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Pelizza L, Plazzi E, Leuci E, Leucci AC, Quattrone E, Azzali S, Pupo S, Paulillo G, Pellegrini P, Menchetti M. Diagnostic shift in adolescents with first episode psychosis: findings from the 2-year follow-up of the "Parma Early Psychosis" program. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02721-2. [PMID: 38951155 DOI: 10.1007/s00127-024-02721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Diagnostic stability for people with First Episode Psychosis (FEP) is essential for treatment, but it remains poorly investigated, especially in adolescents and within a prospective design. The aims of this research were: (a) to examine diagnostic change in Italian adolescents with FEP treated within an "Early Intervention in Psychosis" program during a 2-year follow-up period and (b) to investigate any sociodemographic and clinical predictors at baseline. METHODS At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results. RESULTS 38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms. CONCLUSION Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy.
| | - Enrico Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Anna Caterina Leucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, viale Amendola 2, Reggio Emilia (RE), 42100, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, viale Gramsci 14, Parma (PR), 43100, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, largo Palli 1/a, Parma (PR), 43100, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Università di Bologna, viale Pepoli 5, Bologna (BO), 40123, Italy
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Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Poletti M, Raballo A, Pellegrini P, Menchetti M. Baseline antipsychotic prescription and short-term outcome indicators in individuals at clinical high-risk for psychosis: Findings from the Parma At-Risk Mental States (PARMS) program. Early Interv Psychiatry 2024; 18:71-81. [PMID: 37194411 DOI: 10.1111/eip.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
AIM The prognostic prediction of outcomes in individuals at clinical high-risk for psychosis (CHR-P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta-analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR-P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR-P individuals with more severe psychopathology and worse prognostic trajectories along a 1-year follow-up period. METHODS This research was settled within the 'Parma At-Risk Mental States' program. Baseline and 1-year follow-up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR-P individuals who were taking AP medications at entry were included in the CHR-P-AP+ subgroup. The remaining participants were grouped as CHR-P-AP-. RESULTS Hundred and seventy-eight CHR-P individuals (aged 12-25 years) were enrolled (91 CHR-P-AP+, 87 CHR-P-AP-). Compared to CHR-P AP-, CHR-P AP+ individuals had older age, greater baseline PANSS 'Positive Symptoms' and 'Negative Symptoms' factor subscores and a lower GAF score. At the end of our follow-up, CHR-P-AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non-planned visits compared to CHRP- AP- individuals. CONCLUSIONS In agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in risk calculators.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" - University of Bologna, Bologna, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Simona Pupo
- Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Department of Medicine, Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
- Center for Translational, Phenomenological and Developmental Psychopathology, Perugia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Parma, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, "Alma Mater Studiorum" - University of Bologna, Bologna, Italy
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Lo Buglio G, Pontillo M, Cerasti E, Polari A, Schiano Lomoriello A, Vicari S, Lingiardi V, Boldrini T, Solmi M. A network analysis of anxiety, depressive, and psychotic symptoms and functioning in children and adolescents at clinical high risk for psychosis. Front Psychiatry 2022; 13:1016154. [PMID: 36386985 PMCID: PMC9650363 DOI: 10.3389/fpsyt.2022.1016154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Youths at clinical high risk for psychosis (CHR-P) are characterized by a high prevalence of anxiety and depressive disorders. The present study aimed at developing and analyzing a network structure of CHR-P symptom domains (i.e., positive, negative, disorganization, and general subclinical psychotic symptoms), depressive and anxiety symptoms, and general functioning. Methods Network analysis was applied to data on 111 CHR-P children and adolescents (M age = 14.1), who were assessed using the Structured Interview for Prodromal Syndromes, the Children's Depression Inventory, the Children's Global Assessment Scale, and the Multidimensional Anxiety Scale for Children. Results In the network, negative and disorganization symptoms showed the strongest association (r = 0.71), and depressive and anxiety symptoms showed dense within-domain connections, with a main bridging role played by physical symptoms of anxiety. The positive symptom cluster was not associated with any other node. The network stability coefficient (CS) was slightly below 0.25, and observed correlations observed ranged from 0.35 to 0.71. Conclusion The lack of association between subclinical positive symptoms and other network variables confirmed the independent nature of subclinical positive symptoms from comorbid symptoms, which were found to play a central role in the analyzed network. Complex interventions should be developed to target positive and comorbid symptoms, prioritizing those with the most significant impact on functioning and the most relevance for the young individual, through a shared decision-making process. Importantly, the results suggest that negative and disorganization symptoms, as well as depressive and anxiety symptoms, may be targeted simultaneously.
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Affiliation(s)
- Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Erika Cerasti
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
- Istituto Nazionale di Statistica (Istat), Rome, Italy
| | - Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Stefano Vicari
- Child Psychiatry Unit, Department of Neuroscience Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Marco Solmi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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