterogeneous in term of longitudinal diagnoses; however, the current HRP diagnostic criteria appear strongly biased toward an identification of early phases of SP rather than AP.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK.
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28
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Abstract
PURPOSE OF REVIEW Poor psychosocial functioning in schizophrenia can be conceptualized as an early indicator of chronic neurodevelopmental illness. Alternatively, impaired psychosocial functioning could be the result of social and environmental factors associated with the onset of psychotic illness. We review recent evidence on psychosocial outcome in the early phases of psychotic illness, when young people are less removed from their developmental trajectory, any brain changes may be mutable and there may be greater opportunity for intervention. RECENT FINDINGS In samples with first-episode psychosis, poor premorbid functioning, stable negative symptoms and impaired social cognition and neurocognition may indicate individuals likely to experience poor psychosocial outcome. There is also some evidence of social/environmental predictors of poor outcome. Recent findings from at-risk samples suggest similar patterns, although more research is needed. SUMMARY It is likely that for some patients poor psychosocial outcome is the result of longstanding neurological changes, whereas for others it is related to the secondary consequences of having psychosis. We suggest that measuring psychosocial outcome in the early stages of psychosis is important for our understanding of the cause of schizophrenia, but argue for the importance of the patient's subjective view on their psychosocial recovery.
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Fusar-Poli P, Van Os J. Lost in transition: setting the psychosis threshold in prodromal research. Acta Psychiatr Scand 2013; 127:248-52. [PMID: 23136851 DOI: 10.1111/acps.12028] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 12/13/2022]
Affiliation(s)
- P Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
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Okkels N, Vernal DL, Jensen SOW, McGrath JJ, Nielsen RE. Changes in the diagnosed incidence of early onset schizophrenia over four decades. Acta Psychiatr Scand 2013; 127:62-8. [PMID: 22906158 DOI: 10.1111/j.1600-0447.2012.01913.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore changes in the diagnosed incidence of early onset schizophrenia (EOS) from 1971 to 2010. METHOD Examination of incidence rates of schizophrenia in patients under 18 years of age, using a nationwide, population-based, mental health register. RESULTS The age-standardized incidence rate (IR) of EOS in the period 1971-2010 was 3.17 (95% CI: 3.16, 3.18) per 100 000 person years in the age group 0-18 years, and 9.10 (95% CI: 9.00, 9.21) in the age group 12-18 years. In the period 1971-1993, the age-standardized IR of EOS was 1.80 (95% CI: 1.79, 1.82) per 100 000 person years in the age group 0-18 years, and 5.02 (95% CI: 4.92, 5.11) in the age group 12-18 years. In the period 1994-2010, the age-standardized IR of EOS was 5.15 (95% CI: 5.10, 5.20) per 100 000 person years in the age group 0-18 years, and 15.73 (95% CI: 15.22, 16.22) in the age group 12-18 years. The IR was higher for males than females in the periods 1971-1993 and 1971-2010, but in the period 1994-2010 the IR was higher for females than males. CONCLUSION In recent years, the diagnosed incidence of EOS has increased and the usual male excess has disappeared. The changes in IR could be a result of changes in the diagnostic system, increased awareness of early psychosis or a reflection of actual underlying incidence of the disorder.
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Affiliation(s)
- N Okkels
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark.
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31
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Nieman DH, Velthorst E, Becker HE, de Haan L, Dingemans PM, Linszen DH, Birchwood M, Patterson P, Salokangas RKR, Heinimaa M, Heinz A, Juckel G, von Reventlow HG, Morrison A, Schultze-Lutter F, Klosterkötter J, Ruhrmann S. The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis. Acta Psychiatr Scand 2013; 127:53-61. [PMID: 22775300 DOI: 10.1111/j.1600-0447.2012.01899.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. METHOD Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were assessed with the SCPS, an instrument that has been shown to predict outcome in patients with schizophrenia reliably. RESULTS At 18-month follow-up, 37 participants had made the transition to psychosis. The SCPS total score was predictive of a first psychotic episode (P < 0.0001). SCPS items that remained as independent predictors in the Cox proportional hazard model were as follows: most usual quality of useful work in the past year (P = 0.006), quality of social relations (P = 0.006), presence of thought disorder, delusions or hallucinations in the past year (P = 0.001) and reported severity of subjective distress in past month (P = 0.003). CONCLUSION The SCPS could make a valuable contribution to a more accurate prediction of psychosis in CHR subjects as a second-step tool. SCPS items assessing quality of useful work and social relations, positive symptoms and subjective distress have predictive value for transition. Further research should focus on investigating whether targeted early interventions directed at the predictive domains may improve outcomes.
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Affiliation(s)
- D H Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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32
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Tognin S, Pettersson-Yeo W, Valli I, Hutton C, Woolley J, Allen P, McGuire P, Mechelli A. Using structural neuroimaging to make quantitative predictions of symptom progression in individuals at ultra-high risk for psychosis. Front Psychiatry 2013; 4:187. [PMID: 24523700 PMCID: PMC3905239 DOI: 10.3389/fpsyt.2013.00187] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/24/2013] [Indexed: 12/23/2022] Open
Abstract
Neuroimaging holds the promise that it may one day aid the clinical assessment of individual psychiatric patients. However, the vast majority of studies published so far have been based on average differences between groups, which do not permit accurate inferences at the level of the individual. We examined the potential of structural Magnetic Resonance Imaging (MRI) data for making accurate quantitative predictions about symptom progression in individuals at ultra-high risk for developing psychosis. Forty people at ultra-high risk for psychosis were scanned using structural MRI at first clinical presentation and assessed over a period of 2 years using the Positive and Negative Syndrome Scale. Using a multivariate machine learning method known as relevance vector regression (RVR), we examined the relationship between brain structure at first clinical presentation, characterized in terms of gray matter (GM) volume and cortical thickness (CT), and symptom progression at 2-year follow-up. The application of RVR to whole-brain CT MRI data allowed quantitative prediction of clinical scores with statistically significant accuracy (correlation = 0.34, p = 0.026; Mean Squared-Error = 249.63, p = 0.024). This prediction was informed by regions traditionally associated with schizophrenia, namely the right lateral and medial temporal cortex and the left insular cortex. In contrast, the application of RVR to GM volume did not allow prediction of symptom progression with statistically significant accuracy. These results provide proof-of-concept that it could be possible to use structural MRI to inform quantitative prediction of symptom progression in individuals at ultra-high risk of developing psychosis. This would enable clinicians to target those individuals at greatest need of preventative interventions thereby resulting in a more efficient use of health care resources.
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Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - William Pettersson-Yeo
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Isabel Valli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Chloe Hutton
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London , London , UK
| | - James Woolley
- Division of Experimental Medicine, Imperial College London , London , UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK
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Tandberg M, Ueland T, Andreassen OA, Sundet K, Melle I. Factors associated with occupational and academic status in patients with first-episode psychosis with a particular focus on neurocognition. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1763-73. [PMID: 22310699 DOI: 10.1007/s00127-012-0477-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Employment rates for patients with chronic schizophrenia and first-episode psychosis (FEP) are low despite a larger variation in reported rates for FEP patients. This could partly be due to various methodologies used. The association between neurocognition and occupational functioning is well known in patients with chronic schizophrenia, while corresponding FEP studies are scarce and results more ambiguous. The current study investigated employment rates in a FEP sample using a threefold division of activity that separated students from employed and unemployed patients. Further, it investigated the relationship between students, employed and unemployed patients and clinical, neurocognitive, global, and social functioning. METHODS A total of 128 FEP patients with a broad DSM-IV schizophrenia spectrum disorder were assessed with clinical, neurocognitive, and global and social functioning measures. Three groups were defined based on occupational and academic status. RESULTS Twenty-six percent of the patients were employed, and 23% were students. The students and the employed patients performed better than the unemployed patients on clinical and global and social functioning measures. There were no differences between employed patients and students on any of the investigated measures, although there was a non-significant trend for the students to show better working memory capacity compared to the other two groups. CONCLUSIONS Students and employed patients showed better clinical, global and social functioning compared with unemployed patients. There were no significant differences between the three groups on neurocognitive measures. The results pose an argument for grouping the students with the employed patients if a dichotomous variable is preferred.
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Affiliation(s)
- Marte Tandberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
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Marshall C, Addington J, Epstein I, Liu L, Deighton S, Zipursky RB. Treating young individuals at clinical high risk for psychosis. Early Interv Psychiatry 2012; 6:60-8. [PMID: 21951980 DOI: 10.1111/j.1751-7893.2011.00299.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Typically, studies investigating those at clinical high risk for psychosis have focused on predictors of conversion and treatments that might prevent conversion to full-blown psychosis. Few studies have followed those who do not go on to develop a psychotic illness. METHODS Participants were 48 young people who were at risk for developing psychosis based on the Structured Interview for Prodromal Symptoms criteria and participated in a treatment programme where they were offered up to 6 months of psychosocial treatment and psychiatric management. Attenuated psychotic symptoms, negative symptoms, depression, anxiety, social functioning, alcohol and drug use, and meta-cognitive beliefs were assessed at baseline, 6, 12 and 18 months. Personality characteristics were assessed at baseline. Medication use was tracked and psychiatric visits were logged over the 18-month study period. RESULTS On average, participants attended 12 sessions of psychosocial treatment and had one meeting with the psychiatrist every 6 months. Only 24% were ever prescribed any psychotropic medications, and antipsychotics were not used. Significant improvements were found over time in attenuated positive symptoms, negative symptoms, depression, anxiety, meta-cognitions and social functioning with most improvement occurring in the first 6 months. There was no change in the level of substance use. For personality assessment, participants generally scored high on neuroticism and openness and had low scores on extraversion, agreeableness and conscientiousness. CONCLUSION With minimal treatment and no antipsychotics, young people who present as being at risk for developing a psychotic disorder demonstrate clinical improvement over time. However, a few continued to have the liability of ongoing attenuated psychotic symptoms.
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Affiliation(s)
- Catherine Marshall
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Velthorst E, Nieman DH, Veling W, Klaassen RM, Dragt S, Rietdijk J, Ising H, Wunderink L, Linszen DH, de Haan L, van der Gaag M. Ethnicity and baseline symptomatology in patients with an At Risk Mental State for psychosis. Psychol Med 2012; 42:247-256. [PMID: 21835093 DOI: 10.1017/s0033291711001486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ethnicity has been associated with different incidence rates and different symptom profiles in young patients with psychotic-like disorders. No studies so far have examined the effect of ethnicity on symptoms in people with an At Risk Mental State (ARMS). METHOD In this cross-sectional study, we analysed the relationship between ethnicity and baseline data on the severity of psychopathology scores in 201 help-seeking patients who met the ARMS criteria and agreed to participate in the Dutch Early Detection and Intervention (EDIE-NL) trial. Eighty-seven of these patients had a non-Dutch ethnicity. We explored the possible mediating role of ethnic identity. RESULTS Higher rates of negative symptoms, and of anhedonia in particular, were found in the ethnic minority group. This result could be attributed mainly to the Moroccan-Dutch and Turkish-Dutch subgroups, who also presented with more depression symptoms when the groups were examined separately. The ethnic minority group displayed a lower level of ethnic group identity compared to the immigrants of the International Comparative Study of Ethnocultural Youth (ICSEY). Ethnic identity was inversely related to symptoms in the Moroccan-Dutch patient group. CONCLUSIONS The prevalence of more severe negative symptoms and depression symptoms in ethnic minority groups deserves more attention, as the experience of attenuated positive symptoms when accompanied by negative symptoms or distress has proven to be predictive for transition to a first psychotic episode.
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Affiliation(s)
- E Velthorst
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - D H Nieman
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - W Veling
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - S Dragt
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Rietdijk
- VU University and EMGO Institute, Amsterdam, The Netherlands
| | - H Ising
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - D H Linszen
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - L de Haan
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - M van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
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Ultra high-risk state for psychosis and non-transition: a systematic review. Schizophr Res 2011; 132:8-17. [PMID: 21784618 DOI: 10.1016/j.schres.2011.07.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 06/18/2011] [Accepted: 07/01/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Most effort in ultra high-risk (UHR) research has been directed at defining the clinical and neurobiological characteristics of those UHR subjects who go on to develop psychosis. The characteristics and outcome of the remaining UHR subjects have remained relatively unexplored. METHOD We performed a systematic review of clinical UHR studies to investigate whether information was available on the characteristics and outcome of UHR subjects who did not convert to psychosis. RESULTS Of 2462 potentially relevant papers, 31 met inclusion criteria, i.e. 20 naturalistic and 11 intervention studies. On average 76% (range 46-92.6%) of the UHR patients made no transition to psychosis during follow-up (range 6 to 40 months). Nearly half of the studies provided no characteristics of those UHR subjects who did not develop psychosis. Six studies reported remission rates from initial UHR status (range 15.4% to 54.3%). Linear regression showed that more recent studies reported significantly lower transition rates as compared to earlier publications. An older mean age at baseline was associated with significant lower transition rates in publications with follow-ups exceeding 1 year. CONCLUSIONS Our review illustrates that the long-term outcome of UHR subjects that do not develop psychosis is to date under-investigated. The studies reporting remission rates suggest that UHR criteria capture a non-negligible proportion of subjects that do not convert to psychosis.
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Ziermans TB, Schothorst PF, Sprong M, van Engeland H. Transition and remission in adolescents at ultra-high risk for psychosis. Schizophr Res 2011; 126:58-64. [PMID: 21095104 DOI: 10.1016/j.schres.2010.10.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 10/21/2010] [Accepted: 10/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Future success of early intervention initiatives to prevent the onset of psychosis will rely on the validity of methods to predict clinical outcome. Proper identification is particularly essential for young adolescents, as psychotic-like symptoms are often transitory during this period and mislabeling can lead to early stigmatization and unnecessary treatment. This article presents results from a prospective, naturalistic 2-year follow-up study of a cohort of young adolescents putatively at ultra-high risk (UHR) for psychosis. METHODS Seventy-two adolescents between 12 and 18years were recruited, fulfilling either UHR criteria or the basic symptom-based criterion cognitive disturbances (COGDIS). Incidence of transition as well as the remission rate from UHR status was calculated. Individuals who made a transition (UHR-P) were compared to those who did not (UHR-NP) and to those who remitted (UHR-R) on socio-demographic and clinical characteristics. RESULTS Fifty-seven UHR individuals completed the 2-year follow-up assessment. The confirmed transition rate was 15.6% and 35.3% still met UHR criteria. The remaining 49.1% had remitted from an initial UHR status. The UHR subgroups did not differ on socio-demographic or clinical variables at baseline. CONCLUSIONS Half of young adolescents meeting UHR criteria continue to experience prodromal or psychotic symptoms after 2 years. However, they are at least three times more likely to have remitted from their UHR status than to have made a transition to psychosis. In addition, baseline characteristics are not indicative of clinical outcome at follow-up. Our results emphasize the need for further improvement and stratification of relative risk factors for psychosis.
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Affiliation(s)
- Tim B Ziermans
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
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