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Fässler L, Bighelli I, Leucht S, Sabé M, Bajbouj M, Knaevelsrud C, Böge K. Targeted psychological and psychosocial interventions for auditory hallucinations in persons with psychotic disorders: Protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0306324. [PMID: 38959279 PMCID: PMC11221679 DOI: 10.1371/journal.pone.0306324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND In recent years, a growing body of evidence has demonstrated the efficacy of non-pharmacological interventions for schizophrenia spectrum disorders (SSD) including positive symptoms such as auditory hallucinations (AH). However, clinical trials predominantly examine general treatment effects for positive symptoms. Therefore, previous research is lacking in comprehensive and clear evidence about psychological and psychosocial approaches that are primarily tailored to treat AH. To overcome this knowledge gap in the current literature, we will conduct a systematic review and meta-analysis to assess the efficacy of clearly targeted psychological and psychosocial interventions for AH in persons with SSD. METHODS AND ANALYSIS This study protocol has been developed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will include all randomized controlled trials analyzing the efficacy of targeted psychological and psychosocial interventions especially aimed at treating AH in SSD. We will include studies on adult patients with SSD experiencing AH. The primary outcome will be the change on a published rating scale measuring AH. Secondary outcomes will be delusions, overall symptoms, negative symptoms, depression, social functioning, quality of life, and acceptability (drop-out). We will search relevant databases and the reference lists of included literature. The study selection process will be conducted by two independent reviewers. We will conduct a random-effect meta-analysis to consider heterogeneity across studies. Analyses will be carried out by software packages in R. The risk of bias in each study will be evaluated using the Cochrane Risk of Bias tool. Assessment of heterogeneity and sensitivity analysis will be conducted. DISCUSSION The proposed study will augment the existing evidence by providing an overview of effective treatment approaches and their overall efficacy at treating AH in SSD. These findings will complement existing evidence that may impact future treatment implementations in clinical practice by addressing effective strategies to treat AH and therefore improve outcomes for the addressed population. ETHICS AND DISSEMINATION No ethical issues are foreseen. We will publish the results from this study in peer-reviewed journals and at relevant scientific conferences. TRIAL REGISTRATION PROSPERO registration number: CRD42023475704.
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Affiliation(s)
- Laura Fässler
- Department of Psychiatry and Neurosciences, Charité–University Medicine Berlin, Berlin, Germany
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine and Health, Munich, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Michel Sabé
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Malek Bajbouj
- Department of Psychiatry and Neurosciences, Charité–University Medicine Berlin, Berlin, Germany
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Charité–University Medicine Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
- Medical University Brandenburg–Theodor Fontane, Neuruppin, Germany
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Fekih-Romdhane F, El Hadathy D, González-Nuevo C, Malaeb D, Barakat H, Hallit S. Development and preliminary validation of the Postpartum Psychotic Experiences Scale (PPES). Psychiatry Res 2023; 329:115543. [PMID: 37839316 DOI: 10.1016/j.psychres.2023.115543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
Despite the emerging research interest in postpartum psychotic experiences, there is still a lack of measures for specifically measuring this construct. The contribution of this paper is to design and validate a novel self-report measure, the Postpartum Psychotic Experiences Scale (PPES), to screen for attenuated psychotic symptoms during postpartum. This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery. Starting from an initial pool of 22 items, both Exploratory Factor Analysis and Confirmatory Factor Analysis suggested that remaining 15 items loaded on one factor (α = 0.95). The PPES showed good convergent validity with the Prodromal Questionnaire-Brief scale (correlations >0.8) and good concurrent validity with postpartum depression and anxiety scales. A PPSE score of 8.5 (sensitivity=85.2%, specificity=78.6%) was defined as the optimal cutoff point. At this cutoff, 47% of participating women were considered at possible risk for postpartum psychosis. This study provides, for the first time, a specific self-report measure to assess postpartum PEs reliably and validly. We hope that the PPES will facilitate routine screening for PEs after childbirth among women who are predisposed to developing postpartum psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba 2010 Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Diane El Hadathy
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | | | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Habib Barakat
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Department of Obstetrics and Gynecology, Notre Dame des Secours University Hospital Center, Street 93, Byblos 3, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon; Psychology Department, College of Humanities, Effat University, Jeddah 21478, Saudi Arabia; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Woods SW, Lympus C, McGlashan TH, Walsh BC, Cannon TD. The Mini-SIPS: development of a brief clinical structured interview guide to diagnosing DSM-5 Attenuated Psychosis Syndrome and training outcomes. BMC Psychiatry 2022; 22:784. [PMID: 36514073 PMCID: PMC9746189 DOI: 10.1186/s12888-022-04406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The Mini-SIPS, a condensed version of the Structured Interview for Psychosis-Risk Syndromes (SIPS), is intended to efficiently identify for clinicians the minimum information needed to support a DSM-5 Attenuated Psychosis Syndrome (APS) diagnosis. METHODS The instrument and the DSM-5 criteria are accessible through the online training program. RESULTS Most individuals (67.5%) in the first 212 to complete the training program indicated an intended use of the Mini-SIPS exclusively for clinical purposes. Performance on the post-training quiz was excellent for those with and without prior training in structured diagnostic interviewing. CONCLUSION The Mini-SIPS, and accompanying training program, are offered as public-domain clinical resources to the mental health community.
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Cole Lympus
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Barbara C Walsh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Vouga Ribeiro N, Tavares V, Bramon E, Toulopoulou T, Valli I, Shergill S, Murray R, Prata D. Effects of psychosis-associated genetic markers on brain volumetry: a systematic review of replicated findings and an independent validation. Psychol Med 2022; 52:1-16. [PMID: 36168994 PMCID: PMC9811278 DOI: 10.1017/s0033291722002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Given psychotic illnesses' high heritability and associations with brain structure, numerous neuroimaging-genetics findings have been reported in the last two decades. However, few findings have been replicated. In the present independent sample we aimed to replicate any psychosis-implicated SNPs (single nucleotide polymorphisms), which had previously shown at least two main effects on brain volume. METHODS A systematic review for SNPs showing a replicated effect on brain volume yielded 25 studies implicating seven SNPs in five genes. Their effect was then tested in 113 subjects with either schizophrenia, bipolar disorder, 'at risk mental state' or healthy state, for whole-brain and region-of-interest (ROI) associations with grey and white matter volume changes, using voxel-based morphometry. RESULTS We found FWER-corrected (Family-wise error rate) (i.e. statistically significant) associations of: (1) CACNA1C-rs769087-A with larger bilateral hippocampus and thalamus white matter, across the whole brain; and (2) CACNA1C-rs769087-A with larger superior frontal gyrus, as ROI. Higher replication concordance with existing literature was found, in decreasing order, for: (1) CACNA1C-rs769087-A, with larger dorsolateral-prefrontal/superior frontal gyrus and hippocampi (both with anatomical and directional concordance); (2) ZNF804A-rs11681373-A, with smaller angular gyrus grey matter and rectus gyri white matter (both with anatomical and directional concordance); and (3) BDNF-rs6265-T with superior frontal and middle cingulate gyri volume change (with anatomical and allelic concordance). CONCLUSIONS Most literature findings were not herein replicated. Nevertheless, high degree/likelihood of replication was found for two genome-wide association studies- and one candidate-implicated SNPs, supporting their involvement in psychosis and brain structure.
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Affiliation(s)
- Nuno Vouga Ribeiro
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Vânia Tavares
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’ College London, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Timothea Toulopoulou
- Department of Psychology & National Magnetic Resonance Research Center (UMRAM), Aysel Sabuncu Brain Research Centre (ASBAM), Bilkent University, Ankara, Turkey
| | - Isabel Valli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’ College London, London, UK
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sukhi Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’ College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’ College London, London, UK
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Vaquerizo-Serrano J, Salazar de Pablo G, Singh J, Santosh P. Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis. J Autism Dev Disord 2022; 52:1568-1586. [PMID: 33993403 PMCID: PMC8938385 DOI: 10.1007/s10803-021-05046-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
Psychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.
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Affiliation(s)
- Julio Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK.
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Wang P, Yan CD, Dong XJ, Geng L, Xu C, Nie Y, Zhang S. Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews. World J Clin Cases 2022; 10:2420-2428. [PMID: 35434048 PMCID: PMC8968616 DOI: 10.12998/wjcc.v10.i8.2420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An accurate identification of individuals at ultra-high risk (UHR) based on psychometric tools to prospectively identify psychosis as early as possible is required for indicated preventive intervention. The diagnostic comparability of several psychometric tools, including the comprehensive assessment of at risk mental state (CAARMS), the structured interview for psychosis-risk syndrome (SIPS) and the bonn scale for the assessment of basic symptoms (BSABS), is unknown.
AIM To address the psychometric comparability of CAARMS, SIPS and BSABS for subjects who are close relatives of patients with schizophrenia.
METHODS In total, 189 participants aged 18-58 years who were lineal relative by blood and collateral relatives by blood up to the third degree of kinship of patients with schizophrenia were interviewed in the period of May 2017 to January 2019. Relatives of the participants diagnosed schizophrenia were excluded. All the participants were assessed for a UHR state by three psychometric tools (CAARMS, SIPS and BSABS). The psychometric diagnosis results included at risk of psychosis (UHR+), not at risk of psychosis (UHR-) and psychosis. Demographic and clinical characteristics were also measured. The inter-rater agreement was assessed for evaluation of the coherence of the three scales. Transition rates for UHR+ subjects to psychosis within 2 years were also recorded.
RESULTS The overall agreement percentages were 93.12%, 92.06% and 93.65% of CAARMS and SIPS, SIPS and BSABS and CAARMS and BSABS, respectively. The overall agreement percentage of the relative functional impairment of the three groups (UHR+, not at risk of psychosis and psychosis) were 89.24%, 86.36% and 88.12%, respectively. The inter-rater reliability of the CAARMS, SIPS and BSABS total score was 0.90, 0.89 and 0.85. The inter-rater reliability was very good to excellent for all the subscales of these three instruments. For CAARMS, SIPS and BSABS, the kappa coefficient about UHR criteria agreement was 0.87, 0.84 and 0.82, respectively (P < 0.001). The transition rates of UHR+ to psychosis within 2 years were 16.7% (CAARMS), 10.0% (SIPS) and 17.7% (BSABS).
CONCLUSION There is good diagnostic agreement between the CAARMS, SIPS and BSABS towards identification of UHR participants who are close relatives of patients with schizophrenia.
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Affiliation(s)
- Peng Wang
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Chuan-Dong Yan
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Xiao-Jie Dong
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Lei Geng
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Chao Xu
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Yun Nie
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
| | - Sheng Zhang
- Department of Psychological Rehabilitation, the Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430022, Hubei Province, China
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Westhoff MLS, Ladwig J, Heck J, Schülke R, Groh A, Deest M, Bleich S, Frieling H, Jahn K. Early Detection and Prevention of Schizophrenic Psychosis-A Review. Brain Sci 2021; 12:11. [PMID: 35053755 PMCID: PMC8774083 DOI: 10.3390/brainsci12010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 01/04/2023] Open
Abstract
Psychotic disorders often run a chronic course and are associated with a considerable emotional and social impact for patients and their relatives. Therefore, early recognition, combined with the possibility of preventive intervention, is urgently warranted since the duration of untreated psychosis (DUP) significantly determines the further course of the disease. In addition to established diagnostic tools, neurobiological factors in the development of schizophrenic psychoses are increasingly being investigated. It is shown that numerous molecular alterations already exist before the clinical onset of the disease. As schizophrenic psychoses are not elicited by a single mutation in the deoxyribonucleic acid (DNA) sequence, epigenetics likely constitute the missing link between environmental influences and disease development and could potentially serve as a biomarker. The results from transcriptomic and proteomic studies point to a dysregulated immune system, likely evoked by epigenetic alterations. Despite the increasing knowledge of the neurobiological mechanisms involved in the development of psychotic disorders, further research efforts with large population-based study designs are needed to identify suitable biomarkers. In conclusion, a combination of blood examinations, functional imaging techniques, electroencephalography (EEG) investigations and polygenic risk scores should be considered as the basis for predicting how subjects will transition into manifest psychosis.
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Affiliation(s)
- Martin Lennart Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Johannes Ladwig
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, D-30625 Hannover, Germany;
| | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Maximilian Deest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
| | - Kirsten Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, D-30625 Hannover, Germany; (J.L.); (R.S.); (A.G.); (M.D.); (S.B.); (H.F.); (K.J.)
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Krebs MD, Themudo GE, Benros ME, Mors O, Børglum AD, Hougaard D, Mortensen PB, Nordentoft M, Gandal MJ, Fan CC, Geschwind DH, Schork AJ, Werge T, Thompson WK. Associations between patterns in comorbid diagnostic trajectories of individuals with schizophrenia and etiological factors. Nat Commun 2021; 12:6617. [PMID: 34785645 PMCID: PMC8595374 DOI: 10.1038/s41467-021-26903-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/15/2021] [Indexed: 12/26/2022] Open
Abstract
Schizophrenia is a heterogeneous disorder, exhibiting variability in presentation and outcomes that complicate treatment and recovery. To explore this heterogeneity, we leverage the comprehensive Danish health registries to conduct a prospective, longitudinal study from birth of 5432 individuals who would ultimately be diagnosed with schizophrenia, building individual trajectories that represent sequences of comorbid diagnoses, and describing patterns in the individual-level variability. We show that psychiatric comorbidity is prevalent among individuals with schizophrenia (82%) and multi-morbidity occur more frequently in specific, time-ordered pairs. Three latent factors capture 79% of variation in longitudinal comorbidity and broadly relate to the number of co-occurring diagnoses, the presence of child versus adult comorbidities and substance abuse. Clustering of the factor scores revealed five stable clusters of individuals, associated with specific risk factors and outcomes. The presentation and course of schizophrenia may be associated with heterogeneity in etiological factors including family history of mental disorders.
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Affiliation(s)
- Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Gonçalo Espregueira Themudo
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Aarhus University Hospital, Risskov, Denmark
| | - Anders D Børglum
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department of Biomedicine and iSEQ-Centre for Integrative Sequencing, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University, Aarhus, Denmark
| | - David Hougaard
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Preben Bo Mortensen
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, Aarhus University, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Business and Social Sciences, Aarhus, Denmark
| | - Merete Nordentoft
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael J Gandal
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chun Chieh Fan
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Center for Human Development, University of California, San Diego, CA, USA
| | - Daniel H Geschwind
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Program in Neurobehavioral Genetics, Semel Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrew J Schork
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Neurogenomics Division, The Translational Genomics Research Institute (TGEN), Phoenix, AZ, USA
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark.
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
- Center for GeoGenetics, Globe Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Wesley K Thompson
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services Capital Region of Denmark, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California, San Diego, CA, 92093, USA
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9
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Polari A, Street R, Conus P, Finkelstein A, Hartmann JA, Kim SW, McGorry P, Schley C, Simmons M, Stratford J, Thompson A, Yung A, Nelson B, Lavoie S. Patients', carers' and clinicians' attitudes towards alternative terms to describe the at-risk for psychosis state. Schizophr Res 2021; 237:69-75. [PMID: 34507056 DOI: 10.1016/j.schres.2021.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 07/16/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Language used in psychiatry is important because it provides an understandable and accurate way of describing clinical and theoretical concepts. The use of labels in psychiatry has often been associated with stigma and reduced engagement with clinical services. This studys aims were to generate new terms for the 'at-risk mental state' (ARMS) concept and to investigate what young people, their caregivers and clinicians thought about them as well as terms commonly used in early intervention clinics. Another aim was to understand participants preference related to the best timing to introduce the at-risk concept and the extent and context of the information presented. METHODS New terms illustrating the at-risk concept have been generated by a youth reference group with lived experience of mental illness: 'pre-diagnosis stage' (PDS), potential of developing a mental illness (PDMI) and disposition for developing a mental illness (DDMI). A specifically designed questionnaire was administered to 46 patients with ARMS, 24 caregivers and 52 clinicians to obtain their feedback on newly proposed terms and on the terms already used in clinical practice and research. RESULTS The preferred terms were PDS, PDMI and ARMS. The least favoured terms were Ultra High Risk and Attenuated Psychosis Syndrome, which were thought to be associated with the most stigma. Most participants agreed that disclosure about diagnosis should be delivered early by the key clinician. CONCLUSIONS Patients generated terms such as PDS, PDMI, alongside ARMS should be considered to be used in clinical practice. They present with low stigma and are illustrative of young peoples difficulties.
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Affiliation(s)
- Andrea Polari
- Orygen Specialist Programs, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Rebekah Street
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Lausanne, Switzerland
| | | | - Jessica A Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Magenta Simmons
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Andrew Thompson
- Orygen Specialist Programs, Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison Yung
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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10
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Corcoran CM, Mittal VA, Woods SW. Attenuated Psychosis Syndrome Should Be Moved to the Main Section in DSM-5-TR. JAMA Psychiatry 2021; 78:821-822. [PMID: 33978689 DOI: 10.1001/jamapsychiatry.2021.0838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychiatry, James J. Peters VA Medical Center, New York, New York
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
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11
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Dong F, Calkins ME, Compton P, Medoff-Cooper B, Barzilay R, Taylor JH, Moore TM, Gur RC, Gur RE, Hodgson NA. Association between traumatic stressful events and schizotypal symptoms among a community-based sample of adolescents: A 2-year longitudinal study. Schizophr Res 2021; 233:44-51. [PMID: 34225026 DOI: 10.1016/j.schres.2021.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents. MATERIAL AND METHODS A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later. RESULTS More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034). CONCLUSIONS We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.
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Affiliation(s)
- Fanghong Dong
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA
| | - Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Ran Barzilay
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Jerome H Taylor
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
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12
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Fusar‐Poli P, Correll CU, Arango C, Berk M, Patel V, Ioannidis JP. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021; 20:200-221. [PMID: 34002494 PMCID: PMC8129854 DOI: 10.1002/wps.20869] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally-sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high-risk for psychosis paradigm has received the most empirical validation, while clinical high-risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non-genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi-endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence-based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost-effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK,OASIS Service, South London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
| | - Christoph U. Correll
- Department of PsychiatryZucker Hillside Hospital, Northwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric NeuroscienceFeinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité Universitätsmedizin BerlinBerlinGermany
| | - Celso Arango
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry and Mental Health, Hospital General Universitario Gregorio MarañónMadridSpain,Health Research Institute (IiGSM), School of MedicineUniversidad Complutense de MadridMadridSpain,Biomedical Research Center for Mental Health (CIBERSAM)MadridSpain
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin UniversityBarwon HealthGeelongVICAustralia,Department of PsychiatryUniversity of MelbourneMelbourneVICAustralia,Orygen Youth HealthUniversity of MelbourneMelbourneVICAustralia,Florey Institute for Neuroscience and Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard University T.H. Chan School of Public HealthBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - John P.A. Ioannidis
- Stanford Prevention Research Center, Department of MedicineStanford UniversityStanfordCAUSA,Department of Biomedical Data ScienceStanford UniversityStanfordCAUSA,Department of Epidemiology and Population HealthStanford UniversityStanfordCAUSA
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13
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Worthington MA, Miklowitz DJ, O'Brien M, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cannon TD. Selection for psychosocial treatment for youth at clinical high risk for psychosis based on the North American Prodrome Longitudinal Study individualized risk calculator. Early Interv Psychiatry 2021; 15:96-103. [PMID: 31943807 PMCID: PMC7358123 DOI: 10.1111/eip.12914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/22/2019] [Accepted: 12/14/2019] [Indexed: 01/19/2023]
Abstract
AIM Recent findings suggest that family-focused therapy (FFT) is effective for individuals at clinical high-risk for psychosis (CHR-P). As outcomes of CHR-P individuals are quite varied, certain psychosocial interventions may be differentially effective in subgroups. The present study examined change in positive symptoms for CHR-P individuals at different levels of predicted risk for conversion to psychosis who received either FFT, a brief form of family education termed enhanced care (EC) or treatment as usual. METHODS Participants were drawn from the North American Prodromal Longitudinal Study (NAPLS2). A subset of NAPLS2 participants completed a randomized study involving FFT or EC. The present study includes participants from the FFT-CHR sub-study and non-randomized NAPLS2 participants. Predicted risk of conversion was calculated using the Individualized Risk Calculator for Psychosis. Robust linear regressions evaluated whether the association between predicted risk of conversion and positive symptom change differed across intervention groups. RESULTS A total of 94 participants from the FFT-CHR sub-study (FFT-CHR n = 50, EC n = 44) and 401 non-randomized NAPLS2 participants were included in this study. There was a treatment group by predicted risk of conversion interaction that predicted positive symptom improvement: higher risk individuals improved more with FFT-CHR than EC or the non-randomized NAPLS group, whereas lower-risk individuals did not differ in positive symptom improvement across treatment groups (FFT-CHR vs EC: P = .03, β = 20.27; FFT-CHR vs NAPLS2: P < .001, β = 28.40). CONCLUSIONS Intensive treatments such as FFT-CHR may be most appropriate for individuals at the highest levels of clinical risk for psychosis.
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Affiliation(s)
| | - David J Miklowitz
- Department of Psychiatry, UCLA Semel Institute, University of California, Los Angeles, California
| | - Mary O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, California
| | | | | | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, California
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, California
| | - Elaine F Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut.,Department of Psychiatry, Yale University, New Haven, Connecticut
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14
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McGorry PD, Mei C, Hartmann J, Yung AR, Nelson B. Intervention strategies for ultra-high risk for psychosis: Progress in delaying the onset and reducing the impact of first-episode psychosis. Schizophr Res 2021; 228:344-356. [PMID: 33545668 DOI: 10.1016/j.schres.2020.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 12/26/2022]
Abstract
Over a quarter of a century ago, the formulation of the "at risk mental state" and operational criteria to prospectively identify individuals at "clinical" or "ultra-high risk" (UHR) for psychosis created a global wave of research momentum aimed at predicting and preventing first-episode psychosis. A substantial number of randomized controlled trials (RCTs) were conducted to determine if transition to psychosis could be delayed or even prevented. The efficacy of a range of interventions was examined, with standard meta-analyses clearly indicating that these could at least delay transition for 1-2 years and that outcomes improve. Recently, network meta-analyses have attempted to identify the most effective intervention. These highlighted the fact that no one form of intervention is superior to the rest, a finding interpreted in such a way as to create doubts concerning the value of intervening. These doubts have been reinforced by a subsequent Cochrane review which judged the quality of the evidence as low or very low. Here, we report a narrative review of findings from RCTs and meta-analyses on the efficacy of interventions in UHR. We also critique the network meta-analyses and the Cochrane review, and indicate that many of the trials were of the highest possible quality for such research, and were published in top ranked psychiatry journals, which demand such quality. Although outcomes vary, and the UHR group is clearly heterogeneous, we highlight the clinical benefits of psychosocial treatment. The next generation of clinical trials seek to elucidate the optimal type, duration and sequence of interventions.
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Affiliation(s)
- Patrick D McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison R Yung
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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15
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Hartmann JA, McGorry PD, Destree L, Amminger GP, Chanen AM, Davey CG, Ghieh R, Polari A, Ratheesh A, Yuen HP, Nelson B. Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Front Psychiatry 2021; 11:553578. [PMID: 33488413 PMCID: PMC7819892 DOI: 10.3389/fpsyt.2020.553578] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
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Affiliation(s)
- Jessica A. Hartmann
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick D. McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Louise Destree
- BrainPark, The Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - G. Paul Amminger
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M. Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G. Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Rachid Ghieh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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16
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Woods SW, Bearden CE, Sabb FW, Stone WS, Torous J, Cornblatt BA, Perkins DO, Cadenhead KS, Addington J, Powers AR, Mathalon DH, Calkins ME, Wolf DH, Corcoran CM, Horton LE, Mittal VA, Schiffman J, Ellman LM, Strauss GP, Mamah D, Choi J, Pearlson GD, Shah JL, Fusar-Poli P, Arango C, Perez J, Koutsouleris N, Wang J, Kwon JS, Walsh BC, McGlashan TH, Hyman SE, Gur RE, Cannon TD, Kane JM, Anticevic A. Counterpoint. Early intervention for psychosis risk syndromes: Minimizing risk and maximizing benefit. Schizophr Res 2021; 227:10-17. [PMID: 32402605 PMCID: PMC8218020 DOI: 10.1016/j.schres.2020.04.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malhi et al. in this issue critique the clinical high risk (CHR) syndrome for psychosis. METHOD Response to points of critique. RESULTS We agree that inconsistency in CHR nomenclature should be minimized. We respectfully disagree on other points. In our view: a) individuals with CHR and their families need help, using existing interventions, even though we do not yet fully understand disease mechanisms; b) substantial progress has been made in identification of biomarkers; c) symptoms used to identify CHR are specific to psychotic illnesses; d) CHR diagnosis is not "extremely difficult"; e) the pattern of progression, although heterogenous, is discernible; f) "psychosis-like symptoms" are common but are not used to identify CHR; and g) on the point described as 'the real risk,' CHR diagnosis does not frequently cause harmful stigma. DISCUSSION Malhi et al.'s arguments do not fairly characterize progress in the CHR field nor efforts to minimize stigma. That said, much work remains in areas of consistent nomenclature, mechanisms of disease, dissecting heterogeneity, and biomarkers. With regard to what the authors term the "real risk" of stigma associated with a CHR "label," however, our view is that avoiding words like "risk" and "psychosis" reinforces the stigma that both they and we mean to oppose. Moreover, patients and their families benefit from being given a term that describes what is happening to them.
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Affiliation(s)
- Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA.
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Department Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Fred W Sabb
- Lewis Center for Neuroimaging, University of Oregon, Eugene, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - John Torous
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Alberta, Canada
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Daniel Mamah
- Department of Psychiatry, Washington University in Saint Louis, MO, USA
| | - Jimmy Choi
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Godfrey D Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA; Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, CT, USA
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, King's College London, UK; Department of Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Celso Arango
- Dept. of Child and Adolescent Psychiatry, Universidad Complutense de Madrid, Spain
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, UK
| | | | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, South Korea
| | - Barbara C Walsh
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | | | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
| | - John M Kane
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Alan Anticevic
- Department of Psychiatry, Yale University, New Haven, CT, USA; Department of Psychology, Yale University, New Haven, CT, USA
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17
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Oribe N, Hirano Y, Del Re E, Mesholam-Gately RI, Woodberry KA, Ueno T, Kanba S, Onitsuka T, Shenton ME, Spencer KM, Niznikiewicz MA. Longitudinal evaluation of visual P300 amplitude in clinical high-risk subjects: An event-related potential study. Psychiatry Clin Neurosci 2020; 74:527-534. [PMID: 32519778 DOI: 10.1111/pcn.13083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/11/2022]
Abstract
AIM We previously reported abnormal P300 and N200 in a visual oddball task, and progressive P300 amplitude reduction at 1-year follow-up in patients with first-episode schizophrenia. P300 reduction as well as intact P1/N1 were also observed in clinical high-risk subjects (CHR), but whether or not these components change over time is unknown. This study evaluates, longitudinally, the visual P300, as well as P1, N1, and N200, in CHR. METHODS Visual event-related potentials (ERP) were recorded twice, once at baseline and once at 1-year follow-up in CHR (n = 19) and healthy comparison subjects (HC; n = 28). Participants silently counted infrequent target stimuli ('x') among standard stimuli ('y') presented on the screen while the 64-channel electroencephalogram was recorded. RESULTS No CHR converted to psychosis from baseline to 1-year follow-up in this study. Visual P300 amplitude was reduced and the latency was delayed significantly in CHR at both time points compared with HC. Furthermore, CHR subjects who had more positive symptoms showed more amplitude reduction at both time points. P1, N1, and N200 did not differ between groups. CONCLUSION Visual P300 amplitude was found to be reduced in CHR individuals compared with HC. We note that this finding is in subjects who did not convert to psychosis at 1-year follow-up. The association between visual P300 amplitude and symptoms suggests that for CHR who often experience clinical symptoms and seek medical care, visual P300 may be an important index that reflects the pathophysiological impairment underlying such clinical states.
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Affiliation(s)
- Naoya Oribe
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Department of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Yoshinogari, Japan
| | - Yoji Hirano
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - Elisabetta Del Re
- Departments of Psychiatry and Radiology, Veterans Affairs Boston Healthcare System, and Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Cognitive Neuroscience Laboratory, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Brockton, USA
| | - Raquelle I Mesholam-Gately
- Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Kristen A Woodberry
- Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
- Center for Psychiatric Research, Maine Medical Center Research Institute, Portland, USA
| | - Takefumi Ueno
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Department of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Yoshinogari, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
- Japan Depression Center, Tokyo, Japan
| | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - Martha E Shenton
- Departments of Psychiatry and Radiology, Veterans Affairs Boston Healthcare System, and Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Kevin M Spencer
- Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Margaret A Niznikiewicz
- Cognitive Neuroscience Laboratory, VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Brockton, USA
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18
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Lucas-Molina B, Pérez-Albéniz A, Satorres E, Ortuño-Sierra J, Domínguez Garrido E, Fonseca-Pedrero E. Identifying extended psychosis phenotypes at school: Associations with socio-emotional adjustment, academic, and neurocognitive outcomes. PLoS One 2020; 15:e0237968. [PMID: 32822380 PMCID: PMC7446872 DOI: 10.1371/journal.pone.0237968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022] Open
Abstract
The main goal of the present study was to explore the latent structure of extended psychosis phenotypes in a representative sample of adolescents. Moreover, associations with socio-emotional adjustment, academic achievement, and neurocognition performance across the latent profiles were compared. Participants were 1506 students, 667 males (44.3%), derived from random cluster sampling. Various tools were used to measure psychosis risk, subjective well-being, academic performance, and neurocognition. Based on three psychometric indicators of psychosis risk (schizotypal traits, psychotic-like experiences, and bipolar-like experiences), four latent classes were found: non-risk, low-risk, high reality distortion experiences, and high psychosis liability. The high-risk latent groups scored significantly higher on mental health difficulties, and negative affect, and lower on positive affect and well-being, compared to the two non-risk groups. Moreover, these high-risk groups had a significantly higher number of failed academic subjects compared to the non-risk groups. In addition, no statistically significant differences in efficiency performance were found in the neurocognitive domains across the four latent profiles. This study allows us to improve the early identification of adolescents at risk of serious mental disorder in school settings in order to prevent the incidence and burden associated with these kinds of mental health problems.
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Affiliation(s)
- Beatriz Lucas-Molina
- Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Alicia Pérez-Albéniz
- Department of Educational Sciences, University of La Rioja, Logroño, Spain
- Programa Riojano de Investigación en Salud Mental (PRISMA), University of La Rioja, Logroño, Spain
| | - Encar Satorres
- Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Javier Ortuño-Sierra
- Department of Educational Sciences, University of La Rioja, Logroño, Spain
- Programa Riojano de Investigación en Salud Mental (PRISMA), University of La Rioja, Logroño, Spain
| | | | - Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, Spain
- Programa Riojano de Investigación en Salud Mental (PRISMA), University of La Rioja, Logroño, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Department of Psychiatry, University of Oviedo, Oviedo, Spain
- * E-mail:
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19
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Carpenter WT. Classification Is Essential for the Attenuated Psychosis Syndrome. Biol Psychiatry 2020; 88:289-290. [PMID: 32731923 DOI: 10.1016/j.biopsych.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 01/28/2023]
Affiliation(s)
- William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.
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20
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Fusar-Poli P, Salazar de Pablo G, Correll CU, Meyer-Lindenberg A, Millan MJ, Borgwardt S, Galderisi S, Bechdolf A, Pfennig A, Kessing LV, van Amelsvoort T, Nieman DH, Domschke K, Krebs MO, Koutsouleris N, McGuire P, Do KQ, Arango C. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry 2020; 77:755-765. [PMID: 32159746 DOI: 10.1001/jamapsychiatry.2019.4779] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. OBJECTIVE To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. EVIDENCE REVIEW Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes. FINDINGS In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. CONCLUSIONS AND RELEVANCE This review confirmed recent substantial advancements in the detection and prognosis of CHR-P individuals while suggesting that effective indicated interventions need to be identified. This evidence suggests a need for specialized services to detect CHR-P individuals in primary and secondary care settings, to formulate a prognosis with validated psychometric instruments, and to offer needs-based and psychological interventions.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mark J Millan
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, Croissy sur Seine, Paris, France
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland.,Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre, Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany.,Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Dorien H Nieman
- Amsterdam University Medical Centers, Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModul), Medical Faculty, University of Freiburg, Germany
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, GHU Paris-Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Nikolaos Koutsouleris
- University Hospital, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Philip McGuire
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Kim Q Do
- Center for Psychiatric Neuroscience, Lausanne University Hospital, Lausanne-Prilly, Switzerland
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
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21
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Schmidt S, Schultze-Lutter F, Schimmelmann B, Maric N, Salokangas R, Riecher-Rössler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M, Morrison A, Raballo A, Klosterkötter J, Ruhrmann S. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 2020; 30:388-404. [DOI: 10.1016/j.eurpsy.2015.01.013] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
AbstractThis guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
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22
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Abstract
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what 'risk' entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry, and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA
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23
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Salazar de Pablo G, Catalan A, Fusar-Poli P. Clinical Validity of DSM-5 Attenuated Psychosis Syndrome: Advances in Diagnosis, Prognosis, and Treatment. JAMA Psychiatry 2020; 77:311-320. [PMID: 31746950 DOI: 10.1001/jamapsychiatry.2019.3561] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Since the release of the DSM-5 diagnosis of attenuated psychosis syndrome (DSM-5-APS) in 2013, several research studies have investigated its clinical validity. Although critical and narrative reviews have reviewed these progresses, no systematic review has comprehensively summarized the available evidence regarding the clinical validity of DSM-5-APS. OBJECTIVE To provide current evidence on the clinical validity of DSM-5-APS, focusing on recent advances in diagnosis, prognosis, and treatment. EVIDENCE REVIEW A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, conference proceedings, and trial registries from database inception to June 16, 2019, was conducted following PRISMA and MOOSE guidelines and PROSPERO protocol. Studies with original data investigating individuals diagnosed using DSM-5-APS or meeting comparable criteria were included. The results of the systematic review were summarized in tables and narratively synthesized against established evidence-based antecedent, concurrent, and prognostic validators. A quantitative meta-analysis was conducted to explore the cumulative risk of psychosis onset at 6, 12, 24, and 36 months in individuals diagnosed using DSM-5-APS criteria. FINDINGS The systematic review included 56 articles, which reported on 124 validators, including 15 antecedent, 55 concurrent, and 54 prognostic validators. The epidemiological prevalence of the general non-help-seeking young population meeting DSM-5-APS criteria was 0.3%; the prevalence of individuals meeting DSM-5-APS criteria was variable in clinical samples. The interrater reliability for DSM-5-APS criteria was comparable with that of other DSM-5 mental disorders and can be optimized by the use of specific psychometric instruments. DSM-5-APS criteria were associated with frequent depressive comorbid disorders, distress, suicidality, and functional impairment. The meta-analysis included 23 prospective cohort studies, including 2376 individuals. The meta-analytical risk of psychosis onset was 11% at 6 months, 15% at 12 months, 20% at 24 months, and 23% at 36 months. Research into predisposing and precipitating epidemiological factors, neurobiological correlates, and effective treatments for DSM-5-APS criteria has been limited. CONCLUSIONS AND RELEVANCE Over recent years, DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research into the clinical high-risk state for psychosis. Precipitating and predisposing factors, neurobiological correlates, and effective treatments are undetermined to date.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana Catalan
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.,Mental Health Group, BioCruces Health Research Institute, Bizkaia, Spain.,Neuroscience Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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24
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Youn S, Phillips LJ, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, McGorry PD, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma S, Yuen HP, Yung AR, Nelson B. Basic symptoms in young people at ultra-high risk of psychosis: Association with clinical characteristics and outcomes. Schizophr Res 2020; 216:255-261. [PMID: 31866077 DOI: 10.1016/j.schres.2019.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022]
Abstract
There has been limited research into the predictive value of basic symptoms and their relationship with other psychopathology in patients identified using the 'ultra high risk' (UHR) for psychosis approach. The current study investigated whether basic symptoms, specifically cognitive disturbances (COGDIS), were associated with a greater risk of transition to psychotic disorder and persistent attenuated psychotic symptoms (APS) at medium term follow-up (mean = 3.4 years) in UHR patients, as well as with general psychopathology at baseline. The sample included 304 UHR participants (mean age = 19.12 years) involved in an international multicenter trial of omega-3 fatty acids. UHR individuals who also met the COGDIS criteria (basic symptoms risk criteria) did not have a greater risk of transition than those who met the UHR criteria alone. However, meeting COGDIS risk criteria was associated with a greater likelihood of meeting the UHR attenuated psychotic symptoms risk group (i.e., having persistent attenuated psychotic symptoms) at 12-month follow-up (odds ratio = 1.85; 95% CI = 1.03, 3.32). Greater severity of cognitive basic symptoms was also independently associated with more severe general psychopathology at study entry. The findings do not support the notion that combined risk identification approaches (UHR and basic symptoms) aid in the identification of individuals at greatest risk of psychosis, although this interpretation is limited by the modest transition to psychosis rate (13%) and the time of follow up. However, the findings indicate that basic symptoms may be a clinically useful marker of more severe general psychopathology in UHR groups and risk for persistent attenuated psychotic symptoms.
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Affiliation(s)
- S Youn
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - L J Phillips
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - G P Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - C Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - P D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - M R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - M Schlögelhofer
- Department of Psychiatry, Medical University of Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - H P Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - A R Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - B Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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25
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Yoviene Sykes LA, Ferrara M, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Perkins DO, Mathalon DH, Seidman LJ, Tsuang MT, Walker EF, McGlashan TH, Woodberry KA, Powers AR, Ponce AN, Cahill JD, Pollard JM, Srihari VH, Woods SW. Predictive validity of conversion from the clinical high risk syndrome to frank psychosis. Schizophr Res 2020; 216:184-191. [PMID: 31864837 PMCID: PMC7239715 DOI: 10.1016/j.schres.2019.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023]
Abstract
Although the clinical high risk for psychosis (CHR) paradigm has become well-established over the past two decades, one key component has received surprisingly little investigative attention: the predictive validity of the criteria for conversion or transition to frank psychosis. The current study evaluates the predictive validity of the transition to psychosis as measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS) in CHR individuals. Participants included 33 SIPS converters and 399 CHR non-converters both from the North American Prodromal Longitudinal Study (NAPLS-2), as well as a sample of 67 separately ascertained first-episode psychosis (FEP) patients from the STEP program. Comparisons were made at baseline and one-year follow-up on demographic, diagnostic stability (SCID), and available measurement domains relating to severity of illness (psychotropic medication, psychosocial treatment, and resource utilization). Principal findings are: 1) a large majority of cases in both SIPS converters (n = 27/33, 81.8%) and FEP (n = 57/67, 85.1%) samples met criteria for continued psychosis at one-year follow-up; 2) follow-up prescription rates for current antipsychotic medication were higher in SIPS converters (n = 17/32, 53.1%) compared to SIPS non-converters (n = 81/397, 20.4%), and similar as compared to FEP cases (n = 39/65, 60%); and 3) at follow-up, SIPS converters had higher rates of resource utilization (psychiatric hospitalizations, day hospital admissions, and ER visits) than SIPS non-converters and were similar to FEP in most categories. The results suggest that the SIPS definition of psychosis onset carries substantial predictive validity. Limitations and future directions are discussed.
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Affiliation(s)
- Laura A Yoviene Sykes
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America.
| | - Maria Ferrara
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America; Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, Modena, Italy
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychology and Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States of America
| | | | - Tyrone D Cannon
- Departments of Psychology and Psychiatry, Yale University, New Haven, CT, United States of America
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Thomas H McGlashan
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Kristen A Woodberry
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Center for Psychiatric Research, Maine Medical Center, Portland, ME, United States of America
| | - Albert R Powers
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Allison N Ponce
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - John D Cahill
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Jessica M Pollard
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Vinod H Srihari
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
| | - Scott W Woods
- Department of Psychiatry and Connecticut Mental Health Center, Yale University, New Haven, CT, United States of America
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Provenzano FA, Guo J, Wall MM, Feng X, Sigmon HC, Brucato G, First MB, Rothman DL, Girgis RR, Lieberman JA, Small SA. Hippocampal Pathology in Clinical High-Risk Patients and the Onset of Schizophrenia. Biol Psychiatry 2020; 87:234-242. [PMID: 31771861 DOI: 10.1016/j.biopsych.2019.09.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We examined neuroimaging-derived hippocampal biomarkers in subjects at clinical high risk (CHR) for psychosis to further characterize the pathophysiology of early psychosis. We hypothesized that glutamate hyperactivity, reflected by increased metabolic activity derived from functional magnetic resonance imaging in the CA1 hippocampal subregion and from proton magnetic resonance spectroscopy-derived hippocampal levels of glutamate/glutamine, represents early hippocampal dysfunction in CHR subjects and is predictive of conversion to syndromal psychosis. METHODS We enrolled 75 CHR individuals with attenuated positive symptom psychosis-risk syndrome as defined by the Structured Interview for Psychosis-risk Syndromes. We used optimized magnetic resonance imaging techniques to measure 3 validated in vivo pathologies of hippocampal dysfunction-focal cerebral blood volume, focal atrophy, and evidence of elevated glutamate concentrations. All patients were imaged at baseline and were followed for up to 2 years to assess for conversion to psychosis. RESULTS At baseline, compared with control subjects, CHR individuals had high glutamate/glutamine and elevated focal cerebral blood volume on functional magnetic resonance imaging, but only baseline focal hippocampal atrophy predicted progression to syndromal psychosis. CONCLUSIONS These findings provide evidence that CHR patients with attenuated psychotic symptoms have glutamatergic abnormalities, although only CHR patients who develop syndromal psychosis exhibit focal hippocampal atrophy. Furthermore, these results support the growing evidence that hippocampal dysfunction is an early feature of schizophrenia and related psychotic disorders.
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Affiliation(s)
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, New York
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Xinyang Feng
- Department of Neurology, Columbia University, New York, New York; Department of Biomedical Engineering, Columbia University, New York, New York
| | - Hannah C Sigmon
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gary Brucato
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Douglas L Rothman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Scott A Small
- Department of Neurology, Columbia University, New York, New York.
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Nelson B, McGorry P. The Prodrome of Psychotic Disorders: Identification, Prediction, and Preventive Treatment. Child Adolesc Psychiatr Clin N Am 2020; 29:57-69. [PMID: 31708053 DOI: 10.1016/j.chc.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Twenty-five years ago "at risk" for psychosis criteria were introduced to the field. Prediction studies have identified a range of risk factors involved in transition from "at risk" status to first episode psychotic illness, with recent interest in dynamic and multimodal prediction models. Treatment studies have indicated that risk of transition to psychotic disorder can at least be delayed in this clinical population. Although the strongest evidence to date is for cognitive behavioral therapy, the optimal type and sequence of treatment remains an active area of research.
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Affiliation(s)
- Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia.
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road (Locked Bag 10), Parkville, Victoria 3052, Australia
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28
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Studerus E, Corbisiero S, Mazzariello N, Ittig S, Leanza L, Egloff L, Beck K, Heitz U, Andreou C, Stieglitz RD, Riecher-Rössler A. Can neuropsychological testing facilitate differential diagnosis between at-risk mental state (ARMS) for psychosis and adult attention-deficit/hyperactivity disorder (ADHD)? Eur Psychiatry 2020; 52:38-44. [DOI: 10.1016/j.eurpsy.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/22/2023] Open
Abstract
AbstractBackground:Patients with an at-risk mental state (ARMS) for psychosis and patients with attention-deficit/hyperactivity disorder (ADHD) have many overlapping signs and symptoms and hence can be difficult to differentiate clinically. The aim of this study was to investigate whether the differential diagnosis between ARMS and adult ADHD could be improved by neuropsychological testing.Methods:168 ARMS patients, 123 adult ADHD patients and 109 healthy controls (HC) were recruited via specialized clinics of the University of Basel Psychiatric Hospital. Sustained attention and impulsivity were tested with the Continuous Performance Test, verbal learning and memory with the California Verbal Learning Test, and problem solving abilities with the Tower of Hanoi Task. Group differences in neuropsychological performance were analyzed using generalized linear models. Furthermore, to investigate whether adult ADHD and ARMS can be correctly classified based on the pattern of cognitive deficits, machine learning (i.e. random forests) was applied.Results:Compared to HC, both patient groups showed deficits in attention and impulsivity and verbal learning and memory. However, in adult ADHD patients the deficits were comparatively larger. Accordingly, a machine learning model predicted group membership based on the individual neurocognitive performance profile with good accuracy (AUC = 0.82).Conclusions:Our results are in line with current meta-analyses reporting that impairments in the domains of attention and verbal learning are of medium effect size in adult ADHD and of small effect size in ARMS patients and suggest that measures of these domains can be exploited to improve the differential diagnosis between adult ADHD and ARMS patients.
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29
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Campion J, Taylor MJ, McDaid D, Park AL, Shiers D. Applying economic models to estimate local economic benefits of improved coverage of early intervention for psychosis. Early Interv Psychiatry 2019; 13:1424-1430. [PMID: 30740880 DOI: 10.1111/eip.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
AIM Early Intervention Psychosis Services (EIPS) for people experiencing First Episode Psychosis (FEP) offer important clinical and non-clinical benefits over standard care. Similarly, intervention for Clinical High Risk for Psychosis state (CHR-P) can prevent psychosis, ameliorate symptoms and have non-clinical benefits. This study aimed to estimate associated local economic benefits of FEP and CHR-P services compared with standard care. METHODS Across four south London boroughs, proportion of annual number of new cases of FEP and CHR-P seen by early intervention services was estimated. Economic modelling conducted for England's mental health strategy was applied to estimate local economic impacts of current and improved service provision. RESULTS Across four London boroughs during 2011/2012, proportion of 15-34 year olds with FEP seen by EIPS was 100.2% assuming 80/100 000 annual incidence whereas proportion with CHR-P seen by CHR-P services was 4.1% assuming 200/100 000 annual incidence. Application of economic modelling suggests that provision of EIPS to reach all new FEP cases each year would free up resources of £13.1m over 10 years including £2.0m to National Health Service (NHS) after the first year. Scaling up to reach all new CHR-P cases each year would free up resources of £19.7m over 10 years with an estimated 10-year cost of implementation gap for each 1 year cohort of £18.9m. An earlier related briefing resulted in increased funding for EIPS and new CHR-P services despite overall cuts to mental health services. CONCLUSIONS Estimation of local economic impacts of FEP and CHR-P services was associated with improved investment in such services.
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Affiliation(s)
- Jonathan Campion
- Psychosis Clinical Academic Group and Public Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Brain Sciences, University College London, London, UK
| | - Matthew J Taylor
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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30
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Pozza A, Dèttore D. Modular cognitive‐behavioral therapy for affective symptoms in young individuals at ultra‐high risk of first episode of psychosis: Randomized controlled trial. J Clin Psychol 2019; 76:392-405. [DOI: 10.1002/jclp.22901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Pozza
- Department of Health SciencesUniversity of FlorenceFlorence Italy
| | - Davide Dèttore
- Department of Health SciencesUniversity of FlorenceFlorence Italy
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31
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Worthington MA, Cao H, Cannon TD. Discovery and Validation of Prediction Algorithms for Psychosis in Youths at Clinical High Risk. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:738-747. [PMID: 31902580 DOI: 10.1016/j.bpsc.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 12/19/2022]
Abstract
In the past 2 to 3 decades, clinicians have used the clinical high risk for psychosis (CHR-P) paradigm to better understand factors that contribute to the onset of psychotic disorders. While this paradigm is useful to identify individuals at risk, the CHR-P criteria are not sufficient to predict outcomes from the CHR-P population. Because approximately 25% of the CHR-P population will ultimately convert to psychosis, more precise methods of prediction are needed to account for heterogeneity in both risk factors and outcomes in the CHR-P population. To this end, several groups in recent years have used data-driven approaches to refine predictive algorithms to predict both conversion to psychosis and functional outcomes. These models have generally used either clinical and behavioral data, including demographics and measures of symptom severity, neurocognitive functioning, and social functioning, or neuroimaging data, including structural and functional measures, to predict conversion to psychosis in CHR-P samples. This review focuses on the empirical models that have been derived within each of these lines of research and evaluates the performance and methodology of these models. This review also serves to inform best practices for data-driven approaches and directions moving forward to improve our prediction of psychotic disorders and associated outcomes. Because sample size is still the most critical consideration in the current models, we urge that algorithms to predict conversion be conducted using multisite data in order to obtain the power necessary to conclusively determine predictive accuracy without overfitting.
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Affiliation(s)
| | - Hengyi Cao
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut.
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32
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Fonseca-Pedrero E, Ortuño-Sierra J, Muñiz J, Bobes J. Latent profile analysis of psychosis liability in a community-derived sample of adolescents: Links with mental health difficulties, suicidal ideation, bipolar-like experiences and psychotic-like experiences. Early Interv Psychiatry 2019; 13:1111-1120. [PMID: 30311391 DOI: 10.1111/eip.12741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/04/2018] [Accepted: 09/09/2018] [Indexed: 12/29/2022]
Abstract
AIM The main goal of the present study was to explore the latent structure of schizotypy as an indicator of psychosis liability, in a community-derived sample of adolescents. Links to mental health difficulties, prosocial behaviour, suicidal ideation, bipolar-like experiences and psychotic-like experiences (PLEs) (severity and distress) were compared across schizotypy latent profiles. METHOD The present research included 1588 adolescents selected by a stratified random cluster sampling. The Oviedo Schizotypy Assessment Questionnaire (ESQUIZO-Q), The Paykel Suicide Scale (PSS), The Strengths and Difficulties Questionnaire (SDQ), The Prodromal Questionnaire-Brief (PQ-B), The Mood Disorder Questionnaire (MDQ), The Penn Matrix Reasoning Test (PMRT), The Family Affluence Scale-II (FAS-II), and The Oviedo Infrequency Scale (INF-OV) were used. RESULTS Using latent profile analysis four latent classes (LC) were identified: "Positive schizotypy" (14.1%, n = 224), "Low schizotypy" (51.9%, n = 825), "Social Disorganization schizotypy" (27.2%, n = 432), and "High schizotypy" (6.7%, n = 107). The "High schizotypy" class scored higher on several psychometric indicators of psychopathology (ie, mental health difficulties, suicide ideation, bipolar-like experiences and PLEs) relative to the other three LC. CONCLUSION Four groups of adolescents with different patterns of schizotypal traits and different clinical-pathological meaning were found. Deficits found across schizotypy latent profiles, resembling those found in patients with psychosis and ultra-high risk samples. The identification of homogeneous subgroups of adolescents potentially at risk for psychosis may help us in the prevention of psychotic-spectrum disorders and mental health problems.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - Javier Ortuño-Sierra
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - José Muñiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Department of Psychiatry, University of Oviedo, Oviedo, Spain
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33
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Beck K, Andreou C, Studerus E, Heitz U, Ittig S, Leanza L, Riecher-Rössler A. Clinical and functional long-term outcome of patients at clinical high risk (CHR) for psychosis without transition to psychosis: A systematic review. Schizophr Res 2019; 210:39-47. [PMID: 30651204 DOI: 10.1016/j.schres.2018.12.047] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/09/2018] [Accepted: 12/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on patients at clinical high risk (CHR) for psychosis has so far mainly focused on those with transition to frank psychosis (CHR-T patients). However, the majority of CHR patients do not transition (CHR-NT patients) and relatively little information is available on their clinical and functional outcome. METHODS We conducted a systematic review on clinical and functional long-term outcome of CHR-NT patients. Studies were included if they had an average follow-up period of at least 24 months and reported on long-term outcome of CHR-NT patients in one or more of the following domains: (non-)remission from CHR, prevalence of clinical symptoms and/or clinical diagnoses (axis I and II), and psychosocial functioning. RESULTS Ten publications from seven different single or multicenter studies with average follow-up durations of 2-7.5 years could be included. At the last follow-up assessment 28-71% of CHR-NT patients were not remitted from their CHR and 22-82% still had at least one clinical diagnosis. Approximately half of CHR-NT patients presented with poor psychosocial outcome at 2-year and 6-year follow-up. CONCLUSIONS The results suggest that, in the long-term, the majority of CHR-NT patients are not in full clinical remission and seem to suffer from one or more clinical disorders and psychosocial impairments. Since relatively few studies could be identified, further research is required to better understand the trajectories and clinical needs of CHR-NT patients.
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Affiliation(s)
- Katharina Beck
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Christina Andreou
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Erich Studerus
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Ulrike Heitz
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Sarah Ittig
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland
| | - Letizia Leanza
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland; University of Basel, Division of Clinical Psychology and Epidemiology, Department of Psychology, Basel, Switzerland
| | - Anita Riecher-Rössler
- University of Basel Psychiatric Hospital, Center for Gender Research and Early Detection, Basel, Switzerland.
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Peripheral levels of superoxide dismutase and glutathione peroxidase in youths in ultra-high risk for psychosis: a pilot study. CNS Spectr 2019; 24:333-337. [PMID: 29248027 DOI: 10.1017/s1092852917000803] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED IntroductionOxidative stress has been documented in chronic schizophrenia and in the first episode of psychosis, but there are very little data on oxidative stress prior to the disease onset. OBJECTIVE This work aimed to compare serum levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in young individuals at ultra-high risk (UHR) of developing psychosis with a comparison healthy control group (HC). METHODS Thirteen UHR subjects and 29 age- and sex-matched healthy controls (HC) were enrolled in this study. Clinical assessment included the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Semi-Structured Clinical Interview for DSM-IV Axis-I (SCID-I) or the Kiddie-SADS-Present and Lifetime Version (K-SADS-PL), and the Global Assessment of Functioning (GAF) scale. Activities of SOD and GPx were measured in serum by the spectrophotometric method using enzyme-linked immunosorbent assay kits. RESULTS After adjusting for age and years of education, there was a significant lower activity of SOD and lower GPX activity in the UHR group compared to the healthy control group (rate ratio [RR]=0.330, 95% CI 0.187; 0.584, p<0.001 and RR=0.509, 95% CI 0.323; 0.803, p=0.004, respectively). There were also positive correlations between GAF functioning scores and GPx and SOD activities. CONCLUSION Our results suggest that oxidative imbalances could be present prior to the onset of full-blown psychosis, including in at-risk stages. Future studies should replicate and expand these results.
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35
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Barajas A, Pelaez T, González O, Usall J, Iniesta R, Arteaga M, Jackson C, Baños I, Sánchez B, Dolz M, Obiols JE, Haro JM, Ochoa S, Arranz B, Arteaga M, Asensio R, Autonell J, Baños I, Bañuelos M, Barajas A, Barceló M, Blanc M, Borrás M, Busquets E, Carlson J, Carral V, Castro M, Corbacho C, Coromina M, Dachs I, De Miquel L, Dolz M, Domenech MD, Elias M, Espezel I, Falo E, Fargas A, Foix A, Fusté M, Godrid M, Gómez D, González O, Granell L, Gumà L, Haro JM, Herrera S, Huerta E, Lacasa F, Mas N, Martí L, Martínez R, Matalí J, Miñambres A, Muñoz D, Muñoz V, Nogueroles R, Ochoa S, Ortiz J, Pardo M, Planella M, Pelaez T, Peruzzi S, Rivero S, Rodriguez MJ, Rubio E, Sammut S, Sánchez M, Sánchez B, Serrano E, Solís C, Stephanotto C, Tabuenca P, Teba S, Torres A, Urbano D, Usall J, Vilaplana M, Villalta V. Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset. Early Interv Psychiatry 2019; 13:414-424. [PMID: 29116670 DOI: 10.1111/eip.12498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/16/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. AIM To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. METHODS Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. RESULTS Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. CONCLUSION In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.
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Affiliation(s)
- Ana Barajas
- Department of Research, Centre d'Higiene Mental Les Corts, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain.,Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain.,Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Trinidad Pelaez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Olga González
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Raquel Iniesta
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Maria Arteaga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Chris Jackson
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Iris Baños
- Fundació Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi E Obiols
- Department of Clinical and Psychology, School of Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Josep M Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | | | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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Kırlı U, Binbay T, Drukker M, Elbi H, Kayahan B, Keskin Gökçelli D, Özkınay F, Onay H, Alptekin K, van Os J. DSM outcomes of psychotic experiences and associated risk factors: 6-year follow-up study in a community-based sample. Psychol Med 2019; 49:1346-1356. [PMID: 30101737 DOI: 10.1017/s0033291718001964] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators. METHODS Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis. RESULTS In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness. CONCLUSION The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.
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Affiliation(s)
- Umut Kırlı
- Education and Research Hospital,Van,Turkey
| | - Tolga Binbay
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Marjan Drukker
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
| | - Hayriye Elbi
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | - Bülent Kayahan
- Faculty of Medicine, Department of Psychiatry,Ege University,35140, Izmir,Turkey
| | | | - Ferda Özkınay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Hüseyin Onay
- Faculty of Medicine,Department of Medical Genetics,Ege University,35140, Izmir,Turkey
| | - Köksal Alptekin
- Faculty of Medicine,Department of Psychiatry,Dokuz Eylül University,35340, Izmir,Turkey
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, School of Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network,PO Box 616, Vijverdal 6200 MD, Maastricht,The Netherlands
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Molteni S, Filosi E, Mensi MM, Spada G, Zandrini C, Ferro F, Paoletti M, Pichiecchio A, Bonoldi I, Balottin U. Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study. Front Psychiatry 2019; 10:787. [PMID: 31849719 PMCID: PMC6902080 DOI: 10.3389/fpsyt.2019.00787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 10/02/2019] [Indexed: 02/01/2023] Open
Abstract
In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder-Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.
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Affiliation(s)
- Silvia Molteni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eleonora Filosi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Martina Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Spada
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Chiara Zandrini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federica Ferro
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Paoletti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Ilaria Bonoldi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, United Kingdom
| | - Umberto Balottin
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Fonseca-Pedrero E, Ortuño-Sierra J, Inchausti F, Rodríguez-Testal JF, Debbané M. Beyond Clinical High-Risk State for Psychosis: The Network Structure of Multidimensional Psychosis Liability in Adolescents. Front Psychiatry 2019; 10:967. [PMID: 32116811 PMCID: PMC7026502 DOI: 10.3389/fpsyt.2019.00967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The main goal of the present study was to analyze the network structure of schizotypy dimensions in a representative sample of adolescents from the general population. Moreover, the network structure between schizotypy, mental health difficulties, subjective well-being, bipolar-like experiences, suicide ideation and behavior, psychotic-like experiences, positive and negative affect, prosocial behavior, and IQ was analyzed. METHOD The study was conducted in a sample of 1,506 students selected by stratified random cluster sampling. The Oviedo Schizotypy Assessment Questionnaire, the Personal Wellbeing Index-School Children, the Paykel Suicide Scale, the Mood Disorder Questionnaire, the Strengths and Difficulties Questionnaire, the Prodromal Questionnaire-Brief, the Positive and Negative Affect Schedule for Children Shortened Version, and the Matrix Reasoning Test were used. RESULTS The estimated schizotypy network was interconnected. The most central nodes in terms of standardized Expected Influence (EI) were 'unusual perceptual experiences' and 'paranoid ideation'. Predictability ranged from 8.7% ('physical anhedonia') to 52.7% ('unusual perceptual experiences'). The average predictability was 36.27%, implying that substantial variability remained unexplained. For the multidimensional psychosis liability network predictability values ranged from 9% (estimated IQ) to 74.90% ('psychotic-like experiences'). The average predictability was 43.46%. The results of the stability and accuracy analysis indicated that all networks were accurately estimated. CONCLUSIONS The present paper points to the value of conceptualizing psychosis liability as a dynamic complex system of interacting cognitive, emotional, behavioral, and affective characteristics. In addition, provide new insights into the nature of the relationships between schizotypy, as index of psychosis liability, and the role played by risk and protective factors.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - Javier Ortuño-Sierra
- Department of Educational Sciences, University of La Rioja, Logroño, Spain.,Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain
| | - Felix Inchausti
- Programa Riojano de Investigación en Salud Mental (PRISMA), Logroño, Spain.,Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Gonçalves AMN, Dantas CDR, Banzato CEM, Oda AMGR. A historical account of schizophrenia proneness categories from DSM-I to DSM-5 (1952-2013). REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2018. [DOI: 10.1590/1415-4714.2018v21n4p798.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The history of diagnostic classifications in psychiatry has been recognized as a privileged means of access to the vicissitudes inherent to the configuration of a scientific and professional field, also bringing significant contributions to conceptual history. We have taken as primary sources the five editions of the DSM (1952-2013) to examine the construction of diagnostic categories related to schizophrenia proneness, indicating the scientific and social contexts related to the development of DSM and psychiatry itself. Along this process we highlight the conditions of possibility for the emergence of the Attenuated Psychosis Syndrome, a highly controversial diagnostic proposal, in the elaboration of DSM-5. This proposal ended up being rejected not only on scientific grounds, but also because of feared unintended consequences.
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40
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Fonseca-Pedrero E, Inchausti F, Pérez-Albéniz A, Ortuño-Sierra J. Validation of the Prodromal Questionnaire-Brief in a representative sample of adolescents: Internal structure, norms, reliability, and links with psychopathology. Int J Methods Psychiatr Res 2018; 27:e1740. [PMID: 30198201 PMCID: PMC6877156 DOI: 10.1002/mpr.1740] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The main purpose of the present study was twofold: to validate the Prodromal Questionnaire-Brief (PQ-B) in a community-derived sample of adolescents and to examine the links between psychotic-like experiences and emotional and behavioral problems, prosocial behavior, suicidal ideation, and bipolar-like experiences. METHOD One thousand five hundred eighty-eight students selected by random sampling participated in a cross-sectional survey. The PQ-B, Paykel Suicide Scale, Strengths and Difficulties Questionnaire, Mood Disorder Questionnaire, Penn Matrix Reasoning Test, Family Affluence Scale-II, and Oviedo Infrequency Scale were used. RESULTS The unidimensional factorial structure of the PQ-B items showed adequate goodness of fit index. This model also showed configural and strong invariance across gender. The internal consistency of the PQ-B total frequency score was 0.92. A high degree of overlap was found between psychotic-like experiences and emotional and behavioral problems, suicidal ideation, and bipolar-like experiences. CONCLUSION The PQ-B is a brief, easy, and reliable tool for screening psychotic-like experiences in adolescents from the general population. The assessment of risk for psychosis and its relationship with other psychopathological risk factors in a close-in strategy or two-stage process model may help us to enhance the early identification for youths at heightened risk for serious mental disorders.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, La Rioja, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Asturias, Spain
| | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, La Rioja, Spain
| | - Alicia Pérez-Albéniz
- Department of Educational Sciences, University of La Rioja, Logroño, La Rioja, Spain
| | - Javier Ortuño-Sierra
- Department of Educational Sciences, University of La Rioja, Logroño, La Rioja, Spain
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Cratsley K. The Ethical and Empirical Status of Dimensional Diagnosis: Implications for Public Mental Health? NEUROETHICS-NETH 2018. [DOI: 10.1007/s12152-018-9390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fonseca-Pedrero E, Ortuño J, Debbané M, Chan RCK, Cicero D, Zhang LC, Brenner C, Barkus E, Linscott RJ, Kwapil T, Barrantes-Vidal N, Cohen A, Raine A, Compton MT, Tone EB, Suhr J, Inchausti F, Bobes J, Fumero A, Giakoumaki S, Tsaousis I, Preti A, Chmielewski M, Laloyaux J, Mechri A, Aymen Lahmar M, Wuthrich V, Larøi F, Badcock JC, Jablensky A, Isvoranu AM, Epskamp S, Fried EI. The Network Structure of Schizotypal Personality Traits. Schizophr Bull 2018; 44:S468-S479. [PMID: 29684178 PMCID: PMC6188518 DOI: 10.1093/schbul/sby044] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Elucidating schizotypal traits is important if we are to understand the various manifestations of psychosis spectrum liability and to reliably identify individuals at high risk for psychosis. The present study examined the network structures of (1) 9 schizotypal personality domains and (2) 74 individual schizotypal items, and (3) explored whether networks differed across gender and culture (North America vs China). The study was conducted in a sample of 27001 participants from 12 countries and 21 sites (M age = 22.12; SD = 6.28; 37.5% males). The Schizotypal Personality Questionnaire (SPQ) was used to assess 74 self-report items aggregated in 9 domains. We used network models to estimate conditional dependence relations among variables. In the domain-level network, schizotypal traits were strongly interconnected. Predictability (explained variance of each node) ranged from 31% (odd/magical beliefs) to 55% (constricted affect), with a mean of 43.7%. In the item-level network, variables showed relations both within and across domains, although within-domain associations were generally stronger. The average predictability of SPQ items was 27.8%. The network structures of men and women were similar (r = .74), node centrality was similar across networks (r = .90), as was connectivity (195.59 and 199.70, respectively). North American and Chinese participants networks showed lower similarity in terms of structure (r = 0.44), node centrality (r = 0.56), and connectivity (180.35 and 153.97, respectively). In sum, the present article points to the value of conceptualizing schizotypal personality as a complex system of interacting cognitive, emotional, and affective characteristics.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Javier Ortuño
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - David Cicero
- Department of Psychology, University of Hawaii at Manoa
| | - Lisa C Zhang
- Department of Psychology, University of British Columbia, Canada
| | - Colleen Brenner
- Department of Psychology, University of British Columbia, Canada
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Thomas Kwapil
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Cohen
- Department of Psychology, Louisiana State University, Louisiana, LA
| | - Adrian Raine
- Department of Criminology, University of Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
- Department of Psychology, University of Pennsylvania
| | | | - Erin B Tone
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Julie Suhr
- Department of Psychology, Ohio University Athens, OH
| | - Felix Inchausti
- Department of Medicine, University of Navarra, Pamplona, Spain
| | - Julio Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Axit Fumero
- Department of Psychology, University of La Laguna, Tenerife, Spain
| | | | | | | | | | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Anwar Mechri
- Psychiatry Department, University Hospital of Monastir, Monastir, Tunisia
| | | | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Adela M Isvoranu
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Sacha Epskamp
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Eiko I Fried
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
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Docherty AR, Fonseca-Pedrero E, Debbané M, Chan RCK, Linscott RJ, Jonas KG, Cicero DC, Green MJ, Simms LJ, Mason O, Watson D, Ettinger U, Waszczuk M, Rapp A, Grant P, Kotov R, DeYoung CG, Ruggero CJ, Eaton NR, Krueger RF, Patrick C, Hopwood C, O’Neill FA, Zald DH, Conway CC, Adkins DE, Waldman ID, van Os J, Sullivan PF, Anderson JS, Shabalin AA, Sponheim SR, Taylor SF, Grazioplene RG, Bacanu SA, Bigdeli TB, Haenschel C, Malaspina D, Gooding DC, Nicodemus K, Schultze-Lutter F, Barrantes-Vidal N, Mohr C, Carpenter WT, Cohen AS. Enhancing Psychosis-Spectrum Nosology Through an International Data Sharing Initiative. Schizophr Bull 2018; 44:S460-S467. [PMID: 29788473 PMCID: PMC6188505 DOI: 10.1093/schbul/sby059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The latent structure of schizotypy and psychosis-spectrum symptoms remains poorly understood. Furthermore, molecular genetic substrates are poorly defined, largely due to the substantial resources required to collect rich phenotypic data across diverse populations. Sample sizes of phenotypic studies are often insufficient for advanced structural equation modeling approaches. In the last 50 years, efforts in both psychiatry and psychological science have moved toward (1) a dimensional model of psychopathology (eg, the current Hierarchical Taxonomy of Psychopathology [HiTOP] initiative), (2) an integration of methods and measures across traits and units of analysis (eg, the RDoC initiative), and (3) powerful, impactful study designs maximizing sample size to detect subtle genomic variation relating to complex traits (the Psychiatric Genomics Consortium [PGC]). These movements are important to the future study of the psychosis spectrum, and to resolving heterogeneity with respect to instrument and population. The International Consortium of Schizotypy Research is composed of over 40 laboratories in 12 countries, and to date, members have compiled a body of schizotypy- and psychosis-related phenotype data from more than 30000 individuals. It has become apparent that compiling data into a protected, relational database and crowdsourcing analytic and data science expertise will result in significant enhancement of current research on the structure and biological substrates of the psychosis spectrum. The authors present a data-sharing infrastructure similar to that of the PGC, and a resource-sharing infrastructure similar to that of HiTOP. This report details the rationale and benefits of the phenotypic data collective and presents an open invitation for participation.
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Affiliation(s)
- Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT,Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA,To whom correspondence should be addressed; Department of Psychiatry, University of Utah School of Medicine, 501 Chipeta Way, Salt Lake City, UT 84110, US; tel: +1-801-213-6905, fax: +1-801-581-7109, e-mail:
| | | | - Martin Debbané
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK,Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, Chinese Academy of Sciences, Beijing, China
| | | | - Katherine G Jonas
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY
| | - Oliver Mason
- Department of Psychology, University of Surrey, Guildford, UK
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN
| | | | - Monika Waszczuk
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - Alexander Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Phillip Grant
- Department of Psychology, Justus-Liebig-University Giessen, Giessen, Germany,Technische Hochschule Mittelhessen, University of Applied Sciences, Giessen, Germany
| | - Roman Kotov
- Department of Psychiatry, Stony Brook School of Medicine, Stony Brook, NY
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | - Nicolas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | | | - F Anthony O’Neill
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, UK
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN,Department of Psychiatry, Vanderbilt University, Nashville, TN
| | | | - Daniel E Adkins
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT,Department of Sociology, University of Utah, Salt Lake City, UT
| | | | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands,King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK,Department of Psychiatry, Brain Center Rudolf Magnus Institute, University Medical Center, Utrecht, The Netherlands
| | - Patrick F Sullivan
- Department of Psychiatry, University of North Carolina—Chapel Hill, Chapel Hill, NC,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - John S Anderson
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Andrey A Shabalin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott R Sponheim
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | | | | | - Silviu A Bacanu
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Tim B Bigdeli
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, UK
| | | | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Diane C Gooding
- Department of Psychology, University of Wisconsin—Madison, Madison, WI
| | - Kristin Nicodemus
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Dusseldorf, Germany
| | - Neus Barrantes-Vidal
- Department of Clinical Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain,Centre for Biomedical Research, University of North Carolina at Greensboro, Greensboro, NC,Sant Pere Claver—Fundació Sanitària, Barcelona, Spain
| | - Christine Mohr
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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Fonseca-Pedrero E, Chan RCK, Debbané M, Cicero D, Zhang LC, Brenner C, Barkus E, Linscott RJ, Kwapil T, Barrantes-Vidal N, Cohen A, Raine A, Compton MT, Tone EB, Suhr J, Muñiz J, de Albéniz AP, Fumero A, Giakoumaki S, Tsaousis I, Preti A, Chmielewski M, Laloyaux J, Mechri A, Lahmar MA, Wuthrich V, Larøi F, Badcock JC, Jablensky A, Ortuño-Sierra J. Comparisons of schizotypal traits across 12 countries: Results from the International Consortium for Schizotypy Research. Schizophr Res 2018; 199:128-134. [PMID: 29567403 DOI: 10.1016/j.schres.2018.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 03/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizotypal traits are expressions of underlying vulnerability to psychotic disorders which have a potential impact on mental health status, neurocognition, quality of life, and daily functioning. To date, little research has examined epidemiologic landscape of schizotypal traits at the cross-national level. Our aim was to study the expression of schizotypal traits by sex, age, and country in a combined sample gathered from 12 countries. METHODS A total of 27,001 participants completed the Schizotypal Personality Questionnaire (SPQ). The mean age of participants was 22.12 (SD=6.28); 37.5% (n=10,126) were males. RESULTS Schizotypal traits varied according to sex, age, and country. Females scored higher than males in the positive dimension, whereas males scored higher in the disorganization dimension. By age, a significant decrease in the positive schizotypal traits was observed. Epidemiological expression of schizotypal traits varied by country. Moreover, several interactions by sex, age, and country were found. CONCLUSIONS This pattern is similar to those found in patients with psychosis and psychotic-like experiences. These findings provide new insights and the opportunity to explore the phenotypic expression of schizotypal traits at cross-national level.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Spain; Centro de Investigación en Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijng, China
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Department of Clinical, Educational and Health Psychology, University College London, UK
| | - David Cicero
- Department of Psychology, University of Hawaii at Manoa, USA
| | - Lisa C Zhang
- Department of Psychology, University of British Columbia, Canada
| | - Colleen Brenner
- Department of Psychology, University of British Columbia, Canada
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Thomas Kwapil
- Department of Psychology, University of North Carolina at Greensboro, USA
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain
| | - Alex Cohen
- Department of Psychology, Louisiana State University, USA
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, USA
| | | | - Erin B Tone
- Department of Psychology, Georgia State University, USA
| | - Julie Suhr
- Department of Psychology, Ohio University, USA
| | - José Muñiz
- Centro de Investigación en Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain; Department of Psychology, University of Oviedo, Spain
| | | | - Axit Fumero
- Department of Psychology, University of La Laguna, Spain
| | - Stella Giakoumaki
- Department of Psychology, University of Crete, Rethymno, Crete, Greece
| | - Ioannis Tsaousis
- Department of Psychology, University of Crete, Rethymno, Crete, Greece
| | | | | | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Anwar Mechri
- Psychiatry Department, University Hospital of Monastir Monastir, Tunisia
| | | | - Viviana Wuthrich
- Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Psychology and Neuroscience of Cognition Research Unit, Cognitive Psychopathology Unit, University of Liège, Liège, Belgium
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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Fonseca-Pedrero E, Ortuño-Sierra J, Lucas-Molina B, Debbané M, Chan RCK, Cicero DC, Zhang LC, Brenner C, Barkus E, Linscott RJ, Kwapil T, Barrantes-Vidal N, Cohen A, Raine A, Compton MT, Tone EB, Suhr J, Bobes J, Fumero A, Giakoumaki S, Tsaousis I, Preti A, Chmielewski M, Laloyaux J, Mechri A, Lahmar MA, Wuthrich V, Larøi F, Badcock JC, Jablensky A, Barron D, Swami V, Tran US, Voracek M. Brief assessment of schizotypal traits: A multinational study. Schizophr Res 2018; 197:182-191. [PMID: 29113776 DOI: 10.1016/j.schres.2017.10.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/28/2017] [Accepted: 10/29/2017] [Indexed: 11/27/2022]
Abstract
The Schizotypal Personality Questionnaire-Brief (SPQ-B) was developed with the aim of examining variations in healthy trait schizotypy, as well as latent vulnerability to psychotic-spectrum disorders. No previous study has studied the cross-cultural validity of the SPQ-B in a large cross-national sample. The main goal of the present study was to analyze the reliability and the internal structure of SPQ-B scores in a multinational sample of 28,426 participants recruited from 14 countries. The mean age was 22.63years (SD=7.08; range 16-68years), 37.7% (n=10,711) were men. The omega coefficients were high, ranging from 0.86 to 0.92 for the total sample. Confirmatory factor analysis revealed that SPQ-B items were grouped either in a theoretical structure of three first-order factors (Cognitive-Perceptual, Interpersonal, and Disorganized) or in a bifactor model (three first-order factors plus a general factor of schizotypal personality). In addition, the results supported configural but not strong measurement invariance of SPQ-B scores across samples. These findings provide new information about the factor structure of schizotypal personality, and support the validity and utility of the SPQ-B, a brief and easy tool for assessing self-reported schizotypal traits, in cross-national research. Theoretical and clinical implications for diagnostic systems, psychosis models, and cross-national mental health strategies are derived from these results.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Logroño, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
| | | | - Beatriz Lucas-Molina
- Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - David C Cicero
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Lisa C Zhang
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Brenner
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Thomas Kwapil
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Cohen
- Department of Psychology, Louisiana State University, Louisiana, LA, USA
| | - Adrian Raine
- Departments of Criminology, Psychiatry,and Psychology,University of Pennsylvania, Philadelphia, PA, USA
| | | | - Erin B Tone
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Julie Suhr
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
| | - Axit Fumero
- Department of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | | | | | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Anwar Mechri
- Psychiatry Department, University Hospital of Monastir, Monastir, Tunisia
| | | | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - David Barron
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia
| | - Viren Swami
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia; Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Ulrich S Tran
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
| | - Martin Voracek
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
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46
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Davies C, Radua J, Cipriani A, Stahl D, Provenzani U, McGuire P, Fusar-Poli P. Efficacy and Acceptability of Interventions for Attenuated Positive Psychotic Symptoms in Individuals at Clinical High Risk of Psychosis: A Network Meta-Analysis. Front Psychiatry 2018; 9:187. [PMID: 29946270 PMCID: PMC6005890 DOI: 10.3389/fpsyt.2018.00187] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Attenuated positive psychotic symptoms represent the defining features of the clinical high-risk for psychosis (CHR-P) criteria. The effectiveness of each available treatment for reducing attenuated positive psychotic symptoms remains undetermined. This network meta-analysis (NMA) investigates the consistency and magnitude of the effects of treatments on attenuated positive psychotic symptoms in CHR-P individuals, weighting the findings for acceptability. Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature were searched up to July 18, 2017. Randomized controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months; effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary outcome was treatment acceptability [reported as odds ratio (OR)]. NMAs were conducted for both primary and secondary outcomes. Treatments were cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity analyses and complementary pairwise meta-analyses for the primary outcome were also conducted. Results: Overall, 1,707 patients from 14 studies (57% male, mean age = 20) were included, representing the largest evidence synthesis of the effect of preventive treatments on attenuated positive psychotic symptoms to date. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD = -1.10, 95% CI -2.04 to -0.15), Cognitive Behavioral Therapy-French and Morrison protocol (CBT-F) + NBI (SMD = -1.03, 95% CI -2.05 to -0.01), and risperidone + CBT-F + NBI (SMD = -1.18, 95% CI -2.29 to -0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability, aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR = 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two studies had an overall low risk of bias. Conclusion: On the basis of the current literature, there is no robust evidence to favor any specific intervention for improving attenuated positive psychotic symptoms in CHR-P individuals.
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Affiliation(s)
- Cathy Davies
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- FIDMAG Germanes Hospitalàries, CIBERSAM, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Umberto Provenzani
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Institute for Health Research Maudsley Biomedical Research Centre, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- National Institute for Health Research Maudsley Biomedical Research Centre, London, United Kingdom
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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47
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McGorry PD, Hartmann JA, Spooner R, Nelson B. Beyond the "at risk mental state" concept: transitioning to transdiagnostic psychiatry. World Psychiatry 2018; 17:133-142. [PMID: 29856558 PMCID: PMC5980504 DOI: 10.1002/wps.20514] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The "at risk mental state" for psychosis approach has been a catalytic, highly productive research paradigm over the last 25 years. In this paper we review that paradigm and summarize its key lessons, which include the valence of this phenotype for future psychosis outcomes, but also for comorbid, persistent or incident non-psychotic disorders; and the evidence that onset of psychotic disorder can at least be delayed in ultra high risk (UHR) patients, and that some full-threshold psychotic disorder may emerge from risk states not captured by UHR criteria. The paradigm has also illuminated risk factors and mechanisms involved in psychosis onset. However, findings from this and related paradigms indicate the need to develop new identification and diagnostic strategies. These findings include the high prevalence and impact of mental disorders in young people, the limitations of current diagnostic systems and risk identification approaches, the diffuse and unstable symptom patterns in early stages, and their pluripotent, transdiagnostic trajectories. The approach we have recently adopted has been guided by the clinical staging model and adapts the original "at risk mental state" approach to encompass a broader range of inputs and output target syndromes. This approach is supported by a number of novel modelling and prediction strategies that acknowledge and reflect the dynamic nature of psychopathology, such as dynamical systems theory, network theory, and joint modelling. Importantly, a broader transdiagnostic approach and enhancing specific prediction (profiling or increasing precision) can be achieved concurrently. A holistic strategy can be developed that applies these new prediction approaches, as well as machine learning and iterative probabilistic multimodal models, to a blend of subjective psychological data, physical disturbances (e.g., EEG measures) and biomarkers (e.g., neuroinflammation, neural network abnormalities) acquired through fine-grained sequential or longitudinal assessments. This strategy could ultimately enhance our understanding and ability to predict the onset, early course and evolution of mental ill health, further opening pathways for preventive interventions.
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Affiliation(s)
- Patrick D. McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental HealthUniversity of MelbourneParkvilleAustralia
| | - Jessica A. Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental HealthUniversity of MelbourneParkvilleAustralia
| | - Rachael Spooner
- Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental HealthUniversity of MelbourneParkvilleAustralia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental HealthUniversity of MelbourneParkvilleAustralia
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48
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Tsujino N, Tagata H, Baba Y, Kojima A, Yamaguchi T, Katagiri N, Nemoto T, Mizuno M. Survey of recognition and treatment of at-risk mental state by Japanese psychiatrists. Psychiatry Clin Neurosci 2018; 72:391-398. [PMID: 29485233 DOI: 10.1111/pcn.12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Abstract
AIM The importance of early intervention in psychiatry is widely recognized among psychiatrists. However, it is unknown whether precise knowledge of at-risk mental state has been disseminated. With this survey, we aimed to reveal how Japanese psychiatrists diagnose patients with at-risk mental state and prescribe treatment strategies for them. METHODS Using fictional case vignettes, we conducted a questionnaire survey of psychiatrists (n = 1399) who worked in Tokyo. We mailed study documents to all eligible participants in November 2015 with a requested return date in December. RESULTS Two hundred and sixty (19.3%) psychiatrists responded to the survey. Their correct diagnosis rates for the patients in the at-risk mental state vignettes were low (14.6% for the vignette describing at-risk mental state with attenuated positive symptom syndrome; 13.1% for the vignette describing at-risk mental state with brief intermittent psychotic syndrome). Many psychiatrists selected pharmacotherapy and antipsychotics to treat patients in the at-risk mental state vignettes. The psychiatrists who correctly diagnosed patients in the at-risk mental state vignettes had significantly fewer years of clinical psychiatric experience than did those who diagnosed them as having a non-at-risk mental state (12.5 years vs 22.7 years for the vignette describing at-risk mental state with attenuated positive symptom syndrome, P < 0.01; 14.3 years vs 22.2 years for the vignette describing at-risk mental state with brief intermittent psychotic syndrome, P < 0.01). CONCLUSION This study suggests that precise knowledge of at-risk mental state has not been disseminated among Japanese psychiatrists.
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Affiliation(s)
- Naohisa Tsujino
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Yoko Baba
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Akiko Kojima
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Taiju Yamaguchi
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
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49
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Masillo A, Brandizzi M, Valmaggia LR, Saba R, Lo Cascio N, Lindau JF, Telesforo L, Venturini P, Montanaro D, Di Pietro D, D'Alema M, Girardi P, Fiori Nastro P. Interpersonal sensitivity and persistent attenuated psychotic symptoms in adolescence. Eur Child Adolesc Psychiatry 2018; 27:309-318. [PMID: 28918440 DOI: 10.1007/s00787-017-1047-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
Abstract
Interpersonal sensitivity defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. Interpersonal sensitivity was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of interpersonal sensitivity at baseline are associated with the persistence of attenuated positive psychotic symptoms and general psychopathology at 18-month follow-up. A sample of 85 help-seeking individuals (mean age = 16.6, SD = 5.05) referred an Italian early detection project, completed the interpersonal sensitivity measure and the structured interview for prodromal symptoms (SIPS) at baseline and were assessed at 18-month follow-up using the SIPS. Results showed that individuals with high level of interpersonal sensitivity at baseline reported high level of attenuated positive psychotic symptoms (i.e., unusual thought content) and general symptoms (i.e., depression, irritability and low tolerance to daily stress) at follow-up. This study suggests that being "hypersensitive" to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms and general symptoms, such as depression and irritability, at 18-month follow-up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms.
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Affiliation(s)
- Alice Masillo
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy.
| | - M Brandizzi
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - R Saba
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - N Lo Cascio
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - J F Lindau
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Venturini
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - D Montanaro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - D Di Pietro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - M D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - P Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Fiori Nastro
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
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50
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Woods SW, Powers AR, Taylor JH, Davidson CA, Johannesen JK, Addington J, Perkins DO, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Seidman LJ, Tsuang MT, Walker EF, McGlashan TH. Lack of Diagnostic Pluripotentiality in Patients at Clinical High Risk for Psychosis: Specificity of Comorbidity Persistence and Search for Pluripotential Subgroups. Schizophr Bull 2018; 44:254-263. [PMID: 29036402 PMCID: PMC5814797 DOI: 10.1093/schbul/sbx138] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
More than 20 years after the clinical high risk syndrome for psychosis (CHR) was first articulated, it remains controversial whether the CHR syndrome predicts onset of psychosis with diagnostic specificity or predicts pluripotential diagnostic outcomes. Recently, analyses of observational studies, however, have suggested that the CHR syndrome is not pluripotential for emergent diagnostic outcomes. The present report conducted additional analyses in previously reported samples to determine (1) whether comorbid disorders were more likely to persist in CHR patients compared to a comparison group of patients who responded to CHR recruitment efforts but did not meet criteria, termed help-seeking comparison subjects (HSC); and (2) whether clinically defined pluripotential CHR subgroups could be identified. All data were derived from 2 multisite studies in which DSM-IV structured diagnostic interviews were conducted at baseline and at 6-month intervals. Across samples we observed persistence of any nonpsychotic disorder in 80/147 CHR cases (54.4%) and in 48/84 HSC cases (57.1%, n.s.). Findings with persistence of anxiety, depressive, and bipolar disorders considered separately were similar. Efforts to discover pluripotential CHR subgroups were unsuccessful. These findings add additional support to the view that the CHR syndrome is not pluripotential for predicting various diagnostic outcomes but rather is specific for predicting emergent psychosis.
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Affiliation(s)
- Scott W Woods
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT
| | - Albert R Powers
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT
| | - Jerome H Taylor
- Child Study Center, Yale University, New Haven, CT.,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Charlie A Davidson
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT.,Department of Psychology, Emory University, Atlanta, GA.,Department of Psychiatry, Emory University, Atlanta, GA
| | - Jason K Johannesen
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Carrie E Bearden
- Department of Psychology, UCLA, Los Angeles, CA.,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT.,Department of Psychiatry, Yale University, New Haven, CT
| | | | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA.,Department of Psychiatry, Emory University, Atlanta, GA
| | - Thomas H McGlashan
- Connecticut Mental Health Center, Department of Psychiatry, Yale University, New Haven, CT
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