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De Salve F, Rossi C, Cavalera C, Lara M, Simona B, Sofia T, Mauro P, Osmano O. Personality traits and transition to psychosis one year after the first assessment. Front Psychol 2023; 14:1096626. [PMID: 36743236 PMCID: PMC9893640 DOI: 10.3389/fpsyg.2023.1096626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
Introduction Several studies have identified ultra-high-risk criteria that may characterize an at-risk mental state and predict the transition of psychotic evolution. Personality traits may play a crucial role in this process. Aims The current study aims to: (a) explore the evolution of an initial diagnosis over 12 months; (b) assess differences in social and occupational functioning; (c) identify common (trans-diagnostic) personality traits of psychotic risk. Methods The sample includes 97 (44 males and 53 females) young adults. They completed an assessment that consists of socio-demographic data, the Social and Occupational Functioning Scale, the Early Recognition Inventory-retrospective assessment onset of schizophrenia, and the Personality Inventory for DSM-5 (PID-5). According to the tests' assessment, the sample was divided into three different groups: Ultra-High Risk (UHR), At-Risk, and Not at risk. One year after the first evaluation, psychiatrists administered the QuickSCID-5 to verify the diagnostic trajectories of the sample. Results Overall, the most prevalent category diagnoses were anxiety/depression, personality disorders, and psychosis. Specifically, the most common diagnosis in the UHR group was psychosis. Moreover, in the UHR group, the social and occupational functioning score was the lowest. In terms of differences in PID-5 personality traits, the At-risk and UHR groups scored highest in detachment and disinhibition. No statistically significant differences were found between the groups for negative affectivity, antagonism, and psychoticism traits. Conclusion Results obtained by the current study should be considered an attempt to better understand the diagnostic trajectories and trans-diagnostic personality traits in a group of young help-seekers, specifically in UHR. Findings highlight both the importance of diagnosis and personality traits evaluation to customize a specific intervention based on the level of psychotic risk. Clinical suggestions are reported.
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Affiliation(s)
- Francesca De Salve
- Department of Psychology, Catholic University of Milan, Milan, Italy,*Correspondence: Francesca De Salve, ✉
| | - Chiara Rossi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Cesare Cavalera
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Malvini Lara
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Barbera Simona
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Tagliabue Sofia
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Percudani Mauro
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Oasi Osmano
- Department of Psychology, Catholic University of Milan, Milan, Italy,Oasi Osmano, ✉
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2
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Provenzani U, De Micheli A, Damiani S, Oliver D, Brondino N, Fusar-Poli P. Physical Health in Clinical High Risk for Psychosis Individuals: A Cross-Sectional Study. Brain Sci 2023; 13:128. [PMID: 36672109 PMCID: PMC9857012 DOI: 10.3390/brainsci13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The clinical high risk for psychosis (CHR-P) phase represents an opportunity for prevention and early intervention in young adults, which also could focus on improving physical health trajectories. METHODS We conducted a RECORD-compliant clinical register-based cohort study. The primary outcome was to describe the physical health of assessed CHR-P individuals, obtained via Electronic Health Records at the South London and Maudsley (SLaM) NHS Foundation Trust, UK (January 2013-October 2020). RESULTS The final database included 194 CHR-P subjects (46% female). Mean age was 23.70 ± 5.12 years. Percentage of tobacco smokers was 41% (significantly higher than in the age-matched general population [24%]). We found that 49% of subjects who consumed alcohol had an AUDIT-C (Alcohol Use Disorder Identification Test) score above 5 (hazardous drinking), with an average score of 4.94 (significantly higher than in the general population [2.75]). Investigating diet revealed low fiber intake in most subjects and high saturated fat intake in 10% of the individuals. We found that 47% of CHR-P subjects met the UK recommended physical activity guidelines (significantly lower than in the general population [66%]). Physical parameters (e.g., weight, heart rate, blood pressure) were not significantly different from the general population. CONCLUSIONS This evidence corroborates the need for monitoring physical health parameters in CHR-P subjects, to implement tailored interventions that target daily habits.
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Affiliation(s)
- Umberto Provenzani
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Andrea De Micheli
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Stefano Damiani
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Dominic Oliver
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Natascia Brondino
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Early Psychosis, Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK
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3
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van der Zeijst MCE, Veling W, Makhathini EM, Mbatha ND, Shabalala SS, van Hoeken D, Susser E, Burns JK, Hoek HW. Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study. Front Psychiatry 2022; 13:956003. [PMID: 36245859 PMCID: PMC9558832 DOI: 10.3389/fpsyt.2022.956003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs. Objective We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa. Materials and methods We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals. Results At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms. Conclusion In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.
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Affiliation(s)
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elliot M. Makhathini
- Department of Nursing, Durban University of Technology, Pietermaritzburg, South Africa
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ndukuzakhe D. Mbatha
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sinethemba S. Shabalala
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Jonathan K. Burns
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, Walker EF. Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:176-197. [PMID: 35815004 PMCID: PMC9258423 DOI: 10.1080/23794925.2022.2042874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.
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Affiliation(s)
- Joseph S. DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, , Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Laura H. Adery
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Shaynna N. Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, , New York, NY, USA
- New York Mental Illness Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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5
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Polari A, Yuen HP, Amminger P, Berger G, Chen E, deHaan L, Hartmann J, Markulev C, McGorry P, Nieman D, Nordentoft M, Riecher-Rössler A, Smesny S, Stratford J, Verma S, Yung A, Lavoie S, Nelson B. Prediction of clinical outcomes beyond psychosis in the ultra-high risk for psychosis population. Early Interv Psychiatry 2021; 15:642-651. [PMID: 32558302 DOI: 10.1111/eip.13002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022]
Abstract
AIM Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes. METHODS Several evidence-based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra-high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors. RESULTS When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes. CONCLUSION The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.
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Affiliation(s)
| | - Hok Pan Yuen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Amminger
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Lieuwe deHaan
- Academic Medical Centre, University of Amsterdam and Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Connie Markulev
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Dorien Nieman
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | - Stefan Smesny
- Department of Psychiatry, Universitätsklinikum Jena, Jena, Germany
| | | | - Swapna Verma
- Early Psychosis Intervention Programme (EPIP), Institute of Mental Health, Singapore, Singapore
| | - Alison Yung
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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6
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Izquierdo A, Cabello M, Leal I, Mellor-Marsá B, Ayora M, Bravo-Ortiz MF, Rodriguez-Jimenez R, Ibáñez Á, MacDowell KS, Malpica N, Díaz-Marsá M, Baca-García E, Fares-Otero NE, Melero H, López-García P, Díaz-Caneja CM, Arango C, Ayuso-Mateos JL. The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis. J Psychiatr Res 2021; 136:265-273. [PMID: 33621912 DOI: 10.1016/j.jpsychires.2021.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/15/2021] [Accepted: 02/08/2021] [Indexed: 01/14/2023]
Abstract
The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were "conceptual disorganization", "emotional withdrawal", "lack of spontaneity and flow of conversation", "delusions", "unusual thought content", "dealing with strangers" and "poor rapport". Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.
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Affiliation(s)
- Ana Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Cabello
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Itziar Leal
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Blanca Mellor-Marsá
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miriam Ayora
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - María-Fe Bravo-Ortiz
- Department of Psychiatry, Clinical Psychology and Mental Health, Hospital Universitario de La Paz, Hospital La Paz Institute for Health Research (IdiPAZ), School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángela Ibáñez
- Department of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Karina S MacDowell
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, CIBERSAM, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), IUIN-UCM, Madrid, Spain
| | - Norberto Malpica
- Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos, Madrid, Spain
| | - Marina Díaz-Marsá
- Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Diaz, Hospital Universitario Rey Juan Carlos, Hospital General de Villalba, Hospital Universitario Infanta Elena, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Universidad Católica del Maule, Talca, Chile
| | - Natalia E Fares-Otero
- Department of Psychiatry, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERSAM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Helena Melero
- Laboratorio de Análisis de Imagen Médica y Biometría (LAIMBIO), Universidad Rey Juan Carlos, Madrid, Spain
| | - Pilar López-García
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, IIS Princesa, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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7
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Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Predictors of remission from the ultra-high risk state for psychosis. Early Interv Psychiatry 2021; 15:104-112. [PMID: 31910496 DOI: 10.1111/eip.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 12/14/2019] [Indexed: 02/07/2023]
Abstract
AIM A significant proportion of individuals at Ultra-High Risk (UHR) for psychosis do not transition to manifest psychosis. Many non-transitioning UHR individuals do, however, display poor long-term outcomes such as persistence of attenuated psychotic symptoms. Evidence is scarce on which variables may predict a better clinical and functional prognosis such as remission from the UHR state. METHODS A total of 146 UHR individuals were enrolled in a randomized clinical trial (RCT), with this being analyses secondary to the RCT. Participants were assessed on multiple domains of symptoms, functioning, neuro- and social cognition. Regression analyses elucidated on the predictive power of these measures to remission from the UHR status (ie, not meeting UHR criteria) at 12-month follow-up. RESULTS Of the 91 UHR individuals attending 12-month follow-up, 33 (36%) exhibited remission from the UHR state. Regression analyses revealed baseline functioning to be a significant predictor of risk remission, and this was maintained when controlling for the effect of antipsychotic medication, gender and estimated IQ. The individuals with remission from the UHR state showed lower attenuated psychotic- and depressive symptoms along with better functioning at 12-month follow-up. CONCLUSION Our findings indicate functioning to be a contributor to the symptomatic recovery of UHR individuals, but a large amount of the variance on risk remission is, however, explained by other factors. Additionally, our findings suggest that UHR individuals with better functioning at ascertainment may present with a better clinical and functional prognosis, which may inform on the need for monitoring and intervention in this subgroup.
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Affiliation(s)
- Louise B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Tina D Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
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8
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Carrión RE, Auther AM, McLaughlin D, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman L, Stone W, Tsuang M, Walker EF, Woods SW, Torous J, Cornblatt BA. Social decline in the psychosis prodrome: Predictor potential and heterogeneity of outcome. Schizophr Res 2021; 227:44-51. [PMID: 33131983 DOI: 10.1016/j.schres.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND While an established clinical outcome of high importance, social functioning has been emerging as possibly having a broader significance to the evolution of psychosis and long term disability. In the current study we explored the association between social decline, conversion to psychosis, and functional outcome in individuals at clinical high risk (CHR) for psychosis. METHODS 585 subjects collected in the North American Prodrome Longitudinal Study (NAPLS2) were divided into 236 Healthy Controls (HCs), and CHR subjects that developed psychosis (CHR + C, N = 79), or those that did not (Non-Converters, CHR-NC, N = 270). CHR + C subjects were further divided into those that experienced an atypical decline in social functioning prior to baseline (beyond typical impairment levels) when in min-to-late adolescence (CHR + C-SD, N = 39) or those that did not undergoing a decline (CHR + C-NSD, N = 40). RESULTS Patterns of poor functional outcomes varied across the CHR subgroups: CHR-NC (Poor Social 36.3%, Role 42.2%) through CHR + C-NSD (Poor Social 50%, Poor Role 67.5%) to CHR + C-SD (Poor Social 76.9%, Poor Role 89.7%) functioning. The two Converter subgroups had comparable positive symptoms at baseline. At 12 months, the CHR + C-SD group stabilized, but social functioning levels remained significantly lower than the other two subgroups. CONCLUSIONS The current study demonstrates that pre-baseline social decline in mid-to-late adolescence predicts psychosis. In addition, we found that this social decline in converters is strongly associated with especially poor functional outcome and overall poorer prognosis. Role functioning, in contrast, has not shown similar predictor potential, and rather appears to be an illness indicator that worsens over time.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, United States
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Ming Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - John Torous
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
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9
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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Does cortical brain morphology act as a mediator between childhood trauma and transition to psychosis in young individuals at ultra-high risk? Schizophr Res 2020; 224:116-125. [PMID: 33071072 DOI: 10.1016/j.schres.2020.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/30/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Childhood trauma, particularly sexual abuse, has been associated with transition to psychosis in individuals at "ultra-high risk" (UHR). This study investigated whether the effects of various forms of childhood trauma on transition to psychosis are mediated by cortical thickness and surface area abnormalities. METHODS This prospective study used data from 62 UHR individuals from a previous (PACE 400) cohort study. At follow-up, 24 individuals had transitioned to psychosis (UHR-T) and 38 individuals had not transitioned (UHR-NT). Student-t/Mann-Whitney-U tests were performed to assess morphological differences in childhood trauma (low/high) and transition. Mediation analyses were conducted using regression and bootstrapping techniques. RESULTS UHR individuals with high sexual trauma histories presented with decreased cortical thickness in bilateral middle temporal gyri and the left superior frontal gyrus compared to those with low sexual trauma. Participants with high physical abuse had increased cortical thickness in the right middle frontal gyrus compared to those with low physical abuse. No differences were found for emotional abuse or physical/emotional neglect. Reduced cortical thickness in the right middle temporal gyrus and increased surface area in the right cingulate were found in UHR-T compared to UHR-NT individuals. Sexual abuse had an indirect effect on transition to psychosis, where decreased cortical thickness in the right middle temporal gyrus was a mediator. CONCLUSIONS Results suggest that childhood sexual abuse negatively impacted on cortical development of the right temporal gyrus, and this heightened the risk of transition to psychosis in our sample. Further longitudinal studies are needed to precisely understand this link.
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Azis M, Ristanovic I, Mittal VA. Hypnagogic and hypnopompic hallucinations: Considerations for clinical high-risk assessment and targets for future research. Schizophr Res 2020; 222:514-515. [PMID: 32446701 DOI: 10.1016/j.schres.2020.05.025] [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: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Matilda Azis
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, IL, USA; Department of Psychiatry, Feinberg School of Medicine, Northwestern University, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, IL, USA.
| | - Ivanka Ristanovic
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, IL, USA; Department of Psychiatry, Feinberg School of Medicine, Northwestern University, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, IL, USA; Department of Psychiatry, Feinberg School of Medicine, Northwestern University, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, IL, USA
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12
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Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Pompili M, Raballo A. Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study. Schizophr Res 2020; 220:98-105. [PMID: 32249122 DOI: 10.1016/j.schres.2020.03.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. METHODS 273 young people (13-35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory - II Edition (BDI), and the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. RESULTS UHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS "Anhedonia" scores, and showed a negative correlation with all WHOQOL-BREF scores. CONCLUSIONS Suicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Bologna, Via Castiglione n.29, 40124 Bologna (BO), Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa n.1035, 00189 Rome, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Piazza Università n.1, 06123 Perugia (PG), Italy
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Pontillo M, Tata MC, Averna R, Gargiullo P, Guerrera S, Vicari S. Clinical profile, conversion rate, and suicidal thinking and behaviour in children and adolescents at ultra-high risk for psychosis: a theoretical perspective. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:455. [PMID: 32913830 PMCID: PMC7451377 DOI: 10.4081/ripppo.2020.455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
Over the past years there has been substantial growing interest in the prodromes of psychosis to identify individuals at risk for psychosis prior to their first psychotic episode. Researchers have proposed criteria to detect young adults at Ultra-High Risk (UHR) for psychosis, and these criteria have also been applied to children and adolescents, though few clinical studies have examined this population. This theoretical perspective presents some of the crucial issues in the assessment and treatment of UHR children and adolescents: the presence of a specific clinical profile (i.e., different to that of healthy controls and UHR young adults), the predictive value of UHR criteria, and the presence and clinical significance of suicidal thinking and behaviour. In UHR children and adolescents, like UHR young adults, the presence of Attenuated Psychotic Symptoms (APS) is the most frequently reported inclusion criterion at baseline, with a prevalence of approximately 89–100%. In addition, there are frequently non-psychotic comorbid diagnoses of depressive and anxiety disorders. In contrast to the UHR adult population, UHR children and adolescents demonstrate a lower conversion rate to frank psychosis, most likely due to their high rate of APS. Finally, UHR adolescents report a high prevalence of suicidal ideation and self-injurious behaviour (67.5%), as well as a significantly greater frequency of attempted suicide, relative to adolescents with frank psychosis. On this basis, UHR children and adolescents report a clinical complexity that should be carefully monitored and considered for specific and targeted therapeutic interventions to be planned and developed.
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Affiliation(s)
- Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Roberto Averna
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome.,Institute of Psychiatry, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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Salokangas R, Patterson P, Heinimaa M, Svirskis T, From T, Vaskelainen L, Klosterkötter J, Ruhrmann S, von Reventlow H, Juckel G, Linszen D, Dingemans P, Birchwood M. Perceived negative attitude of others predicts transition to psychosis in patients at risk of psychosis. Eur Psychiatry 2020; 27:264-6. [DOI: 10.1016/j.eurpsy.2010.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/19/2010] [Accepted: 11/21/2010] [Indexed: 11/30/2022] Open
Abstract
AbstractAimOur previous study (Salokangas et al., 2009) suggested that the subjective experience of negative attitude of others (NAO) towards oneself is an early indicator of psychotic development. The aim of this prospective follow-up study was to test this hypothesis.MethodsA total of 55 young psychiatric outpatients assessed as being at current risk of psychosis (CROP) were followed for up to 60 months and rates of transition to psychosis (TTP) identified. CROP was assessed employing the Bonn Scale for assessment of basic symptoms (Schultze-Lutter and Klosterkötter, 2002) and the Structured Interview for prodromal symptoms (Miller et al., 2002). TTP was defined by a psychotic episode lasting for more than one week. Associations between NAO at baseline and TTP were analyzed by a Cox regression survival analysis.ResultsEight (14.5%) TTP were identified: four (57.1%) within seven NAO patients and four (8.7%) within forty-six non-NAO patients. In the multivariate Cox regression analysis, NAO at baseline significantly (P = 0.007) predicted TTP.ConclusionThe prospective follow-up results support our hypothesis that subjective experience of NAO is an early indicator of psychotic in development.
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Difficulty in making contact with others and social withdrawal as early signs of psychosis in adolescents – the Northern Finland Birth Cohort 1986. Eur Psychiatry 2020; 29:345-51. [DOI: 10.1016/j.eurpsy.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 11/19/2013] [Accepted: 11/29/2013] [Indexed: 11/21/2022] Open
Abstract
AbstractAimSocial withdrawal is among the first signs of the prodromal state of psychosis seen in clinical samples. The aim of this prospective study was to find out whether difficulty in making contact with others and social withdrawal precede first episode psychosis in the young general population.MethodsThe members of the Northern Finland Birth Cohort 1986 (n = 6274) completed the PROD-screen questionnaire in 2001–2002. The Finnish Hospital Discharge Register was used to detect both new psychotic and non-psychotic disorders requiring hospitalisation during 2003–2008.ResultsTwenty-three subjects developed psychosis and 89 developed a non-psychotic mental disorder requiring hospitalisation during the follow-up. Of those who developed psychosis, 35% had reported difficulty or uncertainty in making contact with others and 30% social withdrawal in adolescence. In hospitalised non-psychotic disorder, the corresponding precentages were 10 and 13% and in the control group without hospital-treated mental disorder 9 and 11%. The differences between psychotic and non-psychotic hospitalised subjects (P < 0.01) as well as controls (P < 0.001) were statistically significant regarding difficulty or uncertainty in making contact with others.ConclusionsIn this general population-based sample self-reported difficulty or uncertainty in making contact with others in adolescence preceded psychosis specifically compared to hospitalised non-psychotic mental disorders and controls.
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Kwakernaak S, Swildens WE, van Wel TF, Janssen RTJM. Symptomatic and Functional Remission in Young Adults with a Psychotic Disorder in a Rehabilitation Focused Team. Community Ment Health J 2020; 56:549-558. [PMID: 31820293 PMCID: PMC7056708 DOI: 10.1007/s10597-019-00512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 11/30/2019] [Indexed: 12/03/2022]
Abstract
The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR.
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Affiliation(s)
- Sascha Kwakernaak
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Wilma E. Swildens
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Tom F. van Wel
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Richard T. J. M. Janssen
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Health Care Governance, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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Mentalization and Psychosis: A Rationale for the Use of Mentalization Theory to Understand and Treat Non-affective Psychotic Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-019-09449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractSocial functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.
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Haining K, Matrunola C, Mitchell L, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms. Psychol Med 2020; 50:77-85. [PMID: 30862319 PMCID: PMC6949121 DOI: 10.1017/s0033291718003975] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning. METHODS CHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed. RESULTS CHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance. CONCLUSION The current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.
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Affiliation(s)
- Kate Haining
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Claire Matrunola
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Lucy Mitchell
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Ruchika Gajwani
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | - Joachim Gross
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | | | | | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Univ. of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
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Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A. Suicidal Thinking and Behavior in Adolescents at Ultra-High Risk of Psychosis: A Two-year Longitudinal Study. Suicide Life Threat Behav 2019; 49:1637-1652. [PMID: 30932235 DOI: 10.1111/sltb.12549] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Suicide risk in subjects at Ultra-High Risk of psychosis (UHR) has been rarely assessed in adolescence, but it is of obvious importance for prognostic and clinical care reasons. In this study, we aimed to prospectively assess suicide risk and behaviors in UHR adolescents. METHOD We examined 112 help-seeking adolescents (13-18 years, 50% males, 83.9% Caucasian) that were enrolled in the Reggio Emilia At-Risk Mental States (ReARMS) project and followed up for 2 years. Specific items derived from the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II) were used to assess suicide risk. Suicide attempts and completed suicides were also recorded. RESULTS Baseline assessment detected 40 UHR adolescents, 32 FEP (first-episode psychosis), and 40 non-UHR/FEP. We found that 67.5% of UHR adolescents had suicidal ideation, and 18.5% to severe degree. Attempted suicide before enrollment was higher in the UHR group than in non-UHR/FEP peers (17.5% vs. 2.5%). BDI-II suicidal ideation severity was stable at 12-month follow-up and decreased at 24-month follow-up. CONCLUSIONS A high prevalence of suicidal ideation among UHR adolescents was found and supports the routine monitoring of risk of self-injurious thinking and behavior in this at-risk population.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL di Bologna, Bologna, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
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El Bouhaddani S, Veling W, Schaefer B, Doreleijers T, van Domburgh L. Transdiagnostic school-based intervention for adolescents with early persistent psychiatric symptoms: An initial single-group effect study. Early Interv Psychiatry 2019; 13:1199-1207. [PMID: 30479043 DOI: 10.1111/eip.12755] [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: 06/06/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
AIM Mental health intervention programs for adolescents generally focus on specific symptoms, such as anxiety or depression. Psychiatric symptoms in adolescence are often heterogeneous, transient and shift over time. These characteristics require a transdiagnostic approach with emphasis on positive psychological development. This study aimed to examine the feasibility and effectiveness of Mastermind, a novel transdiagnostic intervention targeting general underlying mechanisms of psychiatric symptoms in adolescents. METHODS Adolescents were screened for psychiatric symptoms with the Strengths and Difficulties Scale in a school-based program in two consecutive years. Adolescents were eligible for the intervention when they had psychiatric symptoms at both screening assessments. Participants received an 8 weeks program containing elements of empowerment and attention bias modification. Psychiatric symptoms were assessed before the start of the intervention, immediately after the intervention and at 6-month follow-up. RESULTS A total of 241 adolescents were eligible for the intervention, of whom 80 participated (mean age 12.5 years). Generalized Estimating Equations, adjusted for gender and educational level, showed a decrease of negative attention bias, psychotic, anxiety, depression and behavioural symptoms immediately after intervention. The effects remained at follow-up. Overall risk for psychiatric disorders, distress and low self-esteem had decreased at follow-up. CONCLUSIONS A simple two-step school-based screening can identify adolescents with persistent psychiatric symptoms. The Mastermind transdiagnostic group intervention may be effective to reduce psychiatric symptoms, enhance self-esteem and lower the risk for developing psychiatric disorders.
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Affiliation(s)
| | - Wim Veling
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara Schaefer
- Parnassia Academie, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Theo Doreleijers
- Department of Child and Adolescent Psychiatry, VU Medical Centre, Amsterdam, the Netherlands
| | - Lieke van Domburgh
- Department of Child and Adolescent Psychiatry, VU Medical Centre, Amsterdam, the Netherlands.,Department of Research and Development, Pluryn - Intermetzo, Nijmegen, the Netherlands
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21
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Heins M, Achterhof R, Collip D, Viechtbauer W, Kirtley OJ, Gunther N, van Os J, Feron F, Myin-Germeys I. Social functioning and subclinical psychosis in adolescence: a longitudinal general adolescent population study. Acta Psychiatr Scand 2019; 140:275-282. [PMID: 31265122 DOI: 10.1111/acps.13069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the longitudinal relationship between subclinical psychotic symptoms and social functioning in a representative general population sample of adolescents. METHOD Data were derived from a routine general health screening of 1909 adolescents in a circumscribed region. Baseline measurement was in the second grade of secondary school (T0), and follow-up occurred approximately 2 years later (T1). Social functioning and subclinical psychotic symptoms of hallucinations and delusions were assessed at both time points. RESULTS Baseline (T0) social problems preceded follow-up (T1) subclinical delusions, but not T1 subclinical hallucinations. Similarly, T0 delusions preceded social problems at T1, but T0 hallucinations did not. CONCLUSION This longitudinal general population study demonstrated a bidirectional association between social problems and delusions, but found no link between social problems and hallucinations. This may reflect a downward negative spiral where delusional thoughts and social problems reinforce each other.
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Affiliation(s)
- M Heins
- Faculty of Science and Engineering, University College Maastricht, Maastricht University, Maastricht, the Netherlands
| | - R Achterhof
- Center for Contextual Psychiatry, Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - D Collip
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - W Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - O J Kirtley
- Center for Contextual Psychiatry, Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
| | - N Gunther
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
| | - J van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - F Feron
- Faculty of Health, Medicine and Life Sciences, Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - I Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
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22
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Pelizza L, Paterlini F, Azzali S, Garlassi S, Scazza I, Pupo S, Simmons M, Nelson B, Raballo A. The approved Italian version of the comprehensive assessment of at-risk mental states (CAARMS-ITA): Field test and psychometric features. Early Interv Psychiatry 2019; 13:810-817. [PMID: 29696795 DOI: 10.1111/eip.12669] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
AIM The Comprehensive Assessment of At-Risk Mental States (CAARMS) was specifically developed to assess and detect young people at ultra-high risk (UHR) of developing psychosis. The current study was undertaken to test the reliability and validity of the authorized Italian version of the CAARMS (CAARMS-ITA) in a help-seeking population. METHODS Psychometric properties of the CAARMS-ITA were established using a sample of 223 Italian adolescents and young adults aged between 13 and 35 years, who were divided into 3 groups according to the CAARMS criteria: UHR-negative individuals (UHR [-]; n = 64), UHR-positive (UHR [+]; n = 55) and individuals with a first-episode psychosis (FEP; n = 104). The CAARMS-ITA's reliability was tested measuring interrater reliability and internal consistency. Construct validity was tested comparing the Positive and Negative Syndrome Scale (PANSS) and CAARMS-ITA subscale scores across groups (ie, UHR [-], UHR [+] and FEP). For concurrent validity, we studied correlations between symptoms of the CAARMS-ITA and their equivalents in the PANSS. Finally, the predictive validity was examined by following up with UHR [+] individuals. The 12-month transition rate to psychosis was calculated. RESULTS The CAARMS-ITA showed good interrater reliability. The PANSS "Positive Symptoms" subscale scores in UHR [+] individuals were intermediate between FEP and UHR [-] groups. The positive and negative symptoms scores of the CAARMS-ITA significantly correlated with the corresponding scores of the PANSS. After 12 months, 4 of 41 (9.8%) UHR [+] individuals had transitioned to psychosis. CONCLUSIONS The CAARMS-ITA is a reliable and valid instrument for assessing and detecting at-risk mental states in Italian clinical settings. It also appears to be helpful in the prediction of psychosis transition.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Reggio Emilia Public Health Centre, Reggio Emilia, Italy
| | - Magenta Simmons
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Raballo
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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23
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Cotter J, Bucci S, Drake RJ, Yung AR, Carney R, Edge D. Exploring functional impairment in young people at ultra-high risk for psychosis: A qualitative study. Early Interv Psychiatry 2019; 13:789-797. [PMID: 29512314 DOI: 10.1111/eip.12560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 11/11/2017] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Abstract
AIM Many young people at ultra-high risk (UHR) of developing psychosis exhibit marked and persistent impairments in social and occupational functioning. We aimed to explore UHR patients' subjective experiences of these difficulties and their causes. METHODS We conducted semi-structured interviews with 20 UHR individuals recruited from Early Detection and Intervention Teams in Northwest England. Topics covered included how participants spent their time, their interpersonal relationships, academic and occupational performance, premorbid functioning and clinical treatment. Thematic analysis was used to examine the prevailing themes. RESULTS The sample included individuals with varying degrees of functional impairment, ranging from mild to severe difficulties in functioning. Analysis of the qualitative data elicited themes around 2 topics: breadth of functional difficulties and subjective reasons for poor functioning. Participants reported a range of impairments in their social and occupational functioning which they attributed to a combination of clinical, cognitive and psychological factors. These included variables previously identified in the quantitative literature such as psychiatric symptoms, adverse life experiences and cognitive deficits. However, our findings also included other factors which have received comparably little attention such as self-stigmatizing attitudes and dysfunctional metacognitive beliefs. CONCLUSIONS We propose a model that attempts to explain how these variables interact to drive and sustain functional impairment in the UHR population. This will assist in the development of clinical interventions aimed at promoting functional recovery among UHR individuals.
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Affiliation(s)
- Jack Cotter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Cambridge Cognition, Cambridge, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison R Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Rebekah Carney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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24
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Poletti M, Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Gebhardt E, Pupo S, Andrea R. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Eur Child Adolesc Psychiatry 2019; 28:957-971. [PMID: 30506419 DOI: 10.1007/s00787-018-1262-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/29/2018] [Indexed: 12/25/2022]
Abstract
The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13-18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy.
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, AUSL-IRCSS di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, AUSL di Bologna, Bologna, Italy
| | - Eva Gebhardt
- Cmed Polyspecialistic Diagnostic and Therapeutic Centre, Rome, Italy
| | - Simona Pupo
- Intensive Care Unit, Anesthesia and Resuscitation Service, Guastalla Civil Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raballo Andrea
- Department of Psychology, Childhood and Development Research Group, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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25
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Brüne M, Drommelschmidt KA, Krüger-Özgürdal S, Juckel G. Relationship between metacognitive beliefs and psychosocial performance in at-risk states of psychosis and patients with first psychotic episodes. Early Interv Psychiatry 2019; 13:604-612. [PMID: 29314591 DOI: 10.1111/eip.12536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 09/13/2017] [Accepted: 11/08/2017] [Indexed: 01/06/2023]
Abstract
AIMS Improving diagnostic batteries to identify individuals at-risk for developing psychotic disorders as early as possible is an ongoing challenge in schizophrenia research. Here, we sought to explore whether metacognition in at-risk of developing psychosis would differ from that of first episode psychosis and unaffected controls and whether dysfunctional metacognitive beliefs would be associated with psychosocial functioning in the clinical groups. METHODS Twenty-three subjects at-risk of psychosis were compared with a group of 15 first psychotic episode patients and 21 healthy controls with regard to their metacognitive beliefs and psychosocial functioning. Metacognition was assessed using the Metacognition Questionnaire (MCQ), psychosocial functioning was rated using the Personal and Social Performance Scale (PSP). Depression and anxiety were also evaluated. RESULTS The clinical groups differed significantly from controls in several MCQ scores, particularly the subscales "negative beliefs" and "need for control," as well as on all PSP scales. Furthermore, significant correlations emerged between the metacognition and psychosocial functioning. A mediation analysis revealed that dysfunctional metacognitive beliefs had no direct effect on psychosocial functioning, but was mediated by depressive symptoms. CONCLUSIONS These results corroborate findings assigning depressive symptoms an important role in early recognition of psychosis.
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Affiliation(s)
- Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Kim-Alisha Drommelschmidt
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Seza Krüger-Özgürdal
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Georg Juckel
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
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26
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Abstract
Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. This suggests that for many, their psychosocial disability is enduring, and targeted interventions are therefore needed earlier in their developmental trajectories to ensure that psychosocial disability does not become entrenched. Poor psychosocial functioning also affects individuals with a range of different emerging mental health problems, putting these young people at risk of long-term social marginalisation and economic disadvantage; all of which are known risk factors for the development of psychosis. Identification of the markers of poor psychosocial functioning will help to inform effective treatments. This editorial will discern the early trajectories and markers of poor psychosocial outcome in psychosis, and highlight which individuals are most at risk of having a poor outcome. This editorial will also discuss whether early interventions are currently being targeted appropriately and will propose how intervention and preventative strategies can be implemented, to restore psychosocial trajectories in a way that enables young people to maximise their life chances.
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27
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Hartmann JA, Nelson B, Ratheesh A, Treen D, McGorry PD. At-risk studies and clinical antecedents of psychosis, bipolar disorder and depression: a scoping review in the context of clinical staging. Psychol Med 2019; 49:177-189. [PMID: 29860956 DOI: 10.1017/s0033291718001435] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Identifying young people at risk of developing serious mental illness and identifying predictors of onset of illness has been a focus of psychiatric prediction research, particularly in the field of psychosis. Work in this area has facilitated the adoption of the clinical staging model of early clinical phenotypes, ranging from at-risk mental states to chronic and severe mental illness. It has been a topic of debate if these staging models should be conceptualised as disorder-specific or transdiagnostic. In order to inform this debate and facilitate cross-diagnostic discourse, the present scoping review provides a broad overview of the body of literature of (a) longitudinal at-risk approaches and (b) identified antecedents of (homotypic) illness progression across three major mental disorders [psychosis, bipolar disorder (BD) and depression], and places these in the context of clinical staging. Stage 0 at-risk conceptualisations (i.e. familial high-risk approaches) were identified in all three disorders. However, formalised stage 1b conceptualisations (i.e. ultra-high-risk approaches) were only present in psychosis and marginally in BD. The presence of non-specific and overlapping antecedents in the three disorders may support a general staging model, at least in the early stages of severe psychotic or mood disorders.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
| | - Devi Treen
- Department of Child and Adolescent Psychiatry and Psychology,Hospital Sant Joan de Déu,Barcelona
| | - Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health,Melbourne,Australia
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28
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Ärmänen A, Lahti M, Therman S, Suvisaari J, Lindgren M. Psychological, social and role functioning as predictors of psychosis in an adolescent psychiatric sample. Early Interv Psychiatry 2018; 12:1064-1071. [PMID: 28124493 DOI: 10.1111/eip.12414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/05/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022]
Abstract
AIM Recent evidence from psychosis risk studies of preselected samples suggests that early functional impairment may be a vulnerability marker for psychosis. We investigated whether functional impairment predicted later risk of psychotic disorder and psychiatric hospitalizations in adolescents at entry to general psychiatric services. METHODS A total of 154 adolescents, aged 15 to 18 years, were recruited to the study at entry to general adolescent psychiatric services in Helsinki, Finland. Structured Interview for Prodromal Syndrome and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder for DSM-IV, Clinical version interviews were used to assess psychotic-like symptoms, psychosis risk and psychiatric diagnoses. Of the adolescents, 46 met the criteria for clinical high risk status. The level of functioning was assessed with Global Functioning Social, Role and Psychological scales. The adolescents were followed for 3 to 9 (median = 5) years via a hospital discharge register. Cox regression analyses were used to examine whether baseline functioning predicted psychotic disorders and psychiatric hospitalizations when controlling for the effect of psychosis risk symptoms. RESULTS Impairments in social, role or psychological functioning did not predict psychotic disorders beyond risk symptoms. Impairment in psychological functioning was the only significant predictor of any psychiatric hospitalization after adjusting for positive psychosis risk symptom severity and level of social and role functioning. CONCLUSIONS Psychosis was predicted by psychotic-like experiences at entry to psychiatric services. No aspect of functioning predicted psychosis in adolescents, which is likely to be explained by the low incidence of psychosis transitions. Severe mental disorders as assessed by psychiatric hospitalizations were predicted by more severe symptomatology as assessed by the psychological functioning scale.
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Affiliation(s)
- Anna Ärmänen
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.,The Endocrinology Unit, British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sebastian Therman
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Maija Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
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29
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Koutsouleris N, Kambeitz-Ilankovic L, Ruhrmann S, Rosen M, Ruef A, Dwyer DB, Paolini M, Chisholm K, Kambeitz J, Haidl T, Schmidt A, Gillam J, Schultze-Lutter F, Falkai P, Reiser M, Riecher-Rössler A, Upthegrove R, Hietala J, Salokangas RKR, Pantelis C, Meisenzahl E, Wood SJ, Beque D, Brambilla P, Borgwardt S. Prediction Models of Functional Outcomes for Individuals in the Clinical High-Risk State for Psychosis or With Recent-Onset Depression: A Multimodal, Multisite Machine Learning Analysis. JAMA Psychiatry 2018; 75:1156-1172. [PMID: 30267047 PMCID: PMC6248111 DOI: 10.1001/jamapsychiatry.2018.2165] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Social and occupational impairments contribute to the burden of psychosis and depression. There is a need for risk stratification tools to inform personalized functional-disability preventive strategies for individuals in at-risk and early phases of these illnesses. OBJECTIVE To determine whether predictors associated with social and role functioning can be identified in patients in clinical high-risk (CHR) states for psychosis or with recent-onset depression (ROD) using clinical, imaging-based, and combined machine learning; assess the geographic, transdiagnostic, and prognostic generalizability of machine learning and compare it with human prognostication; and explore sequential prognosis encompassing clinical and combined machine learning. DESIGN, SETTING, AND PARTICIPANTS This multisite naturalistic study followed up patients in CHR states, with ROD, and with recent-onset psychosis, and healthy control participants for 18 months in 7 academic early-recognition services in 5 European countries. Participants were recruited between February 2014 and May 2016, and data were analyzed from April 2017 to January 2018. AIN OUTCOMES AND MEASURES Performance and generalizability of prognostic models. RESULTS A total of 116 individuals in CHR states (mean [SD] age, 24.0 [5.1] years; 58 [50.0%] female) and 120 patients with ROD (mean [SD] age, 26.1 [6.1] years; 65 [54.2%] female) were followed up for a mean (SD) of 329 (142) days. Machine learning predicted the 1-year social-functioning outcomes with a balanced accuracy of 76.9% of patients in CHR states and 66.2% of patients with ROD using clinical baseline data. Balanced accuracy in models using structural neuroimaging was 76.2% in patients in CHR states and 65.0% in patients with ROD, and in combined models, it was 82.7% for CHR states and 70.3% for ROD. Lower functioning before study entry was a transdiagnostic predictor. Medial prefrontal and temporo-parieto-occipital gray matter volume (GMV) reductions and cerebellar and dorsolateral prefrontal GMV increments had predictive value in the CHR group; reduced mediotemporal and increased prefrontal-perisylvian GMV had predictive value in patients with ROD. Poor prognoses were associated with increased risk of psychotic, depressive, and anxiety disorders at follow-up in patients in the CHR state but not ones with ROD. Machine learning outperformed expert prognostication. Adding neuroimaging machine learning to clinical machine learning provided a 1.9-fold increase of prognostic certainty in uncertain cases of patients in CHR states, and a 10.5-fold increase of prognostic certainty for patients with ROD. CONCLUSIONS AND RELEVANCE Precision medicine tools could augment effective therapeutic strategies aiming at the prevention of social functioning impairments in patients with CHR states or with ROD.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Marco Paolini
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | | | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - André Schmidt
- Department of Psychiatry, University Psychiatric Clinic, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - John Gillam
- Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Anita Riecher-Rössler
- Department of Psychiatry, University Psychiatric Clinic, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Rachel Upthegrove
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom,School of Psychology, University of Birmingham, United Kingdom
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia ,Melbourne Health, Melbourne, Australia
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephen J. Wood
- School of Psychology, University of Birmingham, United Kingdom,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Dirk Beque
- Corporate Global Research, GE Corporation, Munich, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, University Psychiatric Clinic, Psychiatric University Hospital, University of Basel, Basel, Switzerland
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Genetic risk for schizophrenia and autism, social impairment and developmental pathways to psychosis. Transl Psychiatry 2018; 8:204. [PMID: 30258131 PMCID: PMC6158250 DOI: 10.1038/s41398-018-0229-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 01/15/2023] Open
Abstract
While psychotic experiences (PEs) are assumed to represent psychosis liability, general population studies have not been able to establish significant associations between polygenic risk scores (PRS) and PEs. Previous work suggests that PEs may only represent significant risk when accompanied by social impairment. Leveraging data from the large longitudinal IMAGEN cohort, including 2096 14-year old adolescents that were followed-up to age 18, we tested whether the association between polygenic risk and PEs is mediated by (increasing) impairments in social functioning and social cognitive processes. Using structural equation modeling (SEM) for the subset of participants (n = 643) with complete baseline and follow-up data, we examined pathways to PEs. We found that high polygenic risk for schizophrenia (p = 0.014), reduced brain activity to emotional stimuli (p = 0.009) and social impairments in late adolescence (p < 0.001; controlling for functioning in early adolescence) each independently contributed to the severity of PEs at age 18. The pathway between polygenic risk for autism spectrum disorder and PEs was mediated by social impairments in late adolescence (indirect pathway; p = 0.025). These findings point to multiple direct and indirect pathways to PEs, suggesting that different processes are in play, depending on genetic loading, and environment. Our results suggest that treatments targeting prevention of social impairment may be particularly promising for individuals at genetic risk for autism in order to minimize risk for psychosis.
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Haidl T, Rosen M, Schultze-Lutter F, Nieman D, Eggers S, Heinimaa M, Juckel G, Heinz A, Morrison A, Linszen D, Salokangas R, Klosterkötter J, Birchwood M, Patterson P, Ruhrmann S. Expressed emotion as a predictor of the first psychotic episode - Results of the European prediction of psychosis study. Schizophr Res 2018; 199:346-352. [PMID: 29661524 DOI: 10.1016/j.schres.2018.03.019] [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: 08/24/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the impact of expressed emotion (EE) on the risk of developing the first psychotic episode (FEP). METHOD The European Prediction of Psychosis Study (EPOS) investigated 245 patients who were at clinical high risk (CHR) of psychosis. The predictive value of EE alone and as a part of the multivariate EPOS model was evaluated. RESULTS "Perceived irritability", a domain of the Level of Expressed Emotion Scale (LEE), was found to be predictive for the First Psychotic Episode (FEP), even as an individual variable. Furthermore, it was selected in the multivariate EPOS prediction model, thereby replacing two of the original predictor variables. This led to an improved revised version that enabled the identification of three significantly different risk classes with a hazard rate of up to 0.911. CONCLUSIONS CHR subjects who perceive the most important person in their individual social environment to be limited in their stress coping skills had a higher risk of conversion to the first psychotic episode. The importance of this risk factor was further demonstrated by an improvement of risk estimation in the original EPOS predictor model. Perceiving a reference person as stress-prone and thus potentially unreliable might amplify self-experienced uncertainty and anxiety, which are often associated with the prodromal phase. Such an enforcement of stress-related processes could promote a conversion to psychosis.
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Affiliation(s)
- Theresa Haidl
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Effingerstrasse 14a, 3011 Bern, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Dorien Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Susanne Eggers
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, Rakennus 11B, 20520 Turku, Finland
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Alexandrinenstraße 1, 344791 Bochum, Germany
| | - Andreas Heinz
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Anthony Morrison
- School of Psychological Sciences, University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Don Linszen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam-Zuidoost, Netherlands; Department of Psychiatry and Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands
| | - Raimo Salokangas
- Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, Rakennus 11B, 20520 Turku, Finland
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Paul Patterson
- Birmingham Children's Hospital, Steelhouse Ln, Birmingham B4 6NH, Birmingham, United Kingdom
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50934 Cologne, Germany.
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Simonsen C, Faerden A, Ueland T, Vaskinn A, Bjella T, Andreassen O, Romm KL, Melle I. Self-rated disability in first treated episode of psychosis: A 1-year follow-up study. Compr Psychiatry 2018; 85:48-54. [PMID: 29981504 DOI: 10.1016/j.comppsych.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Knowledge about self-rated disability over time in psychotic disorders is limited. How self-rated disability relates to clinician-rated global functioning, self-rated life satisfaction and symptomatology was investigated across the first year of treatment in early psychosis. METHODS Participants with first treated episode of psychosis (n = 115) were investigated at baseline and 1-year follow-up. Self-rated Disability was measured with World Health Organization- Disability Assessment Schedule 2.0. Clinician-rated global functioning, self-rated life satisfaction, and symptomatology were measured with appropriate scales. RESULTS Average self-rated disability in first-treated episode of psychosis was high, corresponding with the 10% highest in a general population sample. However, 37% were not disabled at a clinically significant level after one year. Self-rated disability was highest in the two social domains (Getting along with people and Participation in society), but improved significantly from baseline to 1-year. At 1-year follow-up self-rated disability had significant weak to medium correlations with clinician-rated global functioning and positive symptoms, and mainly medium to strong correlations with life satisfaction and depressive symptoms. Yet only baseline depression significantly predicted disability after one year. CONCLUSION Self-rated disability in first treated episode of psychosis is high, but improves across the first year, indicating signs of early recovery. Moreover, self-rated disability is related, but distinct from clinician-rated global functioning and self-rated life satisfaction, suggesting that self-rated disability should also be assessed in order to more fully describe outcomes in first episode psychosis. The findings highlight the need for specialised treatment of depression and social disability in early psychosis.
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Affiliation(s)
- Carmen Simonsen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Norway.
| | - Ann Faerden
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Torill Ueland
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Anja Vaskinn
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Thomas Bjella
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Ole Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kristin Lie Romm
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
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Pelizza L, Azzali S, Garlassi S, Paterlini F, Scazza I, Chiri LR, Pupo S, Raballo A. Adolescents at ultra-high risk of psychosis in Italian neuropsychiatry services: prevalence, psychopathology and transition rate. Eur Child Adolesc Psychiatry 2018; 27:725-737. [PMID: 29058115 DOI: 10.1007/s00787-017-1070-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022]
Abstract
Studies in adolescents on ultra-high risk (UHR) and basic symptoms (BS) criteria for psychosis prediction are scarce. In Italy, early interventions in psychosis are less widespread than in other European countries. In the present study, we (1) assessed the clinical relevance of a UHR diagnosis [according to the comprehensive assessment of at-risk mental states (CAARMS) criteria] to promote the implementation of specific services for UHR adolescents into the Italian health care system; (2) described severity of positive, negative, general, and basic symptoms in UHR adolescents compared to adolescents with first-episode psychosis (FEP) and non-UHR adolescents (i.e., individuals who did not meet CAARMS criteria for UHR or FEP); and (3) investigated the predictive validity of UHR criteria in relation to BS criteria. Seventy-nine adolescents (aged 13-18 years) were assessed with the CAARMS, the positive and negative syndrome scale (PANSS), and the schizophrenia proneness instrument, child and youth version (SPI-CY). Both UHR (n = 25) and FEP (n = 11) had significantly higher PANSS subscale scores compared to non-UHR (n = 43). UHR had significantly lower PANSS-positive symptom scores than FEP, but similar global functioning and PANSS-negative symptoms and general psychopathology scores. Compared to non-UHR, both FEP and UHR had more severe thought and perception BS disturbances, and significantly more often met BS criteria. After 12 months, 2 of 20 (10%) UHR had transitioned to psychosis. They also met both BS criteria. Given the uncertain outcome of UHR adolescents, future research is needed to determine whether the combined assessment of BS with UHR symptoms can improve the accuracy of psychosis prediction in adolescence.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy.
| | - Silvia Azzali
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Sara Garlassi
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Federica Paterlini
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Ilaria Scazza
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Addiction, Bologna Public Health Care Centre, Bologna, Italy
| | - Simona Pupo
- Reggio Emilia Public Health Care Centre, Guastalla Civil Hospital, Guastalla, RE, Italy
| | - Andrea Raballo
- Department of Mental Health and Addiction, Reggio Emilia Public Health Care Centre, c/o CSM Petrella, Via Petrella n.1/A, 42100, Reggio Emilia, RE, Italy
- Department of Psychology and Development, Norwegian University of Science and Technology, Trondheim, Norway
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Rietschel L, Lambert M, Karow A, Zink M, Müller H, Heinz A, de Millas W, Janssen B, Gaebel W, Schneider F, Naber D, Juckel G, Krüger-Özgürdal S, Wobrock T, Wagner M, Maier W, Klosterkötter J, Bechdolf A. Clinical high risk for psychosis: gender differences in symptoms and social functioning. Early Interv Psychiatry 2017; 11:306-313. [PMID: 25808791 DOI: 10.1111/eip.12240] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 02/16/2015] [Indexed: 01/15/2023]
Abstract
AIM Schizophrenia is a heterogeneous disorder that presents differently in men and women: men show a higher propensity to negative symptoms, lower social functioning, earlier age at onset and co-morbid substance abuse, whereas women display more affective symptoms. It is unknown whether these differences extend to subjects at high risk (HR) of psychosis. Thus, the aim of the present study was to address this question. METHODS Clinical symptoms and functioning were assessed using structured interviews in 239 HR subjects (female, n = 80). The definition of being at HR was based on the criteria used in the European Prediction of Psychosis Study (EPOS). RESULTS Men displayed more pronounced negative symptoms, higher rates of past substance abuse disorders and higher deficits in social functioning. No gender difference was found for depression, which affected almost 50% of the cohort, or age at onset for the fulfilment of HR criteria. CONCLUSION The higher impairment in specific symptoms observed in male schizophrenia patients was also present in subjects at HR for psychosis. Further studies are required to determine whether these symptoms are gender-specific predictors of transition to psychosis and whether they warrant gender-specific interventions. The high propensity to depression in the present cohort, which was particularly pronounced in the male cohort compared with the general population, in conjunction with the observed increase in negative symptoms and functional impairment, should alert clinicians to the necessity for the identification and treatment of HR subjects, irrespective of the degree to which these features are associated with transition risk.
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Affiliation(s)
- Liz Rietschel
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hendrik Müller
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charite University Medicine Campus Mitte, Berlin, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charite University Medicine Campus Mitte, Berlin, Germany
| | - Birgit Janssen
- 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
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Dieter Naber
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen and Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Gross-Umstadt, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Lo Cascio N, Curto M, Pasqualetti P, Lindau JF, Girardi N, Saba R, Brandizzi M, Monducci E, Masillo A, Colafrancesco G, Solfanelli A, De Crescenzo F, Kotzalidis GD, Dario C, Ferrara M, Vicari S, Girardi P, Auther AM, Cornblatt BA, Correll CU, Fiori Nastro P. Impairment in Social Functioning differentiates youth meeting Ultra-High Risk for psychosis criteria from other mental health help-seekers: A validation of the Italian version of the Global Functioning: Social and Global Functioning: Role scales. Psychiatry Res 2017; 253:296-302. [PMID: 28412612 DOI: 10.1016/j.psychres.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/26/2017] [Accepted: 04/02/2017] [Indexed: 11/30/2022]
Abstract
Social and occupational impairments are present in the schizophrenia prodrome, and poor social functioning predicts transition to psychosis in Ultra-High Risk (UHR) individuals. We aimed to: 1) validate the Italian version of the Global Functioning: Social (GF: S) and Global Functioning: Role (GF: S) scales; 2) evaluate their association with UHR criteria. Participants were 12-21-years-old (age, mean=15.2, standard deviation=2.1, male/female ratio=117/120) nonpsychotic help-seekers, meeting (N=39) or not (N=198) UHR criteria. Inter-rater reliability was excellent for both scales, which also showed good to excellent concurrent validity, as measured by correlation with Global Assessment of Functioning (GAF) scores. Furthermore, GF:S and GF: R were able to discriminate between UHRs and non-UHRs, with UHRs having lower current scores. After adjusting for current GAF scores, only current GF:S scores independently differentiated UHR from non-UHR (OR=1.33, 95%CI: 1.02-1.75, p=0.033). Finally, UHR participants showed a steeper decrease from highest GF:S and GF: R scores in the past year to their respective current scores, but not from highest past year GAF scores to current scores. GF:S/GS: R scores were not affected by age or sex. GF:S/GF: R are useful functional level and outcome measures, having the advantage over the GAF to not confound functioning with symptom severity. Additionally, the GF:S may be helpful in identifying UHR individuals.
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Affiliation(s)
- Nella Lo Cascio
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy; Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Martina Curto
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Patrizio Pasqualetti
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy; Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, AFaR Division, Rome, Italy
| | - Juliana Fortes Lindau
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, School of Medicine and Psychology, Sapienza University - Rome, Acute Psychiatric Care Unit, Sant'Andrea Hospital, Rome, Italy
| | - Nicoletta Girardi
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Riccardo Saba
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Martina Brandizzi
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Elena Monducci
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alice Masillo
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Giada Colafrancesco
- Pediatrics and Pediatric Neuropsychiatry Department, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Andrea Solfanelli
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, School of Medicine and Psychology, Sapienza University - Rome, Acute Psychiatric Care Unit, Sant'Andrea Hospital, Rome, Italy
| | - Franco De Crescenzo
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy; Institute of Psychiatry and Psychology, Catholic University Medical School, Agostino Gemelli Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, School of Medicine and Psychology, Sapienza University - Rome, Acute Psychiatric Care Unit, Sant'Andrea Hospital, Rome, Italy
| | - Claudia Dario
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Mauro Ferrara
- Pediatrics and Pediatric Neuropsychiatry Department, School of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Stefano Vicari
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, School of Medicine and Psychology, Sapienza University - Rome, Acute Psychiatric Care Unit, Sant'Andrea Hospital, Rome, Italy
| | - Andrea M Auther
- The Zucker Hillside Hospital Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, School of Medicine and Dentistry, Sapienza University, Rome, Italy
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Potentially important periods of change in the development of social and role functioning in youth at clinical high risk for psychosis. Dev Psychopathol 2017; 30:39-47. [PMID: 28420458 DOI: 10.1017/s0954579417000451] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The developmental course of daily functioning prior to first psychosis-onset remains poorly understood. This study explored age-related periods of change in social and role functioning. The longitudinal study included youth (aged 12-23, mean follow-up years = 1.19) at clinical high risk (CHR) for psychosis (converters [CHR-C], n = 83; nonconverters [CHR-NC], n = 275) and a healthy control group (n = 164). Mixed-model analyses were performed to determine age-related differences in social and role functioning. We limited our analyses to functioning before psychosis conversion; thus, data of CHR-C participants gathered after psychosis onset were excluded. In controls, social and role functioning improved over time. From at least age 12, functioning in CHR was poorer than in controls, and this lag persisted over time. Between ages 15 and 18, social functioning in CHR-C stagnated and diverged from that of CHR-NC, who continued to improve (p = .001). Subsequently, CHR-C lagged behind in improvement between ages 21 and 23, further distinguishing them from CHR-NC (p < .001). A similar period of stagnation was apparent for role functioning, but to a lesser extent (p = .007). The results remained consistent when we accounted for the time to conversion. Our findings suggest that CHR-C start lagging behind CHR-NC in social and role functioning in adolescence, followed by a period of further stagnation in adulthood.
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Cotter J, Bartholomeusz C, Papas A, Allott K, Nelson B, Yung AR, Thompson A. Examining the association between social cognition and functioning in individuals at ultra-high risk for psychosis. Aust N Z J Psychiatry 2017; 51:83-92. [PMID: 26698819 DOI: 10.1177/0004867415622691] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Social and role functioning are compromised for the majority of individuals at ultra-high risk of psychosis, and it is important to identify factors that contribute to this functional decline. This study aimed to investigate social cognitive abilities, which have previously been linked to functioning in schizophrenia, as potential factors that impact social, role and global functioning in ultra-high risk patients. METHOD A total of 30 ultra-high risk patients were recruited from an established at-risk clinical service in Melbourne, Australia, and completed a battery of social cognitive, neurocognitive, clinical and functioning measures. We examined the relationships between all four core domains of social cognition (emotion recognition, theory of mind, social perception and attributional style), neurocognitive, clinical and demographic variables with three measures of functioning (the Global Functioning Social and Role scales and the Social and Occupational Functioning Assessment Scale) using correlational and multiple regression analyses. RESULTS Performance on a visual theory of mind task (visual jokes task) was significantly correlated with both concurrent role ( r = 0.425, p = 0.019) and global functioning ( r = 0.540, p = 0.002). In multivariate analyses, it also accounted for unique variance in global, but not role functioning after adjusting for negative symptoms and stress. Social functioning was not associated with performance on any of the social cognition tasks. CONCLUSION Among specific social cognitive abilities, only a test of theory of mind was associated with functioning in our ultra-high risk sample. Further longitudinal research is needed to examine the impact of social cognitive deficits on long-term functional outcome in the ultra-high risk group. Identifying social cognitive abilities that significantly impact functioning is important to inform the development of targeted intervention programmes for ultra-high risk individuals.
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Affiliation(s)
- Jack Cotter
- 1 Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Cali Bartholomeusz
- 2 Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alicia Papas
- 2 Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kelly Allott
- 2 Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- 2 Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alison R Yung
- 1 Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Thompson
- 4 Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Kimhy D, Gill KE, Brucato G, Vakhrusheva J, Arndt L, Gross JJ, Girgis RR. The impact of emotion awareness and regulation on social functioning in individuals at clinical high risk for psychosis. Psychol Med 2016; 46:2907-2918. [PMID: 27050714 DOI: 10.1017/s0033291716000490] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Social functioning (SF) difficulties are ubiquitous among individuals at clinical high risk for psychosis (CHR), but it is not yet clear why. One possibility is suggested by the observation that effective SF requires adaptive emotion awareness and regulation. Previous reports have documented deficits in emotion awareness and regulation in individuals with schizophrenia, and have shown that such deficits predicted SF. However, it is unknown whether these deficits are present prior to the onset of psychosis or whether they are linked to SF in CHR individuals. METHOD We conducted a cross-sectional comparison of emotion awareness and regulation in 54 individuals at CHR, 87 with schizophrenia and 50 healthy controls (HC). Then, within the CHR group, we examined links between emotion awareness, emotion regulation and SF as indexed by the Global Functioning Scale: Social (Cornblatt et al. 2007). RESULTS Group comparisons indicated significant differences between HC and the two clinical groups in their ability to identify and describe feelings, as well as the use of suppression and reappraisal emotion-regulation strategies. Specifically, the CHR and schizophrenia groups displayed comparable deficits in all domains of emotion awareness and emotion regulation. A hierarchical multiple regression analysis indicated that difficulties describing feelings accounted for 23.2% of the SF variance. CONCLUSIONS The results indicate that CHR individuals display substantial emotion awareness and emotion-regulation deficits, at severity comparable with those observed in individuals with schizophrenia. Such deficits, in particular difficulties describing feelings, predate the onset of psychosis and contribute significantly to poor SF in this population.
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Affiliation(s)
- D Kimhy
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - K E Gill
- Department of Psychology,The Catholic University of America,Washington, DC,USA
| | - G Brucato
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - J Vakhrusheva
- Department of Psychiatry,Columbia University,New York, NY,USA
| | - L Arndt
- New York State Psychiatric Institute,New York, NY,USA
| | - J J Gross
- Department of Psychology,Stanford University,Stanford, CA,USA
| | - R R Girgis
- Department of Psychiatry,Columbia University,New York, NY,USA
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McLaughlin D, Carrión RE, Auther AM, Olvet DM, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Heinssen RK, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Goldberg TE, Harvey PD, Cornblatt BA. Functional Capacity Assessed by the Map Task in Individuals at Clinical High-Risk for Psychosis. Schizophr Bull 2016; 42:1234-42. [PMID: 27105902 PMCID: PMC4988745 DOI: 10.1093/schbul/sbw039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Recent studies have recognized that signs of functional disability in schizophrenia are evident in early phases of the disorder, and, as a result, can potentially serve as vulnerability markers of future illness. However, functional measures in the psychosis prodrome have focused exclusively on real-world achievements, rather than on the skills required to carry-out a particular real-world function (ie, capacity). Despite growing evidence that diminished capacity is critical to the etiology of the established disorder, virtually no attention has been directed towards assessing functional capacity in the pre-illness stages. In the present study, we introduce the Map task, a measure to assess functional capacity in adolescent and young-adult high-risk populations. METHODS The Map task was administered to 609 subjects at Clinical High-Risk (CHR) for psychosis and 242 Healthy Controls (HCs) participating in the North American Prodrome Longitudinal Study (NAPLS2). Subjects were required to efficiently complete a set of specified errands in a fictional town. RESULTS CHR participants showed large impairments across major indices of the Map task, relative to the HCs. Most importantly, poor performance on the Map task significantly predicted conversion to psychosis, even after adjusting for age, IQ, clinical state, and other potential confounders. CONCLUSIONS To the best of our knowledge, the Map task is one of the first laboratory-based measures to assess functional capacity in high-risk populations. Functional capacity deficits prior to the onset of psychosis may reflect a basic mechanism that underlies risk for psychosis. Early intervention targeting this domain may help to offset risk and independently improve long-term outcome.
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Affiliation(s)
- Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;
| | | | - Andrea M. Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;,Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY
| | - Doreen M. Olvet
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E. Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | | | - Tyrone D. Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT;,Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Robert K. Heinssen
- Division of Treatment and Prevention Research, National Institute of Mental Health, Rockville, MD
| | | | - Thomas H. McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA;,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | | | - Scott W. Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL;,Research Service, Bruce W. Carter VA Medical Center, Miami, FL
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Ising HK, Ruhrmann S, Burger NAFM, Rietdijk J, Dragt S, Klaassen RMC, van den Berg DPG, Nieman DH, Boonstra N, Linszen DH, Wunderink L, Smit F, Veling W, van der Gaag M. Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders. Psychol Med 2016; 46:1839-1851. [PMID: 26979398 DOI: 10.1017/s0033291716000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders. METHOD Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14-35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses. RESULTS At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class. CONCLUSIONS Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.
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Affiliation(s)
- H K Ising
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - N A F M Burger
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - J Rietdijk
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - S Dragt
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - R M C Klaassen
- Child and Adolescent Department,University Medical Centre,Utrecht,The Netherlands
| | - D P G van den Berg
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D H Nieman
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - N Boonstra
- Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands
| | - D H Linszen
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - L Wunderink
- Department of Education and Research,GGZ Friesland,Leeuwarden,The Netherlands
| | - F Smit
- VU University and EMGO+, Institute of Health and Care Research,Amsterdam,The Netherlands
| | - W Veling
- Department of Psychiatry,University Medical Center Groningen and University of Groningen,Groningen,The Netherlands
| | - M van der Gaag
- Department of Psychiatry,Parnassia Psychiatric Institute,The Hague,The Netherlands
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42
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Kambeitz-Ilankovic L, Meisenzahl EM, Cabral C, von Saldern S, Kambeitz J, Falkai P, Möller HJ, Reiser M, Koutsouleris N. Prediction of outcome in the psychosis prodrome using neuroanatomical pattern classification. Schizophr Res 2016; 173:159-165. [PMID: 25819936 DOI: 10.1016/j.schres.2015.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 01/11/2023]
Abstract
To date, research into the biomarker-aided early recognition of psychosis has focused on predicting the transition likelihood of clinically defined individuals with different at-risk mental states (ARMS) based on structural (and functional) brain changes. However, it is currently unknown whether neuroimaging patterns could be identified to facilitate the individualized prediction of symptomatic and functional recovery. Therefore, we investigated whether cortical surface alterations analyzed by means of multivariate pattern recognition methods could enable the single-subject identification of functional outcomes in twenty-seven ARMS individuals. Subjects were dichotomized into 'good' vs. 'poor' outcome groups on average 4years after the baseline MRI scan using a Global Assessment of Functioning (GAF) threshold of 70. Cortical surface-based pattern classification predicted good (N=14) vs. poor outcome status (N=13) at follow-up with an accuracy of 82% as determined by nested leave-one-cross-validation. Neuroanatomical prediction involved cortical area reductions in superior temporal, inferior frontal and inferior parietal areas and was not confounded by functional impairment at baseline, or antipsychotic medication and transition status over the follow-up period. The prediction model's decision scores were correlated with positive and general symptom scores in the ARMS group at follow-up, whereas negative symptoms were not linked to predicted poorer functional outcome. These findings suggest that poorer functional outcomes are associated with non-resolving attenuated psychosis and could be predicted at the single-subject level using multivariate neuroanatomical risk stratification methods. However, the generalizability and specificity of the suggested prediction model should be thoroughly investigated in future large-scale and cross-diagnostic MRI studies.
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Affiliation(s)
| | - Eva M Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Carlos Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Sebastian von Saldern
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
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43
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Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis. Eur Child Adolesc Psychiatry 2016; 25:7-16. [PMID: 25711287 DOI: 10.1007/s00787-015-0692-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.
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Social functioning as a predictor of the use of mental health resources in patients with severe mental disorder. Psychiatry Res 2015; 230:189-93. [PMID: 26343834 DOI: 10.1016/j.psychres.2015.08.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/28/2015] [Accepted: 08/30/2015] [Indexed: 11/21/2022]
Abstract
Previous studies have tried to determine the factors causing greater use of health resources by patients with mental disorders. These studies have essentially focused on socio-economic variables. Nevertheless, many other variables, such as social functioning, have not yet been explored. This study aims to assess the effect of social functioning on mental health service use in a sample of patients with severe mental disorder (schizophrenia, other psychotic disorders or bipolar affective disorder) in an area of Spain. The Social Functioning Scale (SFS) was administered to 172 family members of patients with a severe mental disorder who were receiving care at a community mental health unit. Analysis of bivariate logistic regression identified specific areas as predictors of the use of mental health resources over a 12-month follow-up period. The overall social functioning score predicted need for hospital admissions. In addition, interpersonal behaviour had a major role in the number of outpatient visits, while social isolation significantly predicted the need for hospitalization. These results point out the necessity for including psychosocial variables, such as social functioning in current mental health resource use models.
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45
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Sweeney S, Air T, Zannettino L, Galletly C. Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis. Front Public Health 2015; 3:259. [PMID: 26636059 PMCID: PMC4653578 DOI: 10.3389/fpubh.2015.00259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022] Open
Abstract
The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services.
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Affiliation(s)
- Shaun Sweeney
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Tracy Air
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Lana Zannettino
- School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
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46
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Quality of Life and Disability in Chinese People Living with Severe Mental Illness. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40737-015-0037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Cornblatt BA, Carrión RE, Auther A, McLaughlin D, Olsen RH, John M, Correll CU. Psychosis Prevention: A Modified Clinical High Risk Perspective From the Recognition and Prevention (RAP) Program. Am J Psychiatry 2015; 172:986-94. [PMID: 26046336 PMCID: PMC4993209 DOI: 10.1176/appi.ajp.2015.13121686] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Early intervention and prevention of psychosis remain a major challenge. Prediction would be greatly advanced with improved ability to identify individuals at true risk, which, at present, is moderate at best. The authors tested a modified strategy to improve prediction by selecting a more homogeneous high-risk sample (attenuated positive symptom criteria only, age range of mid-teens to early 20s) than is currently standard, combined with a systematic selection of neurodevelopmental deficits. METHOD A sample of 101 treatment-seeking adolescents (mean age, 15.9 years) at clinical high risk for psychosis were followed clinically for up to 5 years (mean follow-up time, 3.0 years, SD=1.6). Adolescents were included only if they exhibited one or more attenuated positive symptoms at moderate to severe, but not psychotic, severity levels. Cox regression was used to derive a risk index. RESULTS The overall conversion rate to psychosis was 28.3%. The final predictor model, with a positive predictive validity of 81.8%, consisted of four variables: disorganized communication, suspiciousness, verbal memory deficits, and decline in social functioning during follow-up. Significant effects also suggest narrowing the risk age range to 15-22 years. CONCLUSIONS Clinical high risk criteria that emphasize disorganized communication and suspiciousness while also including compromised verbal memory and declining social functioning have the potential to improve predictive accuracy compared with attenuated positive symptoms used alone. On the resulting risk index (a weighted combination of the predictors), low scores were interpreted as signifying minimal risk, with little treatment necessary, high scores as suggesting aggressive intervention, and intermediate scores, although less informative, as supporting psychosocial treatment.
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Fusar-Poli P, Rocchetti M, Sardella A, Avila A, Brandizzi M, Caverzasi E, Politi P, Ruhrmann S, McGuire P. Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis. Br J Psychiatry 2015; 207:198-206. [PMID: 26329563 DOI: 10.1192/bjp.bp.114.157115] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment. AIMS To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes. METHOD Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654). RESULTS People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did. CONCLUSIONS Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
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Affiliation(s)
- Paolo Fusar-Poli
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Matteo Rocchetti
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alberto Sardella
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Alessia Avila
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Martina Brandizzi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Edgardo Caverzasi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Pierluigi Politi
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Stephan Ruhrmann
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK
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49
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Falkenberg I, Valmaggia L, Byrnes M, Frascarelli M, Jones C, Rocchetti M, Straube B, Badger S, McGuire P, Fusar-Poli P. Why are help-seeking subjects at ultra-high risk for psychosis help-seeking? Psychiatry Res 2015; 228:808-15. [PMID: 26071897 DOI: 10.1016/j.psychres.2015.05.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
In addition to attenuated psychotic symptoms, individuals at high clinical risk of developing psychosis display a wide range of psychopathological features. Some of these may be subjectively perceived as more troubling than others and may therefore be more likely to trigger help-seeking behavior. We aimed at investigating the nature and prevalence of symptoms subjectively considered most distressing by high-risk individuals at the time of their presentation to early recognition services and to determine their impact on baseline and longitudinal functional and clinical outcomes. The clinical records of 221 clients meeting ultra-high risk (UHR) criteria and receiving care at a specialized early intervention service ("Outreach and Support in South London") between 2001 and 2011 were reviewed. Main outcome measures were reason to seek help as subjectively reported by the clients, comorbid DSM-IV SCID diagnoses, transition to psychosis, psychosocial functioning at baseline and after a median follow-up period of 4.5 years. Affective symptoms, i.e., depression and/or anxiety, were the most commonly reported subjective reasons to seek help (47.1%). Sub-threshold psychotic symptoms were reported by 39.8%. There was no significant association between subjective complaints at presentation and transition to psychosis. However, the group reporting affective symptoms as their main subjective reason to seek help at baseline had a significantly poorer longitudinal outcome in psychosocial functioning relative to the group reporting sub-threshold psychotic symptoms. Assessment of subjective complaints in UHR individuals at initial presentation may help to identify predictors of future functional outcome and tailor treatments accordingly.
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Affiliation(s)
- Irina Falkenberg
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Lucia Valmaggia
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Majella Byrnes
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Marianna Frascarelli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Ceri Jones
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany
| | - Steven Badger
- OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
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50
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Harrop C, Ellett L, Brand R, Lobban F. Friends interventions in psychosis: a narrative review and call to action. Early Interv Psychiatry 2015; 9:269-78. [PMID: 25130455 DOI: 10.1111/eip.12172] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Abstract
AIMS To highlight the importance of friendships to young people with psychosis, and the need for clinical interventions to help maintain peer relationships during illness. To structure a research agenda for developing evidence-based interventions with friends. METHOD An argument is developed through a narrative review of (i) the proven efficacy of family interventions, and (by comparison) a relative absence of friend-based interventions; (ii) the particular primacy of friendships and dating for young people, and typical effects of exclusion; and (iii) reduced friendship networks and dating experiences in psychosis, in pre-, during and post-psychosis phases, also links between exclusion and psychosis. RESULTS We put forward a model of how poor friendships can potentially be a causal and/or maintenance factor for psychotic symptoms. Given this model, our thesis is that interventions aiming to maintain social networks can be hugely beneficial clinically for young people with psychosis. We give a case study to show how such an intervention can work. CONCLUSIONS We call for 'friends interventions' for young people with psychosis to be developed, where professionals directly work with a young person's authentic social group to support key friendships and maintain social continuity. An agenda for future research is presented that will develop and test theoretically driven interventions.
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Affiliation(s)
- Chris Harrop
- Early Intervention Service, West London Mental Health Trust, Middlesex, UK
| | - Lyn Ellett
- Department of Clinical Psychology, Royal Holloway, University of London, Surrey, UK
| | - Rachel Brand
- Early Intervention Service, South West London and St Georges Mental Health Trust, London, UK
| | - Fiona Lobban
- Spectrum Centre, University of Lancaster, Lancaster, UK
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