1
|
Ku B, Yuan Q, Christensen GM, Dimitrov L, Risk B, Huels A. Exposure profiles of social-environmental neighborhood factors and psychotic-like experiences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.21.24312315. [PMID: 39228699 PMCID: PMC11370530 DOI: 10.1101/2024.08.21.24312315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Importance Recent research has demonstrated that domains of social determinants of health (SDOH) (e.g., air pollution and social context) are associated with psychosis. However, SDOHs have often been studied in isolation. Objective To identify distinct exposure profiles, estimate their associations with persistent distressing psychotic-like experiences (PLE), and evaluate whether involvement with physical activities partially explains this association. Design Setting and Participants This population-based study used data from the Adolescent Brain and Cognitive Development (ABCD) Study. Participants were recruited from 22 US sites between September 2016 and January 2022. Data from baseline and three follow-ups were included. Exposures Area-level geocoded variables spanning various domains of SDOH, including socioeconomic status (SES), education, crime, built environment, social context, and crime, were clustered using a self-organizing map method to identify exposure profiles. Main Outcomes and Measures Persistent distressing PLE was derived from the Prodromal Questionnaire-Brief Child Version across four years. Generalized linear mixed modeling tested the association between exposure profiles and persistent distressing PLE as well as physical activities (i.e., team and individual sports), adjusting for individual-level covariates including age, sex, race/ethnicity, highest level of parent education, family-relatedness, and study sites. Results Among 8,145 participants (baseline mean [SD] age, 9.92 [0.63] years; 3,868 (47.5%) females; 5,566 (68.3%) White, 956 (11.7%) Black, 159 (2.0%) Asian, and 1,480 (18.4%) Hispanic participants), five exposure profiles were identified. Compared to the reference Profile 1 (suburban affluent areas, 2521 children, 30.9%), Profile 3 (rural areas with low walkability and high ozone; 1459 children, 17.9%; adjusted OR: 1.34, 95% CI: 1.09-1.64) and Profile 4 (urban areas with high SES deprivation, high crime, and high pollution; 715 children, 8.8%; adjusted OR: 1.40, 95% CI: 1.08-1.81), were associated with persistent distressing PLE. Team sports mediated 6.14% of the association for Profile 3. Conclusion and Relevance This study found that neighborhoods characterized by rural areas with low walkability and urban areas with high socioeconomic deprivation, air pollutants, and crime were associated with persistent distressing PLE. Further research is needed to explore the pathways through which different environmental factors may impact the development of psychosis.
Collapse
|
2
|
Walker EF, Aberizk K, Yuan E, Bilgrami Z, Ku BS, Guest RM. Developmental perspectives on the origins of psychotic disorders: The need for a transdiagnostic approach. Dev Psychopathol 2024:1-11. [PMID: 38406831 PMCID: PMC11345878 DOI: 10.1017/s0954579424000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Research on serious mental disorders, particularly psychosis, has revealed highly variable symptom profiles and developmental trajectories prior to illness-onset. As Dante Cicchetti pointed out decades before the term "transdiagnostic" was widely used, the pathways to psychopathology emerge in a system involving equifinality and multifinality. Like most other psychological disorders, psychosis is associated with multiple domains of risk factors, both genetic and environmental, and there are many transdiagnostic developmental pathways that can lead to psychotic syndromes. In this article, we discuss our current understanding of heterogeneity in the etiology of psychosis and its implications for approaches to conceptualizing etiology and research. We highlight the need for examining risk factors at multiple levels and to increase the emphasis on transdiagnostic developmental trajectories as a key variable associated with etiologic subtypes. This will be increasingly feasible now that large, longitudinal datasets are becoming available and researchers have access to more sophisticated analytic tools, such as machine learning, which can identify more homogenous subtypes with the ultimate goal of enhancing options for treatment and preventive intervention.
Collapse
Affiliation(s)
- Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Katrina Aberizk
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Emerald Yuan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Zarina Bilgrami
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, GA, USA
| |
Collapse
|
3
|
Cullen AE, Labad J, Oliver D, Al-Diwani A, Minichino A, Fusar-Poli P. The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence. Curr Neuropharmacol 2024; 22:350-377. [PMID: 36946486 PMCID: PMC10845079 DOI: 10.2174/1570159x21666230322145049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 03/23/2023] Open
Abstract
Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.
Collapse
Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Javier Labad
- CIBERSAM, Sabadell, Barcelona, Spain
- Department of Mental Health and Addictions, Consorci Sanitari del Maresme, Mataró, Spain
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Adam Al-Diwani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Amedeo Minichino
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Musci RJ, Kush JM, Masyn KE, Esmaeili MA, Susukida R, Goulter N, McMahon R, Eddy JM, Ialongo NS, Tolan P, Godwin J, Wilcox HC. Psychosis Symptom Trajectories Across Childhood and Adolescence in Three Longitudinal Studies: An Integrative Data Analysis with Mixture Modeling. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1636-1647. [PMID: 37615885 DOI: 10.1007/s11121-023-01581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
Psychotic-like experiences (PLEs) are common throughout childhood, and the presence of these experiences is a significant risk factor for poor mental health later in development. Given the association of PLEs with a broad number of mental health diagnoses, these experiences serve as an important malleable target for early preventive interventions. However, little is known about these experiences across childhood. While these experiences may be common, longitudinal measurement in non-clinical settings is not. Therefore, in order to explore longitudinal trajectories of PLEs in childhood, we harmonized three school-based randomized control trials with longitudinal follow-up to identify heterogeneity in trajectories of these experiences. In an integrative data analysis (IDA) using growth mixture modeling, we identified three latent trajectory classes. One trajectory class was characterized by persistent PLEs, one was characterized by high initial probabilities but improving across the analytic period, and one was characterized by no reports of PLEs. Compared to the class without PLEs, those in the improving class were more likely to be male and have higher levels of aggressive and disruptive behavior at baseline. In addition to the substantive impact this work has on PLE research, we also discuss the methodological innovation as it relates to IDA. This IDA demonstrates the complexity of pooling data across multiple studies to estimate longitudinal mixture models.
Collapse
Affiliation(s)
- Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA.
| | - Joseph M Kush
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA
| | - Katherine E Masyn
- Division of Epidemiology and Biostatistics, School of Public, Health George State University, Atlanta, GA, USA
| | - Masoumeh Amin Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA
| | - Natalie Goulter
- Department of Psychology, Simon Fraser University and B.C. Children's Hospital Research Institute, Burnaby, BC, Canada
| | - Robert McMahon
- Department of Psychology, Simon Fraser University and B.C. Children's Hospital Research Institute, Burnaby, BC, Canada
| | - J Mark Eddy
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA
| | - Patrick Tolan
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Jennifer Godwin
- Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 331, Baltimore, MD, 21205, USA
| |
Collapse
|
5
|
Rinaldi G, Osman N, Kaess M, Schimmelmann BG, Kindler J, Schultze-Lutter F, Michel C. Exploring the complex relationships between coping strategies, locus of control and self-esteem with psychopathology: structural equation modeling with a special focus on clinical high-risk of psychosis. Eur Psychiatry 2023; 66:e88. [PMID: 37848406 PMCID: PMC10755569 DOI: 10.1192/j.eurpsy.2023.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Coping strategies, competence, and locus of control (LOC) beliefs are important predictors of mental health (MH). However, research into their complex interactions has produced mixed results. Our study investigated them further in the previously unexplored context of clinical high-risk (CHR) of psychosis. METHODS We tested six alternative structural equation models in a community sample (N = 523), hypothesizing a mediating role of coping and treating CHR symptoms as (i) an additional mediator or (ii) a specific outcome. Our measurement model included two latent factors of MH: (1) psychopathology (PP), consisting of presence of mental disorders, global and psychosocial functioning, and (2) self-rated health (SRH) status. RESULTS In the model with the best Akaike Information Criterion and the latent factors as outcome variables, maladaptive coping completely mediated the impact of maladaptive LOC on PP and SRH. Additionally, CHR symptoms partially mediated the effect of maladaptive coping on PP and SRH in the community sample, as long as sex was not entered into the model. In the clinical sample (N = 371), the model did not support a mediation by CHR symptoms, despite significant pathways with both coping and MH outcomes; further, competence beliefs directly impacted SRH. CONCLUSIONS Coping strategies are an important intervention target for MH promotion, especially in the community. In clinical populations, interventions focusing on coping strategies may improve CHR symptoms, thus potentially supporting better MH, especially SRH. Additionally, due to their mostly cascading effects on MH, improving competence and LOC beliefs may also promote psychological well-being.
Collapse
Affiliation(s)
- Giulia Rinaldi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
6
|
Austin SF, Hastrup LH, van Os J, Simonsen E. Psychotic experiences and mental health outcomes in the general population: The Lolland-Falster Health Study. Schizophr Res 2023; 260:85-91. [PMID: 37633127 DOI: 10.1016/j.schres.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200 Slagelse, Denmark; Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
| | - Jim van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Psychosis Studies and King's Health Partners, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Erik Simonsen
- Mental Health Services, East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Hosseini SR, Nooripour R, Ghanbari N, Firoozabadi A, Peters E. Evaluation of reliability and validity of the Persian version of Peters et al. delusions inventory (PDI-40) in iranian non-clinical and clinical samples. BMC Psychol 2023; 11:294. [PMID: 37759258 PMCID: PMC10537839 DOI: 10.1186/s40359-023-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Some individuals may manifest psychotic symptoms that do not fulfill the requisite clinical criteria for a formal diagnosis of psychosis. The assessment of susceptibility to delusions, encompassing both clinical and non-clinical cohorts, frequently makes use of the Peters et al. Delusions Inventory (PDI-40). This study aimed to evaluate the reliability and validity of the Persian version of Peters et al. Delusions Inventory (PDI-40) in Iranian non-clinical and clinical samples. METHODS The present study employed a cross-sectional, correlational design in 2020. A total of 1402 Iranian participants were recruited for the study, which consisted of three distinct stages. The first stage involved an Exploratory Factor Analysis (EFA) conducted on a non-clinical sample of 512 participants. The second stage comprising different non-clinical sample 764 participants to perform a Confirmatory Factor Analysis (CFA). In the third stage, a clinical sample of 126 psychotic patients was compared to a non-clinical sample. All participants completed the PDI-40, the Community Assessment of Psychotic Experiences (CAPE-42), and the Depression, Anxiety, and Stress Scale (DASS-21). The internal structure of PDI-40 was examined through the analysis of its factor structure using LISREL 8.8. RESULTS The EFA analysis unveiled nine components within Persian version of PDI-40. The CFA analysis demonstrated an excellent fit of the nine-factor structure of Persian PDI-40 to the data. The total score exhibited high internal reliability, as indicated by Cronbach's alpha coefficient of 0.92. Moreover, Persian PDI-40 exhibited satisfactory evidence of convergent validity, as significant correlations were observed between dimensions of PDI-40 and subscales of CAPE-42 and DASS-21. Lastly, findings indicated that psychotic participants scored higher than non-clinical participants in all components of the PDI-40(p < 0.05). CONCLUSION Persian version of the PDI-40 demonstrates strong reliability and validity for assessing delusion proneness in both non-clinical and clinical samples in Iran. The observed distinctions between psychotic and non-clinical participants underscore its potential as a valuable tool for discerning delusion proneness in diverse contexts.
Collapse
Affiliation(s)
- Seyed Ruhollah Hosseini
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Roghieh Nooripour
- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran
| | - Nikzad Ghanbari
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Shahid Beheshti University, Tehran, Iran
| | - Abbas Firoozabadi
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
8
|
Hinterbuchinger B, Koch M, Trimmel M, Litvan Z, Baumgartner J, Meyer EL, Friedrich F, Mossaheb N. Psychotic-like experiences in non-clinical subgroups with and without specific beliefs. BMC Psychiatry 2023; 23:397. [PMID: 37270507 DOI: 10.1186/s12888-023-04876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/16/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Assuming a transdiagnostic and extended psychosis phenotype, psychotic-like experiences (PLEs) and psychotic symptoms are on a phenomenological and temporal continuum between clinical and non-clinical populations. Recent research points towards differences in PLE proneness in different subgroups and clinical impact of different PLE subtypes. This study examines the prevalence of PLEs in three groups of individuals with and without specific sets of beliefs aiming to elucidate the question whether proneness to PLEs varies according to traditional versus less traditional supernatural beliefs. METHODS The anonymized 16-item version of the Prodromal Questionnaire (PQ-16) was used to assess PLEs in three groups including individuals with religious beliefs (RB), belief in esoterism and paranormal phenomena (EB), and those embedded in scientific evidence approach and scepticism towards para-scientific theories (non-believers, NB). Male and female participants between 18 and 90 years were eligible for participation. RESULTS The sample comprised 159 individuals including 41 RB individuals, 43 EB individuals, and 75 NB individuals. The mean PQ-16 score of the EB individuals (6.86 ± 4.13) was significantly higher compared to NB individuals (3.43 ± 2.99) and to RB individuals (3.38 ± 3.23) with almost twice the score (both p-values < 0.001). There was no significant difference between the PQ-16 scores of the NB group and the RB group (p = 0.935). No significant impact of age (p = 0.330) and gender (p = 0.061) was found on the PQ16-Score. Group affiliation to esoterism was associated with a higher PQ-16 score compared to group affiliation to religious beliefs (p < 0.001) and group affiliation to scepticism (p = 0.011), while the latter two did not differ significantly (p = 0.735). No significant difference was found between the three groups in the degree of distress related to the affirmatively answered PQ-16 items (p = 0.74). CONCLUSION Under the assumption of a transdiagnostic psychosis phenotype, our findings provide more insight which subgroups within non-clinical samples have a higher likelihood of reporting PLEs.
Collapse
Affiliation(s)
- B Hinterbuchinger
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - M Koch
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Trimmel
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Z Litvan
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Baumgartner
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - E L Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, 1090, Vienna, Austria
| | - F Friedrich
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
9
|
Marr C, Gaskin C, Kasinathan J, Kaye S, Singh Y, Dean K. The prevalence of mental illness in young people in custody over time: a comparison of three surveys in New South Wales. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2023; 31:235-253. [PMID: 38628250 PMCID: PMC11018085 DOI: 10.1080/13218719.2023.2192257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/09/2023] [Indexed: 04/19/2024]
Abstract
Few studies have examined the prevalence of mental illness in young people over time within the same jurisdiction. In the current study, we compared data from three large surveys of youth in custody in New South Wales, conducted in 2003, 2009 and 2015. We examined rates of mental illness, self-harm and suicidal behaviours, substance use and childhood trauma and found little consistent change over time, though some fluctuations were observed regarding certain mental illnesses and substance use. We also descriptively compared findings with observed rates for the general population and found that young people in custody showed higher levels of all examined variables. In sum, these data suggest little improvement in the well-being of young people in custody in New South Wales over time. Better identification and treatment of these issues are vital if young people are to be prevented from becoming enmeshed in the criminal justice system.
Collapse
Affiliation(s)
- Carey Marr
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
| | - Claire Gaskin
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - John Kasinathan
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - Sharlene Kaye
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Yolisha Singh
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| | - Kimberlie Dean
- School of Clinical Medicine, Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW, Australia
- Justice Health and Forensic Mental Health Network, University of New South Wales, Randwick, NSW, Australia
| |
Collapse
|
10
|
Tomita Y, Suzuki K, Yamasaki S, Toriumi K, Miyashita M, Ando S, Endo K, Yoshikawa A, Tabata K, Usami S, Hiraiwa-Hasegawa M, Itokawa M, Kawaji H, Kasai K, Nishida A, Arai M. Urinary exosomal microRNAs as predictive biomarkers for persistent psychotic-like experiences. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:14. [PMID: 36906656 PMCID: PMC10008540 DOI: 10.1038/s41537-023-00340-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Psychotic-like experiences (PLEs) occur occasionally in adolescence and mostly disappear with increasing age. Their presence, if persistent, is considered a robust risk factor for subsequent psychiatric disorders. To date, only a few biological markers have been investigated for persistent PLE prediction. This study identified urinary exosomal microRNAs that can serve as predictive biomarkers for persistent PLEs. This study was part of a population-based biomarker subsample study of the Tokyo Teen Cohort Study. A total of 345 participants aged 13 (baseline) and 14 (follow-up) years underwent PLE assessments by experienced psychiatrists using semi-structured interviews. We defined remitted and persistent PLEs based on longitudinal profiles. We obtained urine at baseline and the expression levels of urinary exosomal miRNAs were compared between 15 individuals with persistent PLEs and 15 age- and sex-matched individuals with remitted PLEs. We constructed a logistic regression model to examine whether miRNA expression levels could predict persistent PLEs. We identified six significant differentially expressed microRNAs, namely hsa-miR-486-5p, hsa-miR-199a-3p, hsa-miR-144-5p, hsa-miR-451a, hsa-miR-143-3p, and hsa-miR-142-3p. The predictive model showed an area under the curve of 0.860 (95% confidence interval: 0.713-0.993) for five-fold cross-validation. We found a subset of urinary exosomal microRNAs that were differentially expressed in persistent PLEs and presented the likelihood that a microRNA-based statistical model could predict them with high accuracy. Therefore, urine exosomal miRNAs may serve as novel biomarkers for the risk of psychiatric disorders.
Collapse
Affiliation(s)
- Yasufumi Tomita
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Suzuki
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Community Mental Health, Shinshu University School of Medicine, Matsumoto, Japan
| | - Syudo Yamasaki
- Unit for Mental Health Promotion, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuya Toriumi
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Unit for Mental Health Promotion, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Endo
- Unit for Mental Health Promotion, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Akane Yoshikawa
- Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichi Tabata
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoshi Usami
- Center for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- Department of Evolutionary Studies of Biosystems, The Graduate University for the Advanced Studies, SOKENDAI, Hayama, Japan
| | - Masanari Itokawa
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Hideya Kawaji
- Research Center for Genome & Medical Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, University of Tokyo, Tokyo, Japan
| | - Atsushi Nishida
- Unit for Mental Health Promotion, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Makoto Arai
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| |
Collapse
|
11
|
Tandon R. Computational psychiatry and the psychopathology of psychosis: Promising leads and blind alleys. Schizophr Res 2023; 254:143-145. [PMID: 36889180 DOI: 10.1016/j.schres.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI, United States of America.
| |
Collapse
|
12
|
Staines L, Healy C, Coughlan H, Clarke M, Kelleher I, Cotter D, Cannon M. Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions. Psychol Med 2022; 52:1-12. [PMID: 36004805 PMCID: PMC9772919 DOI: 10.1017/s0033291722002550] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/31/2022]
Abstract
Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.
Collapse
Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College, Dublin 4, Ireland
- Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin 6, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| |
Collapse
|
13
|
Karcher NR. Psychotic-like experiences in childhood and early adolescence: Clarifying the construct and future directions. Schizophr Res 2022; 246:205-206. [PMID: 35809352 PMCID: PMC10387228 DOI: 10.1016/j.schres.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Nicole R Karcher
- Washington University in St. Louis School of Medicine, United States of America.
| |
Collapse
|
14
|
Schultze-Lutter F, Walger P, Franscini M, Traber-Walker N, Osman N, Walger H, Schimmelmann BG, Flückiger R, Michel C. Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis. World J Psychiatry 2022; 12:425-449. [PMID: 35433326 PMCID: PMC8968502 DOI: 10.5498/wjp.v12.i3.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In children and adolescents compared to adults, clinical high-risk of psychosis (CHR) criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant. Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were: (1) Pluripotential; (2) A transdiagnostic risk factor; and (3) Simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.
AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.
METHODS In the mainly cross-sectional examinations, 8–17-year-old community subjects (n = 233) randomly chosen from the population register of the Swiss Canton Bern, and inpatients (n = 306) with primary diagnosis of attention-deficit/hyperactivity disorder (n = 86), eating disorder (n = 97), anxiety including obsessive–compulsive disorder (n = 94), or autism spectrum disorder (n = 29), not clinically suspected to develop psychosis, were examined for CHR symptoms/criteria. Positive items of the Structured Interview for Psychosis-Risk Syndromes (SIPS) were used to assess the symptomatic ultra-high-risk criteria, and the Schizophrenia Proneness Instrument, Child and Youth version (SPI-CY) was used to assess the 14 basic symptoms relevant to basic symptom criteria. We examined group differences in frequency and severity of CHR symptoms/criteria using χ2 tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes, and their association with functioning using correlation analyses.
RESULTS The 7.3% prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5% rate in inpatients. Frequency and severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS [χ2 (4) = 9.425; P = 0.051, Cramer’s V = 0.132; and Z = -4.281, P < 0.001; Rosenthal’s r = 0.184], and thought pressure [χ2 (4) = 11.019; P = 0.026, Cramer’s V = 0.143; and Z = -2.639, P = 0.008; Rosenthal’s r = 0.114], derealization [χ2 (4) = 32.380; P < 0.001, Cramer’s V = 0.245; and Z = -3.924, P < 0.001; Rosenthal’s r = 0.169] and visual perception disturbances [χ2 (4) = 10.652; P = 0.031, Cramer’s V = 0.141; and Z = -2.822, P = 0.005; Rosenthal’s r = 0.122] of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients, in particular in those with eating, anxiety/obsessive–compulsive and autism spectrum disorders. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest correlation yielded for suspiciousness/persecutory ideas (Kendall’s tau = -0.172, P < 0.001).
CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity.
Collapse
Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya 60286, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Petra Walger
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich 8032, Germany
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf 40629, North-Rhine Westphalia, Germany
| | - Helene Walger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich 80336, Bavaria, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland
| |
Collapse
|
15
|
Cortisol Levels in Childhood Associated With Emergence of Attenuated Psychotic Symptoms in Early Adulthood. Biol Psychiatry 2022; 91:226-235. [PMID: 34715990 PMCID: PMC7612877 DOI: 10.1016/j.biopsych.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In individuals at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. This study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms. METHODS A sample of children (N = 109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire. RESULTS Diurnal cortisol (β = 0.915, 95% CI: 0.062-1.769) and daily stressors (β = 0.379, 95% CI: 0.034-0.723) at T1 were independently associated with total Prodromal Questionnaire scores at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between T1 diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081-1.405), with the highest predicted T2 total Prodromal Questionnaire scores occurring when both diurnal cortisol and daily stressors were increased. CONCLUSIONS Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasize the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time periods.
Collapse
|
16
|
Sun M, Wang D, Jing L, Yang N, Zhu R, Wang J, Chen X, Zhou L. Comparisons between self-reported and interview-verified psychotic-like experiences in adolescents. Early Interv Psychiatry 2022; 16:69-77. [PMID: 33590730 DOI: 10.1111/eip.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Abstract
AIM The 15-item positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15) has been widely used for measuring self-reported psychotic-like experiences (PLEs). However, its validity has not been well established. This study aimed to explore the consistency of self-reported PLEs (PLEs-S) and interview-verified PLEs (PLEs-I) based on the same items of the CAPE-P15. METHODS A total of 1255 college students completed the CAPE-P15 for measuring lifetime and current PLEs. Half of the students with high-risk scores and 5% of the rest were interviewed through telephone. Telephone interviews were based on the items of the CAPE-P15 using the symptom criteria for attenuated positive symptom syndrome. RESULTS When considering the presence of PLEs only, all κ values and correspondence rates (CRs) fell below the thresholds. However, there was adequate consistency for lifetime PLEs when associated distress was also considered in self-report (κ = .432, CR = 90.0%). Among three factors, only bizarre experiences (BEs) showed adequate diagnostic accuracy in detecting lifetime PLEs when combined with distress. Cut-off points of 1.30 (sensitivity of 89.2% and specificity of 92.3%) and 1.57 (sensitivity of 79.2% and specificity of 73.8%) for frequency scores were found to best identify genuine PLEs during lifetime and in the past month, respectively. CONCLUSIONS Although the validity of the CAPE-P15 for genuine PLEs is unsatisfactory, the scale showed much better diagnostic accuracy when combined with associated distress, especially for detecting lifetime PLEs. Self-report items on BEs may be more sensitive and specific when identifying PLEs in late adolescence.
Collapse
Affiliation(s)
- Meng Sun
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dongfang Wang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, School of Psychology, South China Normal University, Guangzhou, China
| | - Ling Jing
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ning Yang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Rongting Zhu
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jiali Wang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaodong Chen
- Department of Chronic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| |
Collapse
|
17
|
Feyaerts J, Henriksen MG, Vanheule S, Myin-Germeys I, Sass LA. Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. Lancet Psychiatry 2021; 8:237-249. [PMID: 33485408 DOI: 10.1016/s2215-0366(20)30460-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Delusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice.
Collapse
Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Mads G Henriksen
- Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark; Mental Health Center Amager, Copenhagen, Denmark; Mental Health Center Glostrup, Brøndbyvester, Denmark
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Louis A Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| |
Collapse
|
18
|
Stainton A, Chisholm K, Woodall T, Hallett D, Reniers RLEP, Lin A, Wood SJ. Gender differences in the experience of psychotic-like experiences and their associated factors: A study of adolescents from the general population. Schizophr Res 2021; 228:410-416. [PMID: 33556674 DOI: 10.1016/j.schres.2021.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
"Psychotic-Like Experiences" (PLEs) are common in the general population. While they are usually transient and resolve spontaneously, they can be distressing and signify increased risk for later psychosis or other psychopathology. It is important to investigate factors associated with PLEs which could be targeted to reduce their prevalence and impact. Males and females are known to experience PLEs differently, but any gender differences in the relationships between PLEs and other, potentially targetable, factors are currently unknown. 302 adolescents (175 females, mean age = 16.03, SD = 0.75; 127 males, mean age = 16.09, SD = 0.74) from secondary schools in the West Midlands region of the UK completed baseline self-report measures of positive PLEs, measured by the Community Assessment of Psychic Experiences (CAPE-P), and several potentially related factors including: cannabis use, perceived stress, anxiety, depression, and daily hassles. PLEs were common in this sample, with 67.5% of individuals experiencing at least one CAPE-P item 'often' or 'almost always'. Females reported significantly higher levels of PLEs, and associated distress, than males. Anxiety, depressive, and stress symptoms were similarly associated with PLEs in both genders. However, there was a significant interaction of gender and daily hassles in the association with PLEs. In summary, there were significant gender differences in the experience of PLEs in this sample. Although daily hassles were more common in females, they had a significantly stronger association with PLEs in males. Thus, addressing "daily life stress" in adolescents may require tailoring towards the more emotional perception of stress in females, and towards everyday life hassles in males.
Collapse
Affiliation(s)
- Alexandra Stainton
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
| | - Katharine Chisholm
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom; School of Psychology, Aston University, Birmingham, United Kingdom
| | - Tamara Woodall
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Danielle Hallett
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Renate L E P Reniers
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Stephen J Wood
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Orygen, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| |
Collapse
|
19
|
Distress severity in perceptual anomalies moderates the relationship between prefrontal brain structure and psychosis proneness in nonclinical individuals. Eur Arch Psychiatry Clin Neurosci 2021; 271:1111-1122. [PMID: 33532868 PMCID: PMC8354976 DOI: 10.1007/s00406-020-01229-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
In the general population, psychosis risk phenotypes occur independently of attenuated prodromal syndromes. Neurobiological correlates of vulnerability could help to understand their meaningfulness. Interactions between the occurrence of psychotic-like experiences (PLE) and other psychological factors e.g., distress related to PLE, may distinguish psychosis-prone individuals from those without risk of future psychotic disorder. We aimed to investigate whether (a) correlates of total PLE and distress, and (b) symptom dimension-specific moderation effects exist at the brain structural level in non-help-seeking adults reporting PLE below and above the screening criterion for clinical high-risk (CHR). We obtained T1-weighted whole-brain MRI scans from 104 healthy adults from the community without psychosis CHR states for voxel-based morphometry (VBM). Brain structural associations with PLE and PLE distress were analysed with multiple linear regression models. Moderation of PLE by distress severity of two types of positive symptoms from the Prodromal Questionnaire (PQ-16) screening inventory was explored in regions-of-interest after VBM. Total PQ-16 score was positively associated with grey matter volume (GMV) in prefrontal regions, occipital fusiform and lingual gyri (p < 0.05, FDR peak-level corrected). Overall distress severity and GMV were not associated. Examination of distress severity on the positive symptom dimensions as moderators showed reduced strength of the association between PLE and rSFG volume with increased distress severity for perceptual PLE. In this study, brain structural variation was related to PLE level, but not distress severity, suggesting specificity. In healthy individuals, positive relationships between PLE and prefrontal volumes may indicate protective features, which supports the insufficiency of PLE for the prediction of CHR. Additional indicators of vulnerability, such as distress associated with perceptual PLE, change the positive brain structure relationship. Brain structural findings may strengthen clinical objectives through disentanglement of innocuous and risk-related PLE.
Collapse
|
20
|
Hinterbuchinger B, Mossaheb N. Psychotic-Like Experiences: A Challenge in Definition and Assessment. Front Psychiatry 2021; 12:582392. [PMID: 33854445 PMCID: PMC8039445 DOI: 10.3389/fpsyt.2021.582392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/16/2021] [Indexed: 11/24/2022] Open
Abstract
Assuming a continuum between psychotic experiences and psychotic symptoms aligned between healthy individuals and patients with non-psychotic and psychotic disorders, recent research has focused on subclinical psychotic experiences. The wide variety of definitions, assessment tools, and concepts of psychotic-like experiences (PLEs) might contribute to the mixed findings concerning prevalence and persistence rates and clinical impact. In this narrative review, we address the panoply of terminology, definitions, and assessment tools of PLEs and associated concerns with this multitude. Moreover, the ambiguous results of previous studies regarding the clinical relevance of PLEs are described. In conclusion, we address clinical implications and highly suggest conceptual clarity and consensus concerning the terminology and definition of PLEs. The development of an agreed upon use of a "gold standard" assessment tool seems essential for more comparable findings in future research.
Collapse
Affiliation(s)
- Barbara Hinterbuchinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
21
|
Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2005-2015. [PMID: 33000312 PMCID: PMC8519877 DOI: 10.1007/s00127-020-01969-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/23/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE In mental health care, patients and their care providers may conceptualize the nature of the disorder and appropriate action in profoundly different ways. This may lead to dropout and lack of compliance with the treatments being provided, in particular in young patients with more severe disorders. This study provides detailed information about patient-provider (dis)agreement regarding the care needs of children and adolescents. METHODS We used the Camberwell Assessment of Need (CANSAS) to assess the met and unmet needs of 244 patients aged between 6 and 18 years. These needs were assessed from the perspectives of both patients and their care providers. Our primary outcome measure was agreement between the patient and care provider on unmet need. By comparing a general outpatient sample (n = 123) with a youth-ACT sample (n = 121), we were able to assess the influence of severity of psychiatric and psychosocial problems on the extent of agreement on patient's unmet care needs. RESULTS In general, patients reported unmet care needs less often than care providers did. Patients and care providers had the lowest extents of agreement on unmet needs with regard to "mental health problems" (k = 0.113) and "information regarding diagnosis/treatment" (k = 0.171). Comparison of the two mental healthcare settings highlighted differences for three-quarters of the unmet care needs that were examined. Agreement was lower in the youth-ACT setting. CONCLUSIONS Clarification of different views on patients' unmet needs may help reduce nonattendance of appointments, noncompliance, or dropout. Routine assessment of patients' and care providers' perceptions of patients' unmet care needs may also help provide information on areas of disagreement.
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Neuropsychological profile of children and adolescents with psychosis risk syndrome: the CAPRIS study. Eur Child Adolesc Psychiatry 2020; 29:1311-1324. [PMID: 31897849 DOI: 10.1007/s00787-019-01459-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
Neuropsychological underperformance is well described in young adults at clinical high risk for psychosis, but the literature is scarce on the cognitive profile of at-risk children and adolescents. The aim of this study is to describe the neuropsychological profile of a child and adolescent sample of patients with psychosis risk syndrome (PRS) compared to healthy controls and to analyze associations between attenuated psychotic symptoms and cognitive impairment. Cross-sectional baseline data analysis from a longitudinal, naturalistic, case-control, two-site study is presented. Eighty-one help-seeking subjects with PRS and 39 healthy controls (HC) aged between 10 and 17 years of age were recruited. PRS was defined by: positive or negative attenuated symptoms, Brief Limited Intermittent Psychotic Symptoms (BLIPS), genetic risk (first- or second-degree relative), or schizotypal personality disorder plus impairment in functioning. A neuropsychological battery was administered to assess general intelligence, verbal and visual memory, visuospatial abilities, speed processing, attention, and executive functions. The PRS group showed lower general neuropsychological performance scores at a multivariate level and lower scores than controls in general intelligence and executive functions. Lower scores on executive function and poorer attention were associated with high scores of positive attenuated psychotic symptoms. No association with attenuated negative symptoms was found. This study provides evidence of cognitive impairment in PRS children and adolescents and shows a relationship between greater cognitive impairment in executive functions and attention tasks and severe attenuated positive symptoms. However, longitudinal studies are needed to clarify the nature of cognitive impairment as a possible vulnerability marker.
Collapse
|
24
|
Hermans K, van der Steen Y, Kasanova Z, van Winkel R, Reininghaus U, Lataster T, Bechdolf A, Gimpel-Drees J, Wagner M, Myin-Germeys I. Temporal dynamics of suspiciousness and hallucinations in clinical high risk and first episode psychosis. Psychiatry Res 2020; 290:113039. [PMID: 32460186 DOI: 10.1016/j.psychres.2020.113039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
The objective of the current study is to elucidate the temporal dynamics of suspiciousness and hallucinations as they occur in daily life in the early stages of psychosis. Their prevalence and co-occurrence, as well as their temporal relation to affect and delusions, were compared between patients with a first psychotic episode (FEP) and individuals at clinical high risk for psychosis (CHRp). The Experience Sampling Method was used to investigate suspiciousness and hallucinatory experiences, delusions, and affect at semi-random moments throughout six days in 33 CHRp and 34 FEP. Overall, 91% of CHRp and 59% of FEP reported suspiciousness, and 24% and 39% reported hallucinations, respectively. Hallucinations almost always co-occurred with suspiciousness, whereas suspiciousness was often present without hallucinations. Suspicious episodes in CHRp occurred with marked increases in delusional intensity, while hallucinatory experiences were mostly absent. In FEP, a decrease of positive affect preceded suspicious episodes, while an increase of negative affect preceded hallucinatory episodes. Our results indicated the presence of a delusional mood (atmosphere) in CHRp as an experience in itself, without co-occurring or following hallucinations, thus refuting the anomalous experience hypothesis of psychosis. The co-occurrence of hallucinations, on the other hand, indicates a more severe stage of symptomatology.
Collapse
Affiliation(s)
- Karlijn Hermans
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium.
| | - Yori van der Steen
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; Maastricht University, School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry & Neuropsychology, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven en de Kempen, Eindhoven, The Netherlands
| | - Zuzana Kasanova
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Ruud van Winkel
- University Psychiatric Center, Catholic University Leuven, Campus Kortenberg, Leuvensesteenweg, Kortenberg, Belgium; Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | - Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Tineke Lataster
- Maastricht University, School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry & Neuropsychology, Maastricht, The Netherlands
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre (FRITZ), Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany; Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Judith Gimpel-Drees
- University of Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany
| | - Michael Wagner
- University of Bonn, Department of Neurodegenerative Diseases and Geriatric Psychiatry, Bonn, Germany
| | - Inez Myin-Germeys
- Catholic University Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| |
Collapse
|
25
|
Psychometric properties of the 15-item positive subscale of the community assessment of psychic experiences. Schizophr Res 2020; 222:160-166. [PMID: 32522467 DOI: 10.1016/j.schres.2020.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/19/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A new 15-item version of the positive subscale of Community Assessment of Psychic Experiences (CAPE-P15) has been recently proposed and used to measure psychotic-like experiences. The wide application of this scale is thought to be feasible and cost-effective, due to its manageable length and higher level of internal consistency. However, its psychometric properties have not been well established. METHODS The validity and reliability of the CAPE-P15 were assessed in 1255 college students across two time frames (over a lifetime and in the past month). Confirmatory factor analysis was used to confirm its construct validity and measurement invariance across sex. Pearson's correlation analysis was used to investigate its clinical and concurrent validity. We also calculated the test-retest reliability and internal consistency to verify the reliability of the scale. Finally, telephone interviews were performed to explore the consistency between self-reported and interview-verified CAPE-P15 scores. RESULTS The scale has adequate psychometric properties in terms of construct, clinical and concurrent validity; measurement invariance across sex; test-retest reliability; and internal consistency. We also confirmed considerably high consistency between self-reported and interview-verified CAPE-P15 scores. CONCLUSIONS This study confirms that the CAPE-P15 is a valid and reliable instrument for assessing psychotic-like experiences in college students, both over a lifetime and in the past month. This overall assessment of the CAPE-P15 supports its more widespread use in this population. However, further research is needed to assess its utility in clinical settings, as well as in general population.
Collapse
|
26
|
Heilskov SER, Urfer-Parnas A, Nordgaard J. Delusions in the general population: A systematic review with emphasis on methodology. Schizophr Res 2020; 216:48-55. [PMID: 31836260 DOI: 10.1016/j.schres.2019.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022]
Abstract
The presence of delusions is considered a key feature of psychosis, but despite the psychopathological centrality of the concept of delusion, its definition and comprehension is a matter of continuing debate. In recent years studies showing that delusions are common in the general population have accumulated and challenged the way we perceive psychotic illness. In this systematic review, we examine the basis of the psychosis continuum-hypothesis, by reviewing a representative section of the original literature that report measures of delusional ideation in the general population, focusing specifically on methodology. Three online databases were systematically searched for relevant studies. After applying criteria of inclusion and exclusion, 17 articles were included for comprehensive review. Estimates of the distribution of delusions in the general population vary substantially, as does the mode of assessment. The methodology relies with few exceptions exclusively on self-report and fully structured interview by lay person. We conclude that measures of delusions in the general population should be interpreted cautiously due to inherent difficulties in methodology. Hypothesizing a continuum of delusion between normality and full-blown psychosis is deemed premature based on the reviewed studies.
Collapse
Affiliation(s)
| | | | - Julie Nordgaard
- Mental Health Center Amager, Gl. Kongevej 33, 1610, Copenhagen V, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| |
Collapse
|
27
|
Baryshnikov I, Aaltonen K, Suvisaari J, Koivisto M, Heikkinen M, Joffe G, Isometsä E. Features of borderline personality disorder as a mediator of the relation between childhood traumatic experiences and psychosis-like experiences in patients with mood disorder. Eur Psychiatry 2020; 49:9-15. [PMID: 29353179 DOI: 10.1016/j.eurpsy.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022] Open
Abstract
AbstractBackgroundPsychosis-like experiences (PEs) are common in patients with non-psychotic disorders. Several factors predict reporting of PEs in mood disorders, including mood-associated cognitive biases, anxiety and features of borderline personality disorder (BPD). Childhood traumatic experiences (CEs), often reported by patients with BPD, are an important risk factor for mental disorders. We hypothesized that features of BPD may mediate the relationship between CEs and PEs. In this study, we investigated the relationships between self-reported PEs, CEs and features of BPD in patients with mood disorders.MethodsAs part of the Helsinki University Psychiatric Consortium study, McLean Screening Instrument (MSI), Community Assessment of Psychic Experiences (CAPE-42) and Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n = 282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, multiple regression and mediation analyses were conducted.ResultsTotal scores of MSI correlated strongly with scores of the CAPE-42 dimension “frequency of positive symptoms” (rho = 0.56; p ≤ 0.001) and moderately with scores of TADS (rho = 0.4; p ≤ 0.001). Total score of MSI and its dimension “cognitive symptoms”, including identity disturbance, distrustfulness and dissociative symptoms, fully mediated the relation between TADS and CAPE-42. Each cognitive symptom showed a partial mediating role (dissociative symptoms 43% (CI = 25–74%); identity disturbance 40% (CI = 30-73%); distrustfulness 18% (CI = 12-50%)).ConclusionsSelf-reported cognitive-perceptual symptoms of BPD fully mediate, while affective, behavioural and interpersonal symptoms only partially mediate the relationships between CEs and PEs. Recognition of co-morbid features of BPD in patients with mood disorders reporting PEs is essential.
Collapse
|
28
|
Niles HF, Walsh BC, Woods SW, Powers AR. Does hallucination perceptual modality impact psychosis risk? Acta Psychiatr Scand 2019; 140:360-370. [PMID: 31355420 PMCID: PMC6752971 DOI: 10.1111/acps.13078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Subthreshold perceptual abnormalities are commonly used to identify individuals at clinical high risk (CHR) for developing a psychotic disorder. Predictive validity for modality-specific perceptual abnormality severity on psychosis risk is unknown. METHODS We examined prospectively collected data from 164 individuals age 12-35 meeting criteria for CHR followed for 6-24 months or until conversion to psychosis. Using intake interview notes, baseline perceptual abnormality scores were split into auditory, visual, somatic/tactile, and olfactory/gustatory components, and auditory scores were further split into those for verbal vs non-verbal content. Relationships between perceptual abnormality characteristics and conversion were assessed with Cox proportional hazards regression and logistic regression. RESULTS Unusual thought content and paranoia were predictive of conversion, but no modality-specific perceptual abnormality score predicted conversion status or days to conversion. However, when auditory perceptual abnormalities were further categorized as verbal vs non-verbal, the severity of verbal experiences was predictive of conversion to psychosis (P = 0.007). CONCLUSIONS Perceptual abnormality scores failed to meaningfully predict conversion to psychosis in either direction in this CHR sample. However, verbal auditory experiences may identify a group of CHR individuals at elevated risk of conversion. Further exploration of the relationship between phenomenological aspects of perceptual abnormalities and conversion risk is warranted.
Collapse
Affiliation(s)
- Halsey F. Niles
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Barbara C. Walsh
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Scott W. Woods
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Albert R. Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| |
Collapse
|
29
|
Chan CC, Bulbena-Cabre A, Rutter S, Benavides C, McClure MM, Calabrese W, Rosell DR, Koenigsberg HW, Goodman M, New AS, Hazlett EA, Perez-Rodriguez MM. Comparison of self-report and clinician-rated schizotypal traits in schizotypal personality disorder and community controls. Schizophr Res 2019; 209:263-268. [PMID: 30635257 PMCID: PMC6614007 DOI: 10.1016/j.schres.2018.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Given the common use of self-report questionnaires to assess schizotypy in personality pathology and schizophrenia research, it is important to determine the concordance between self-report and clinician ratings. 250 individuals with schizotypal personality disorder (SPD) and 116 community controls (CTR) were assessed on schizotypal traits using a clinical interview, the Structured Interview for DSM-IV Personality disorders (SIDP), and a self-report questionnaire, the Schizotypal Personality Questionnaire (SPQ). Ordinal logistic regressions examined concordance between self-reported and clinician-rated scores in CTR and SPD separately. Analyses of variance examined how the SPQ performed on differentiating between CTR with low schizotypy, CTR with high schizotypy, and SPD. For both CTR and SPD, higher SPQ subscale scores were significantly associated with higher clinician ratings on the respective SIDP items for the Ideas of Reference, Magical Thinking, Unusual Perceptual Experience, Suspiciousness, and Social Anxiety items, but not the Odd Speech or Limited Affect items. Higher SPQ subscale scores for Odd Behavior and Lack of Close Friends were significantly associated with the clinician-rated SIDP item scores in CTR but not SPD. CTR with low schizotypy scored lower on all SPQ subscales than CTR with high schizotypy, who did not differ from SPD. Self-report ratings are concordant with clinician ratings for positive schizotypal traits, whereas certain disorganization and interpersonal traits are not, particularly for individuals with SPD. The SPQ can differentiate between high and low schizotypy controls, but not between high schizotypy controls and individuals with SPD. Assessment of schizotypal traits should include both self-report questionnaires and clinician ratings.
Collapse
Affiliation(s)
- Chi C. Chan
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
| | - Andrea Bulbena-Cabre
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Sarah Rutter
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Caridad Benavides
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Margaret M. McClure
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Fairfield University, Fairfield, CT, USA
| | - William Calabrese
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Daniel R. Rosell
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Harold W. Koenigsberg
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Antonia S. New
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Erin A. Hazlett
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - M. Mercedes Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
| |
Collapse
|
30
|
Nordgaard J, Buch Pedersen M, Hastrup LH, Haahr UH, Simonsen E. Assessing psychosis in the general population: Self-rated versus clinician-rated. Schizophr Res 2019; 206:446-447. [PMID: 30558977 DOI: 10.1016/j.schres.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Julie Nordgaard
- Mental Health Center Amager, Gl. Kongevej 33, 1610 Copenhagen, Denmark.
| | | | - Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark; Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| |
Collapse
|
31
|
Nordgaard J, Buch-Pedersen M, Hastrup LH, Haahr UH, Simonsen E. Measuring Psychotic-Like Experiences in the General Population. Psychopathology 2019; 52:240-247. [PMID: 31454823 DOI: 10.1159/000502048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/11/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The notion of a full psychosis continuum in which psychosis is seen on a continuum with normal experience rests heavily on studies showing that psychotic symptoms are common in the general population. However, the methods of assessment in the studies have been criticized. OBJECTIVES (1) to investigate how many from the general population who answered positively on a psychotic-like symptoms questionnaire and (2) to clinically assess a subset of those with psychotic-like experiences (PLE). METHODS A self-rating questionnaire concerning PLEs was given to individuals from the general population. A subsample of those, who scored positively for PLEs, was clinically assessed for psychosis. RESULTS Totally, 5.7% of the participants rated positive for PLEs according to the self-rating questionnaire. Forty of these were clinically assessed and 7 (17.5%) of them were found to have had a psychotic experience, 4 of them were already in psychiatric treatment. CONCLUSION The self-reported psychotic-like phenomena were more common in the general population than psychotic disorders. However, when assessed clinically, the experienced phenomena did correspond to psychotic phenomena except in a few patients, who were found to suffer from a psychotic disorder. Overall, we did not find support for the full psychosis continuum model.
Collapse
Affiliation(s)
| | | | | | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
32
|
Moriyama TS, van Os J, Gadelha A, Pan PM, Salum GA, Manfro GG, Mari JDJ, Miguel EC, Rohde LA, Polanczyk GV, McGuire P, Bressan RA, Drukker M. Differences Between Self-Reported Psychotic Experiences, Clinically Relevant Psychotic Experiences, and Attenuated Psychotic Symptoms in the General Population. Front Psychiatry 2019; 10:782. [PMID: 31736802 PMCID: PMC6829673 DOI: 10.3389/fpsyt.2019.00782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/01/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child's report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents. Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6-14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents' information about the child's positive attributes and levels of psychopathology and psychologist assessment of blunted affect. Results: Most associations were qualitatively similar, and there was a dose-response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening. Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
Collapse
Affiliation(s)
- Tais Silveira Moriyama
- Centro de Atendimento Especializado, Instituto Bairral de Psiquiatria, Itapira, Brazil.,Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom.,Department of Psychiatry, UMC Utrecht Brain Centre, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Ary Gadelha
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Pedro Mario Pan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Philip McGuire
- Department of Psychosis Studies, King's College London, King's Health Partners, London, United Kingdom
| | - Rodrigo Affonseca Bressan
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian High-Risk Cohort Study for Psychiatric Disorders, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| |
Collapse
|
33
|
Köther U, Lincoln TM, Moritz S. Emotion perception and overconfidence in errors under stress in psychosis. Psychiatry Res 2018; 270:981-991. [PMID: 29685325 DOI: 10.1016/j.psychres.2018.03.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 01/09/2023]
Abstract
Vulnerability stress models are well-accepted in psychosis research, but the mechanisms that link stress to psychotic symptoms remain vague. Little is known about how social cognition and overconfidence in errors, two putative mechanisms for the pathogenesis of delusions, relate to stress. Using a repeated measures design, we tested four groups (N=120) with different liability to psychosis (schizophrenia patients [n=35], first-degree relatives [n=24], participants with attenuated positive symptoms [n=19] and healthy controls [n=28]) and depression patients (n=14) as a clinical control group under three randomized experimental conditions (no stress, noise and social stress). Parallel versions of the Emotion Perception and Confidence Task, which taps both emotion perception and confidence, were used in each condition. We recorded subjective stress, heart rate, skin conductance level and salivary cortisol to assess the stress response across different dimensions. Independent of the stress condition, patients with schizophrenia showed poorer emotion perception performance and higher confidence in emotion perception errors than participants with attenuated positive symptoms and healthy controls. However, they did not differ from patients with depression or first-degree relatives. Stress did not influence emotion perception or the extent of high-confident errors, but patients with schizophrenia showed an increase in high-confident emotion perception errors conditional on higher arousal. A possible clinical implication of our findings is the necessity to provide stress management programs that aim to reduce arousal. Moreover, patients with schizophrenia might benefit from interventions that help them to reduce overconfidence in their social cognition judgements in times in which they feel being under pressure.
Collapse
Affiliation(s)
- Ulf Köther
- Department of Psychiatry and Psychotherapy, University, Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Tania M Lincoln
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University, Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
34
|
Schultze-Lutter F, Schmidt SJ, Theodoridou A. Psychopathology-a Precision Tool in Need of Re-sharpening. Front Psychiatry 2018; 9:446. [PMID: 30283368 PMCID: PMC6156265 DOI: 10.3389/fpsyt.2018.00446] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/29/2018] [Indexed: 01/15/2023] Open
Abstract
Psychopathology is the scientific exploration of abnormal mental states that, for more than a century, has provided a Gestalt for psychiatric disorders and guided clinical as well as scientific progress in modern psychiatry. In the wake of the immense technical advances, however, psychopathology has been increasingly marginalized by neurobiological, genetic, and neuropsychological research. This ongoing erosion of psychiatric phenomenology is further fostered by clinical casualness as well as pressured health care and research systems. The skill to precisely and carefully assess psychopathology in a qualified manner used to be a core attribute of mental health professionals, but today's curricula pay increasingly less attention to its training, thus blurring the border between pathology and variants of the "normal" further. Despite all prophecies that psychopathology was doomed, and with neurobiological parameters having yet to show their differential-diagnostic superiority and value for differential indication, psychiatric diagnosis continues to rely exclusively on psychopathology in DSM-5 and ICD-11. Their categorical systematic, however, is equally challenged, and, supported by advances in machine learning, a personalized symptom-based approach to precision psychiatry is increasingly advocated. The current paper reviews the objectives of psychopathology and the recent debate on the role of psychopathology in future precision psychiatry-from guiding neurobiological research by relating neurobiological changes to patients' experiences to giving a framework to the psychiatric encounter. It concludes that contemporary research and clinic in psychiatry do not need less but rather more differentiated psychopathologic approaches in order to develop approaches that integrate professional knowledge and patients' experience.
Collapse
Affiliation(s)
- Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stefanie J. Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
35
|
Zhang T, Xu L, Tang Y, Cui H, Wei Y, Tang X, Hu Q, Wang Y, Zhu Y, Jiang L, Hui L, Liu X, Li C, Wang J. Isolated hallucination is less predictive than thought disorder in psychosis: Insight from a longitudinal study in a clinical population at high risk for psychosis. Sci Rep 2018; 8:13962. [PMID: 30228293 PMCID: PMC6143535 DOI: 10.1038/s41598-018-32215-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
Perceptual abnormalities (PAs) such as auditory hallucinations are one of the most common symptoms of psychotic patients. However, it remains unclear whether symptoms of sub-clinical PAs also play a key role in predicting psychosis. In an ongoing prospective follow-up study of individuals at a clinical high risk (CHR) of psychosis, we evaluated the potential of first-time experience of PAs and/or thought content disorders (TCDs) to predict psychosis. Conversion to psychosis was the major focus of this follow-up study. A total of 511 CHRs were recruited, of whom 443 (86.7%) completed the clinical follow-up of at least 6 months and up to 2 years. CHRs were divided into four groups according to the presence of PAs and/or TCDs. At the follow-up endpoint, 39 (19.9%) CHRs in the “TCDs-only” group, 2 (8.3%) in the “PAs-only” group, 45 (17.0%) in the “TCDs-and-PAs” group, and 1 (3.8%) in the “None” group converted to psychosis. Survival analysis revealed a higher conversion rate in CHRs with TCDs compared with those with PAs only. CHRs with isolated PAs had shown a higher level of dysphoric mood at baseline compared with those with TCDs. About 89% TCDs contents were related with their experienced PAs. Compared with TCDs, the isolated PAs are not strongly associated with increased susceptibility to psychosis.
Collapse
Affiliation(s)
- TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Qiang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Yan Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - YiKang Zhu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - LiJuan Jiang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China
| | - Li Hui
- Institute of Mental Health, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, 215137, Suzhou, P. R. China
| | - XiaoHua Liu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China.
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, P. R. China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P. R. China. .,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, P. R. China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, China.
| |
Collapse
|
36
|
Pontillo M, De Luca M, Pucciarini ML, Vicari S, Armando M. All that glitters is not gold: prevalence and relevance of psychotic-like experiences in clinical sample of children and adolescents aged 8-17 years old. Early Interv Psychiatry 2018; 12:702-707. [PMID: 27578268 DOI: 10.1111/eip.12370] [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] [Received: 01/08/2016] [Revised: 04/09/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022]
Abstract
AIM Recent studies have examined the prevalence of psychotic-like experiences (PLEs) and their relationship with functioning, psychopathology and distress in adult and mixed young adult and adolescent samples. There is, however, a lack of knowledge about the prevalence and clinical weight of PLEs in clinical child and adolescent (CAD) populations. Available research has primarily been conducted on community populations, and even clinical samples mostly used self-reported questionnaires. These studies also recruited participants 12 years old and older, with a consequent lack of information on children from 8 to 11 years old. We examined the prevalence of PLEs and their relationship with psychiatric diagnosis, functioning, intelligence quotient (IQ), anxiety and depressive symptoms in a clinical sample aged 8-17 years old. METHODS The study was conducted on a clinical sample of 46 CAD with PLEs compared to a clinical sample of 60 CAD without PLEs. The two groups were compared on global, social and role functioning, IQ, anxiety and depressive symptoms, and number of psychiatric diagnoses. RESULTS Global, role and social functioning were significantly lower in the CAD clinical sample with PLEs. These significant differences were maintained when the covariate IQ, number of psychiatric diagnoses or level of anxiety or depression was added. No significant age-related differences in the presence of PLEs were found. CONCLUSION The findings of this study show that PLEs are common in a clinical sample of CAD, even those under 12 years old. The presence of PLEs should therefore be investigated and considered in planning treatment of non-psychotic psychiatric disorders in CAD.
Collapse
Affiliation(s)
- Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Maria De Luca
- Neuropsychology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Maria Laura Pucciarini
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Marco Armando
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy.,Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| |
Collapse
|
37
|
Clinical high risk for psychosis in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2018; 27:683-700. [PMID: 28914382 DOI: 10.1007/s00787-017-1046-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
Abstract
The concept of being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16. Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed, reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies, assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication of the few studies found.
Collapse
|
38
|
Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG. Prevalence and clinical relevance of interview-assessed psychosis-risk symptoms in the young adult community. Psychol Med 2018; 48:1167-1178. [PMID: 28889802 PMCID: PMC6088777 DOI: 10.1017/s0033291717002586] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND An efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic. METHODS Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16-40 years; response rate: 63.4%). RESULTS The point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse. CONCLUSIONS Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.
Collapse
Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
39
|
Nelson B, Hartmann JA, Parnas J. Detail, dynamics and depth: useful correctives for some current research trends. Br J Psychiatry 2018; 212:262-264. [PMID: 29693537 DOI: 10.1192/bjp.2018.52] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several research trends in contemporary psychiatry would benefit from greater emphasis on detailed assessment, modelling dynamic change, and micro-level analysis. This may assist with clarifying nosological and pathoaetiological issues. We make this case by referring to three areas: psychopathology and nosology; prediction research; and 'big N' data sets.Declaration of interestNone.
Collapse
Affiliation(s)
- Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health,Australia, andCentre for Youth Mental Health,University of Melbourne,Australia
| | - Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health,Australia, andCentre for Youth Mental Health,University of Melbourne,Australia
| | - Josef Parnas
- Psychiatric Center Hvidovre & Center for Subjectivity Research,University of Copenhagen,Denmark
| |
Collapse
|
40
|
Schultze-Lutter F, Klosterkötter J, Gaebel W, Schmidt SJ. Psychosis-risk criteria in the general population: frequent misinterpretations and current evidence. World Psychiatry 2018; 17:107-108. [PMID: 29352561 PMCID: PMC5775131 DOI: 10.1002/wps.20498] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| |
Collapse
|
41
|
Fonseca-Pedrero E, Ortuño-Sierra J, Chocarro E, Inchausti F, Debbané M, Bobes J. Psychosis risk screening: Validation of the youth psychosis at-risk questionnaire - brief in a community-derived sample of adolescents. Int J Methods Psychiatr Res 2017; 26:e1543. [PMID: 27790784 PMCID: PMC6877222 DOI: 10.1002/mpr.1543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/18/2016] [Accepted: 09/23/2016] [Indexed: 12/17/2022] Open
Abstract
There have been several attempts to identify individuals potentially at high risk for psychotic-spectrum disorders using brief screening measures. However, relatively few studies have tested the psychometric properties of the psychosis screening measures in representative samples of adolescents. The main purpose of the present study was to analyse the prevalence, factorial structure, measurement invariance across gender, and reliability of the Youth Psychosis At-Risk Questionnaire - Brief (YPARQ-B) in a community-derived sample of adolescents. Additionally, the relationship between YPARQ-B, depressive symptoms, psychopathology, stress manifestations, and prosocial skills was analysed. One thousand and twenty students from high schools participated in a cross-sectional survey. The YPARQ-B, the Reynolds Adolescent Depression Scale, the Strengths and Difficulties Questionnaire, and the Student Stress Inventory - Stress Manifestations were used. A total of 85.1% of the total sample self-reported at least one subclinical psychotic experience. We observed a total of 10.9% of adolescents with a cutoff score of ≥11 or 6.8% with a cutoff score of ≥13. The analysis of internal structure of the YPARQ-B yielded an essentially unidimensional structure. The YPARQ-B scores showed measurement invariance across gender. The internal consistency of the YPARQ-B total score was 0.94. Furthermore, self-reported subclinical psychotic experiences were associated with depressive symptoms, emotional and behavioural problems, poor prosocial skills, and stress manifestations. These results would appear to indicate that YPARQ-B is a brief and easy tool to assess self-reported subclinical psychotic experiences in adolescents from the general population. The assessment of these experiences in community settings, and its associations with psychopathology, may help us to enhance the possibility of an early identification of adolescents potentially at risk for psychosis and mental health problems.
Collapse
Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain.,Prevention Program for Psychosis (P3), Oviedo, Spain.,Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
| | | | - Edurne Chocarro
- Department of Educational Sciences, University of La Rioja, La Rioja, Spain
| | - Felix Inchausti
- Mental Health Services, Complejo Hospitalario of Navarre, Pamplona, Spain
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julio Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, University of Oviedo, Oviedo, Spain
| |
Collapse
|
42
|
Abstract
Attenuated psychotic symptoms (APS) are the key criteria to identify the individuals at enhanced risk of developing psychotic disorders. Competing clinicians-rated or self-rated psychometric instruments can also be used to detect APS, which makes it difficult to interpret their actual clinical significance. This article summarizes the empirical differences between the clinicians-rated and self-rated interviews and explores the impact of the context (referral pathways, settings, and assessment procedures) on the clinical significance of the APS.
Collapse
Affiliation(s)
- Paolo Fusar-Poli
- King's College London, Institute of Psychiatry Psychology and Neuroscience, PO63, De Crespigny Park, SE5 8AF London, UK
- OASIS Service, South London And the Maudsley NHS Foundation Trust, London, UK
| | - Andrea Raballo
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo, Oslo, Norway
| | - Josef Parnas
- Department of Clinical Medicine, Region Hovedstadens Psykiatri, Brøndby, Denmark
| |
Collapse
|
43
|
Baryshnikov I, Suvisaari J, Aaltonen K, Koivisto M, Melartin T, Näätänen P, Suominen K, Karpov B, Heikkinen M, Oksanen J, Paunio T, Joffe G, Isometsä E. Self-reported psychosis-like experiences in patients with mood disorders. Eur Psychiatry 2017; 51:90-97. [PMID: 28797561 DOI: 10.1016/j.eurpsy.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Self-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. METHODS The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n=282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE. RESULTS PEs are common in patients with mood disorders. The "frequency of positive symptoms" score of CAPE-42 correlated strongly with total score of SPQ-B (rho=0.63; P<0.001) and moderately with total scores of BDI, MDQ, OASIS and MSI (rho varied from 0.37 to 0.56; P<0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ, SPQ-B and MSI (rφ varied from 0.2 to 0.5; P<0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the "frequency of positive symptoms" score of CAPE-42. CONCLUSIONS Several, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms.
Collapse
Affiliation(s)
- I Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Suominen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - B Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Oksanen
- Department of Mental Health and Substance Abuse, Social Services and Health Care, Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; National Institute for Health and Welfare, Mental Health Unit, 00271 Helsinki, Finland.
| |
Collapse
|
44
|
Parnas J, Henriksen MG. Epistemological error and the illusion of phenomenological continuity. World Psychiatry 2016; 15:126-7. [PMID: 27265698 PMCID: PMC4911771 DOI: 10.1002/wps.20326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Josef Parnas
- Faculty of Health and Medical Sciences & Faculty of HumanitiesUniversity of CopenhagenCopenhagenDenmark
| | - Mads Gram Henriksen
- Faculty of Health and Medical Sciences & Faculty of HumanitiesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
45
|
Affiliation(s)
- Anita Riecher‐Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric ClinicsBaselSwitzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric ClinicsBaselSwitzerland
| |
Collapse
|
46
|
Granö N, Kallionpää S, Karjalainen M, Roine M, Ranta K, Heinimaa M. Discrepancy between self-reported and interviewed psychosis risk symptoms: auditory distortions are the most reliably reported symptom by self-report. Early Interv Psychiatry 2016; 10:129-36. [PMID: 24861468 DOI: 10.1111/eip.12154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
AIM In the recent literature, there has been growing interest in assessment methods for detecting increased risk of developing psychosis. Self-report methods are popular but may lead to different results compared to clinical interviews. METHODS The difference in psychosis risk scores was tested between self-reported psychosis risk symptoms (PROD-SR) and self-reported symptoms additionally confirmed by interview (PROD-SR + I). The symptom categories were derived from 12 common psychosis risk symptoms included in the PROD screening instrument. The data were collected by questionnaires and interviews conducted with 395 adolescents (mean age 15.3 years) in an early intervention and detection team, JERI, at Helsinki University Central Hospital, Finland. RESULTS The results show a significant difference between the PROD-SR risk symptom sum scores and the PROD-SR + I risk symptom sum scores (N = 395; Z = -15.123; P < 0.001). In an item-by-item analysis, the item 'Disorders in connection with hearing' had the strongest kappa value (0.827) agreement between an interviewed and self-report psychosis risk item. Agreement in most items remained between slight and substantial (kappa values from 0.082 to 0.649). CONCLUSIONS The results suggest that there is a significant difference between psychosis risk symptom responses collected by self-report and self-report responses which are additionally confirmed by interview. Auditory disorders are the most reliably reported item with self-report.
Collapse
Affiliation(s)
- Niklas Granö
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - Santeri Kallionpää
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - Marjaana Karjalainen
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - Mikko Roine
- Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - Klaus Ranta
- Department of Adolescents Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Turku, Finland
| |
Collapse
|
47
|
Salokangas RKR, Schultze-Lutter F, Hietala J, Heinimaa M, From T, Ilonen T, Löyttyniemi E, von Reventlow HG, Juckel G, Linszen D, Dingemans P, Birchwood M, Patterson P, Klosterkötter J, Ruhrmann S. Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project. Soc Psychiatry Psychiatr Epidemiol 2016; 51:247-57. [PMID: 26643940 DOI: 10.1007/s00127-015-1160-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. METHODS In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. RESULTS At baseline, 54.3% of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4%. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. CONCLUSION Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.
Collapse
Affiliation(s)
- Raimo K R Salokangas
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.,Psychiatric Clinic, Turku University Central Hospital, Turku, Finland.,Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tiina From
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | | | - Heinrich Graf von Reventlow
- Ev. Zentrum für Beratung und Therapie am Weißen Stein, Evangelischer Regionalverband Frankfurt am Main, Frankfurt Am Main, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Don Linszen
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry and Psychology, University of Maastricht, Maastricht, The Netherlands
| | - Peter Dingemans
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Mediant, Enschede, The Netherlands
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Paul Patterson
- Youthspace, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | |
Collapse
|
48
|
Brandizzi M, Schultze-Lutter F, Masillo A, Lanna A, Curto M, Lindau JF, Solfanelli A, Listanti G, Patanè M, Kotzalidis G, Gebhardt E, Meyer N, Di Pietro D, Leccisi D, Girardi P, Fiori Nastro P. Self-reported attenuated psychotic-like experiences in help-seeking adolescents and their association with age, functioning and psychopathology. Schizophr Res 2014; 160:110-7. [PMID: 25458860 DOI: 10.1016/j.schres.2014.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/13/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Self-rated attenuated psychotic-like experiences (APLEs) are increasingly used to screen for ultra-high-risk (UHR) across all ages. However, self-rated psychotic-like experiences (PLEs), in particular perception-related ones, were more frequent in children and adolescents, in which they possessed less clinical significance. We therefore explored the prevalence of different factors of APLEs in help-seeking adolescents, and their relationship with age, functioning and psychopathology. METHOD As a part of the "Liberiamo il Futuro" project, help-seeking adolescents (N=171; 11-18 years, 53% male) were screened with the 92-item Prodromal Questionnaire (PQ-92). A factor analysis was performed on the PQ-92 positive items (i.e., APLEs) to identify different APLE-factors. These were assessed for their association with age, functioning and psychopathology using regression analyses. RESULTS APLEs were very common in help-seeking adolescents, and formed four factors: "Conceptual Disorganization and Suspiciousness", "Perceptual Abnormalities", "Bizarre Experiences", and "Magical Ideation". Associations with age and functioning but not psychopathology were found for "Perceptual Abnormalities" that was significantly more severe in 11-12-year-olds, while "Conceptual Disorganization and Suspiciousness" was significantly related to psychopathology. CONCLUSION In line with findings on PLEs, prevalence and clinical significance of APLEs, especially perception-related ones, might depend on age and thus neurodevelopmental stage, and may fall within the normal spectrum of experience during childhood. This should be considered when screening for UHR status in younger age groups.
Collapse
Affiliation(s)
- Martina Brandizzi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy; Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy.
| | - Frauke Schultze-Lutter
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Haus A 3000 Bern 60, Bern, Switzerland
| | - Alice Masillo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Andrea Lanna
- Department of Computer, Control, and Management Engineering "A. Ruberti", Sapienza University of Rome, Rome 00185, Italy
| | - Martina Curto
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Juliana Fortes Lindau
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Andrea Solfanelli
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Giulia Listanti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Martina Patanè
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - Giorgio Kotzalidis
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Eva Gebhardt
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Nicholas Meyer
- Institute of Psychiatry, King's College, 16 De Crespigny Park, SE5 8AF London, United Kingdom
| | - Diana Di Pietro
- Community Mental Health Service, ASL Rome H, 00041 Rome, Italy
| | - Donato Leccisi
- Community Mental Health Service, ASL Rome H, 00041 Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| |
Collapse
|
49
|
Schultze-Lutter F, Michel C, Ruhrmann S, Schimmelmann BG. Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study. Schizophr Bull 2014; 40:1499-508. [PMID: 24353096 PMCID: PMC4193691 DOI: 10.1093/schbul/sbt171] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population. METHOD Analyses involved 1229 participants (age 16-40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. "Symptom," "onset/worsening," "frequency," and "distress/disability" criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique. RESULTS The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome. CONCLUSIONS At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.
Collapse
Affiliation(s)
- Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and
| |
Collapse
|
50
|
Woodberry KA, Serur RA, Hallinan SB, Mesholam-Gately RI, Giuliano AJ, Wojcik JD, Keshavan MS, Frazier JA, Goldstein JM, Shenton ME, McCarley RW, Seidman LJ. Frequency and pattern of childhood symptom onset reported by first episode schizophrenia and clinical high risk youth. Schizophr Res 2014; 158:45-51. [PMID: 24924404 PMCID: PMC4207713 DOI: 10.1016/j.schres.2014.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown. METHODS This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at "clinical high risk" (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13-17), or adulthood (18+). RESULTS Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset. CONCLUSION Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.
Collapse
Affiliation(s)
- Kristen A Woodberry
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
| | - Rachael A Serur
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sean B Hallinan
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Raquelle I Mesholam-Gately
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Anthony J Giuliano
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychology, Worcester Recovery Center and Hospital, Worcester, MA, United States
| | - Joanne D Wojcik
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Matcheri S Keshavan
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jean A Frazier
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States; University of Massachusetts Memorial Health Care, Worcester, MA, United States
| | - Jill M Goldstein
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Division of Women's Health, Connors Center for Women's Health and Gender Biology, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Division of Psychiatric Neuroscience, Massachusetts General Hospital, Boston, MA, United States
| | - Martha E Shenton
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiology, Harvard Medical School, Boston, MA, United States; Veterans Affairs Boston Healthcare System, Brockton, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Robert W McCarley
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Veterans Affairs Boston Healthcare System, Brockton, MA, United States
| | - Larry J Seidman
- Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|