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Pearson M, R Egglestone S, Winship G. The biological paradigm of psychosis in crisis: A Kuhnian analysis. Nurs Philos 2023; 24:e12418. [PMID: 36779230 DOI: 10.1111/nup.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 11/24/2022] [Accepted: 01/14/2023] [Indexed: 02/14/2023]
Abstract
The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy of Thomas Kuhn to explore the impact of what Kuhn terms 'anomalies' within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing.
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Bouter DC, Ravensbergen SJ, Lakerveld J, Hoogendijk WJG, Grootendorst-van Mil NH. Associations between the urban environment and psychotic experiences in adolescents. Schizophr Res 2023; 260:123-131. [PMID: 37639836 DOI: 10.1016/j.schres.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents. METHODS Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects. RESULTS Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = -0.46, 95 % CI -0.77; -0.14) and low greenspace density (B = -0.49, 95 % CI -0.73; -0.11), illustrating that these associations with PE were specific for boys. CONCLUSION Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.
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Affiliation(s)
- D C Bouter
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J Ravensbergen
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - J Lakerveld
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - N H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Demler VF, Sterner EF, Wilson M, Zimmer C, Knolle F. Association between increased anterior cingulate glutamate and psychotic-like experiences, but not autistic traits in healthy volunteers. Sci Rep 2023; 13:12792. [PMID: 37550354 PMCID: PMC10406950 DOI: 10.1038/s41598-023-39881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
Despite many differences, autism spectrum disorder and schizophrenia spectrum disorder share environmental risk factors, genetic predispositions as well as neuronal abnormalities, and show similar cognitive deficits in working memory, perspective taking, or response inhibition. These shared abnormalities are already present in subclinical traits of these disorders. The literature proposes that changes in the inhibitory GABAergic and the excitatory glutamatergic system could explain underlying neuronal commonalities and differences. Using magnetic resonance spectroscopy (1H-MRS), we investigated the associations between glutamate concentrations in the anterior cingulate cortex (ACC), the left/right putamen, and left/right dorsolateral prefrontal cortex and psychotic-like experiences (Schizotypal Personality Questionnaire) and autistic traits (Autism Spectrum Quotient) in 53 healthy individuals (26 women). To investigate the contributions of glutamate concentrations in different cortical regions to symptom expression and their interactions, we used linear regression analyses. We found that only glutamate concentration in the ACC predicted psychotic-like experiences, but not autistic traits. Supporting this finding, a binomial logistic regression predicting median-split high and low risk groups for psychotic-like experiences revealed ACC glutamate levels as a significant predictor for group membership. Taken together, this study provides evidence that glutamate levels in the ACC are specifically linked to the expression of psychotic-like experiences, and may be a potential candidate in identifying early risk individuals prone to developing psychotic-like experiences.
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Affiliation(s)
- Verena F Demler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Elisabeth F Sterner
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Martin Wilson
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, UK
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Franziska Knolle
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
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Magnani L, Carmisciano L, dell'Orletta F, Bettinardi O, Chiesa S, Imbesi M, Limonta G, Montagna E, Turone I, Martinasso D, Aguglia A, Serafini G, Amore M, Amerio A, Costanza A, Sibilla F, Calcagno P, Patti S, Molino G, Escelsior A, Trabucco A, Marzano L, Brunato D, Ravelli AA, Cappucciati M, Fiocchi R, Guerzoni G, Maravita D, Macchetti F, Mori E, Paglia CA, Roscigno F, Saginario A. Linguistic profile automated characterisation in pluripotential clinical high-risk mental state (CHARMS) conditions: methodology of a multicentre observational study. BMJ Open 2023; 13:e066642. [PMID: 36948562 PMCID: PMC10040055 DOI: 10.1136/bmjopen-2022-066642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Language is usually considered the social vehicle of thought in intersubjective communications. However, the relationship between language and high-order cognition seems to evade this canonical and unidirectional description (ie, the notion of language as a simple means of thought communication). In recent years, clinical high at-risk mental state (CHARMS) criteria (evolved from the Ultra-High-Risk paradigm) and the introduction of the Clinical Staging system have been proposed to address the dynamicity of early psychopathology. At the same time, natural language processing (NLP) techniques have greatly evolved and have been successfully applied to investigate different neuropsychiatric conditions. The combination of at-risk mental state paradigm, clinical staging system and automated NLP methods, the latter applied on spoken language transcripts, could represent a useful and convenient approach to the problem of early psychopathological distress within a transdiagnostic risk paradigm. METHODS AND ANALYSIS Help-seeking young people presenting psychological distress (CHARMS+/- and Clinical Stage 1a or 1b; target sample size for both groups n=90) will be assessed through several psychometric tools and multiple speech analyses during an observational period of 1-year, in the context of an Italian multicentric study. Subjects will be enrolled in different contexts: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa-IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Mental Health Department-territorial mental services (ASL 3-Genoa), Genoa, Italy; and Mental Health Department-territorial mental services (AUSL-Piacenza), Piacenza, Italy. The conversion rate to full-blown psychopathology (CS 2) will be evaluated over 2 years of clinical observation, to further confirm the predictive and discriminative value of CHARMS criteria and to verify the possibility of enriching them with several linguistic features, derived from a fine-grained automated linguistic analysis of speech. ETHICS AND DISSEMINATION The methodology described in this study adheres to ethical principles as formulated in the Declaration of Helsinki and is compatible with International Conference on Harmonization (ICH)-good clinical practice. The research protocol was reviewed and approved by two different ethics committees (CER Liguria approval code: 591/2020-id.10993; Comitato Etico dell'Area Vasta Emilia Nord approval code: 2022/0071963). Participants will provide their written informed consent prior to study enrolment and parental consent will be needed in the case of participants aged less than 18 years old. Experimental results will be carefully shared through publication in peer-reviewed journals, to ensure proper data reproducibility. TRIAL REGISTRATION NUMBER DOI:10.17605/OSF.IO/BQZTN.
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Affiliation(s)
- Luca Magnani
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Felice dell'Orletta
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Ornella Bettinardi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Silvia Chiesa
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Massimiliano Imbesi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Giuliano Limonta
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Elisa Montagna
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Ilaria Turone
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Dario Martinasso
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Andrea Aguglia
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Mario Amore
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Andrea Amerio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Department of Psychiatry, Service of Adult Psychiatry (SPA), University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Francesca Sibilla
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Pietro Calcagno
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Sara Patti
- Department of Mental Health and Pathological Addictions, Genoa Local Authority, Genoa, Liguria, Italy
| | - Gabriella Molino
- Department of Mental Health and Pathological Addictions, Genoa Local Authority, Genoa, Liguria, Italy
| | - Andrea Escelsior
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alice Trabucco
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Lisa Marzano
- Departement of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Dominique Brunato
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Andrea Amelio Ravelli
- Italian Natural Language Processing Lab, Institute of Computational Linguistics "Antonio Zampolli", CNR di Pisa, Pisa, Italy
| | - Marco Cappucciati
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Roberta Fiocchi
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Gisella Guerzoni
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Davide Maravita
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Fabio Macchetti
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Elisa Mori
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Chiara Anna Paglia
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Federica Roscigno
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
| | - Antonio Saginario
- Department of Mental Health and Pathological Addictions, Piacenza Local Authority, Piacenza, Italy
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Sá KN, Baptista RF, Shirahige L, Razza LB, Nogueira M, Coura MHF, Afonso-Santos L, Tanaka C, Baptista AF, Monte-Silva K, Brunoni AR. Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders. THE EUROPEAN JOURNAL OF PSYCHIATRY 2023. [DOI: 10.1016/j.ejpsy.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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6
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Fekih-Romdhane F, Farah N, Malaeb D, Cheour M, Obeid S, Hallit S. Validation of the Arabic Version of the Community Assessment of Psychic Experiences (CAPE-42) in a Large Sample of Young Adults from the General Population. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Yan L, Kang C, Wang X, Yang L, Zhao N, Zhang X. Association of serum lipid levels with psychotic symptoms in young, first-episode and drug naïve outpatients with major depressive disorder: A large-scale cross-sectional study. Psychiatry Res 2022; 317:114864. [PMID: 36179590 DOI: 10.1016/j.psychres.2022.114864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/03/2022] [Accepted: 09/24/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) patients with psychotic symptoms have more complex clinical symptoms and higher relapse rates. The purpose of this study was to compare serum lipid differences between psychotic major depressive disorder (PMD) and non-psychotic major depressive disorder (NPMD) in a large sample of young first-episode drug naïve (FEDN) patients. METHODS We recruited 1289 young MDD patients. Socio-demographic information, clinical data, and lipid parameters were collected. The Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the positive symptom subscale of the Positive and Negative Syndrome Scale were used to assess patients' depressive, anxiety and psychotic symptoms, respectively. RESULTS Compared with the NPMD group, the PMD group had higher HAMD, HAMA scores, and higher TC, TG, and LDL-C levels. Correlation analysis showed that psychotic symptoms were significantly associated with the total score of HAMD and HAMA, and the levels of serum lipid. In addition, logistic regression analysis found that TC was associated with psychotic symptoms in young FEDN MDD patients. CONCLUSION Our results suggest TC levels may be associated with psychotic symptoms in young MDD patients. The importance of regular psychotic symptom assessment in young MDD patients with high TC levels should be taken into account.
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Affiliation(s)
- Lijuan Yan
- Department of Psychiatry and Psychology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuanyi Kang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaohong Wang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Liying Yang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Na Zhao
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Ma WF, Yeh TP, Ho YF, Chang SM, Lin YP. The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university. Perspect Psychiatr Care 2022; 58:1372-1380. [PMID: 34462933 DOI: 10.1111/ppc.12939] [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: 11/11/2020] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS This screen model can be used in early detection for undergraduates with HRDP from large general samples.
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Affiliation(s)
- Wei-Fen Ma
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,College of Health Care, Ph.D Program for Health Science and Industry, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Tzu-Pei Yeh
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Ya-Fang Ho
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Shan-Mei Chang
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
| | - Yun-Ping Lin
- College of Health Care, School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taichung, Taiwan
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Zhao J, Lu XH, Liu Y, Wang N, Chen DY, Lin IA, Li XH, Zhou FC, Wang CY. The Unique Contribution of Past Bullying Experiences to the Presence of Psychosis-Like Experiences in University Students. Front Psychiatry 2022; 13:839630. [PMID: 35573375 PMCID: PMC9096161 DOI: 10.3389/fpsyt.2022.839630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Both bullying and psychosis-like experiences (PLEs) have gained much attention in recent years, but their interactions are not fully unraveled. The aim of the current study was to validate the Chinese version of Bullying Scale for Adults (C-BSA), and to investigate whether past bullying experiences independently predict the presence of PLEs in university students. METHODS The validity and reliability of the C-BSA were determined in two independent samples. A battery of psychological inventories was also administered to assess the presence of PLEs, maltreatment history in the family, and current depression and anxiety, including the 15-item positive subscale of the community assessment of psychic experiences (CAPE-p15), the Chinese version of the Childhood Trauma Questionnaire (CTQ), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). RESULTS In the construction sample (N = 629), a Cronbach's α of 0.921 indicated a good internal consistency of C-BSA. The exploratory factor analysis (EFA) yielded a four-factor model and a three-factor model, and both were verified by using the confirmatory factorial analysis (CFA) in the validation sample (N = 629). The total scores of C-BSA were significantly correlated with that of CTQ, CAPE-p15, SDS, and SAS. Multivariate logistic regression revealed that bullying was associated with 2.0 or 3.7 times of risk for the presence of PLEs (numbers of bullying types < = 3 or > 3, respectively) after controlling for CTQ, SDS, and SAS scores. CONCLUSIONS C-BSA has shown good psychometric properties in college students. The contribution of past bullying experiences to the present PLEs seems to be independent of other childhood trauma, current depression, and anxiety.
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Affiliation(s)
- Jie Zhao
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Xiao-Hua Lu
- Psychological Consulting Center, Beijing Jiaotong University, Beijing, China
| | - Yuan Liu
- Nursing Department, National University Polyclinic, Singapore, Singapore
| | - Nan Wang
- Department of General Psychiatry, Central Region, Institute of Mental Health, Singapore, Singapore
| | - Dong-Yang Chen
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Iun-An Lin
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Fu-Chun Zhou
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Chuan-Yue Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
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10
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Adjorlolo S, Anum A. Positive and negative psychosis risk symptoms among adolescents in Ghana. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1933110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Ghana
- Research and Grant Institute of Ghana, Legon, Ghana
| | - Adote Anum
- Department of PsychologySchool of Social Sciences, College of Humanities, University of Ghana, Legon, Ghana
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Knolle F, Ronan L, Murray GK. The impact of the COVID-19 pandemic on mental health in the general population: a comparison between Germany and the UK. BMC Psychol 2021; 9:60. [PMID: 33892807 PMCID: PMC8064888 DOI: 10.1186/s40359-021-00565-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to dramatic social and economic changes in daily life. First studies report an impact on mental health of the general population showing increased levels of anxiety, stress and depression. In this study, we compared the impact of the pandemic on two culturally and economically similar European countries: the UK and Germany. METHODS Participants (UK = 241, German = 541) completed an online-survey assessing COVID-19 exposure, impact on financial situation and work, substance and media consumption, mental health using the Symptom-Check-List-27 (SCL-27) and the Schizotypal Personality Questionnaire. RESULTS We found distinct differences between the two countries. UK responders reported a stronger direct impact on health, financial situation and families. UK responders had higher clinical scores on the SCL-27, and higher prevalence. Interestingly, German responders were less hopeful for an end of the pandemic and more concerned about their life-stability. CONCLUSION As 25% of both German and UK responders reported a subjective worsening of the general psychological symptoms and 20-50% of German and UK responders reached the clinical cut-off for depressive and dysthymic symptoms as well as anxieties, it specifically shows the need for tailored intervention systems to support large proportions of the general public.
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Affiliation(s)
- Franziska Knolle
- grid.6936.a0000000123222966Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany ,grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Lisa Ronan
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Graham K. Murray
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.450563.10000 0004 0412 9303Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK ,grid.5335.00000000121885934Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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12
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Abstract
Psychiatry's most recent foray into the area of risk and prevention has been spear-headed by work on at-risk mental states for psychotic disorders. Twenty-five years' research and clinical application have led us to reformulate the clinical evolution of these syndromes, blurred unhelpful conceptual boundaries between childhood and adult life by adopting a developmental view and has changed the shape of many mental health services as part of a global movement to increase quality. But there are problems: fragmentary psychotic experiences are common in young people but transition from risk-state to full syndrome is uncommon away from specialist clinics with rarefied referrals and can, anyway, be subtle; diagnostic over-shadowing by the prospect of schizophrenia and other psychotic disorders may divert clinical attention from the kaleidoscopic and disabling range of probably treatable psychopathology with which people with risk syndromes present. We use a 19th Century lyric poem, The Lady of Shallot, as an allegory for Psychiatry warning us against regarding these mental states only as pointers towards diagnoses that probably will not occur. Viewed from the fresh perspective of common mental disorders they tell us a great deal about the psychopathological crucible of the second and third decades, the nature of diagnosis, and point towards new treatment paradigms.
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Affiliation(s)
- Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, NR4 7TJ, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
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13
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Hartmann JA, McGorry PD, Destree L, Amminger GP, Chanen AM, Davey CG, Ghieh R, Polari A, Ratheesh A, Yuen HP, Nelson B. Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach. Front Psychiatry 2021; 11:553578. [PMID: 33488413 PMCID: PMC7819892 DOI: 10.3389/fpsyt.2020.553578] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/02/2020] [Indexed: 12/26/2022] Open
Abstract
Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a "pluripotent" approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
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Affiliation(s)
- Jessica A. Hartmann
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick D. McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Louise Destree
- BrainPark, The Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - G. Paul Amminger
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew M. Chanen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G. Davey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Rachid Ghieh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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14
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Morrison AP, Pyle M, Byrne R, Broome M, Freeman D, Johns L, James A, Husain N, Whale R, MacLennan G, Norrie J, Hudson J, Peters S, Davies L, Bowe S, Smith J, Shiers D, Joyce E, Jones W, Hollis C, Maughan D. Psychological intervention, antipsychotic medication or a combined treatment for adolescents with a first episode of psychosis: the MAPS feasibility three-arm RCT. Health Technol Assess 2021; 25:1-124. [PMID: 33496261 PMCID: PMC7869006 DOI: 10.3310/hta25040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis. OBJECTIVES The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options. DESIGN This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial. SETTING Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear. PARTICIPANTS People aged 14-18 years experiencing a first episode of psychosis either with an International Classification of Diseases, Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months. INTERVENTIONS Psychological intervention involved up to 26 hours of cognitive-behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant's psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication. MAIN OUTCOME MEASURES The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events. RESULTS We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention, n = 18; antipsychotic medication, n = 22; combined treatment, n = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive-behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small. LIMITATIONS Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects. CONCLUSIONS It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness. FUTURE WORK An adequately powered definitive trial is required to provide robust evidence. TRIAL REGISTRATION Current Controlled Trials ISRCTN80567433. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Johns
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony James
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Nusrat Husain
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Early Intervention in Psychosis Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Richard Whale
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emmeline Joyce
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Wendy Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chris Hollis
- National Institute for Health Research MindTech MedTech Co-operative, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Daniel Maughan
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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Aloba O, Opakunle T. The Brief 10-Item Community Assessment of Psychic Experiences-Positive Scale (Brief CAPE-P10): Initial psychometric properties, gender measurement invariance and mean differences among Nigerian adolescents. Early Interv Psychiatry 2020; 14:723-733. [PMID: 31749283 DOI: 10.1111/eip.12903] [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: 11/20/2018] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate the Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) for its psychometric properties in terms of its reliability and validity, in addition to its factor structure and gender measurement invariance among Nigerian adolescents (n = 1336, Mage = 15.15). METHODS The sample consisted of 606 (45.4%) males, who completed the 20-items CAPE-P in addition to the Positive and Negative Suicide Ideation Inventory (PANSI), the Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale (RSES). We compared 11 a priori models of the CAPE-P with the aim of identifying the one with the best fit indices applying Confirmatory Factor Analysis (CFA). Gender measurement invariance was examined with nested multiple-group confirmatory factor analysis (MGCFA). RESULTS All the 11 a priori models had poor fit indices. An examination of the scale's 20 items revealed that 10 items had poor correlation with the overall scale. The remaining 10 items which we labelled as the Brief CAPE-P10 were subjected to CFA which yielded a 3-factor model (Bizarre Experiences-5 items, Delusional Ideation-3 items and Perceptual Anomalies-2 items) with satisfactory fit indices (CFI = 0.961, SRMR = 0.0376, RMSEA = 0.062/90% CI = 0.052-0.069). The validity and reliability of the Brief CAPE-P10 and its subscales were modestly satisfactory. MGCFA affirmed the configural, metric and scalar gender invariance of the 3-factor Brief CAPE-P10. CONCLUSIONS The Brief CAPE-P10 is a promising instrument for the evaluation of PLEs among Nigerian adolescents.
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Affiliation(s)
- Olutayo Aloba
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tolulope Opakunle
- Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria
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Chaplin AB, Jones PB, Khandaker GM. Association between common early-childhood infection and subsequent depressive symptoms and psychotic experiences in adolescence: a population-based longitudinal birth cohort study. Psychol Med 2020; 52:1-11. [PMID: 33183379 PMCID: PMC9386436 DOI: 10.1017/s0033291720004080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/09/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Childhood infections are associated with adult psychosis and depression, but studies of psychotic experiences (PEs) and depressive symptoms in childhood, adolescence, and early-adulthood are scarce. Previous studies have typically examined severe infections, but studies of common infections are also scarce. METHODS Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, we examined associations of the number of infections in childhood from age 1.5 to 7.5 years with depressive symptom scores at age 10, 13, 14, 17, 18, and 19 years, and with PEs at 12 and 18 years. We performed additional analysis using infection burden ('low' = 0-4 infections, 'medium' = 5-6, 'high' = 7-9, or 'very high' = 10-22 infections) as the exposure. RESULTS The risk set comprised 11 786 individuals with childhood infection data. Number of childhood infections was associated with depressive symptoms from age 10 (adjusted beta = 0.14; standard error (s.e.) = 0.04; p = <0.01) to 17 years (adjusted beta = 0.17; s.e. = 0.08; p = 0.04), and with PEs at age 12 (suspected/definite PEs: adjusted odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.09-1.27). These effect sizes were larger when the exposure was defined as very high infection burden (depressive symptoms age 17: adjusted beta = 0.79; s.e. = 0.29; p = 0.01; suspected/definite PEs at age 12: adjusted OR = 1.60; 95% CI = 1.25-2.05). Childhood infections were not associated with depressive/psychotic outcomes at age 18 or 19. CONCLUSIONS Common early-childhood infections are associated with depressive symptoms up to mid-adolescence and with PEs subsequently in childhood, but not with these outcomes in early-adulthood. These findings require replication including larger samples with outcomes in adulthood.
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Affiliation(s)
- Anna B. Chaplin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Venuleo C, Salvatore G, Ruggieri RA, Marinaci T, Cozzolino M, Salvatore S. Steps Towards a Unified Theory of Psychopathology: The Phase Space of Meaning Model. CLINICAL NEUROPSYCHIATRY 2020; 17:236-252. [PMID: 34908999 PMCID: PMC8629070 DOI: 10.36131/cnfioritieditore20200405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The hypothesis of a general psychopathology factor (p factor) has been advanced in recent years. It is an innovation with breakthrough potential, in the perspective of a unified view of psychopathology; however, what remains a controversial topic is how its nature might be conceptualized. The current paper outlines a semiotic, embodied and psychoanalytic conceptualization of psychopathology - the Phase Space of Meaning (PSM) model - aimed at providing ontological grounds to the p factor hypothesis. Framed within a more general model of how the mind works, the PSM model maintains that the p factor can be conceived as the empirical marker of the degree of rigidity of the meaning-maker's way of interpreting experience, namely of the dimensions of meanings used to map the environment's variability. As to the clinical implications, two main aspects are outlined. First, according PSM model, psychopathology is not an invariant condition, and does not have a set dimensionality, but is able to vary it locally, in order to address the requirement of situated action. Second, psychopathology is conceived as one of the mind's modes of working, rather than the manifestation of its disruption. Finally, the puzzling issue of the interplay between stability and variability in the evolutionary trajectories of patients along with their life events is addressed and discussed.
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Affiliation(s)
- Claudia Venuleo
- Department of History, Society, and Human Studies, University of Salento, Lecce, Italy
| | | | | | - Tiziana Marinaci
- Department of History, Society, and Human Studies, University of Salento, Lecce, Italy
| | - Mauro Cozzolino
- Department of Human, Philosophical and Training Sciences, University of Salerno, Salerno, Italy
| | - Sergio Salvatore
- Department of Dynamic and Clinical Psychology, University La Sapienza, Rome, Italy
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Gin K, Stewart C, Jolley S. A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms. Clin Psychol Psychother 2020; 28:56-78. [DOI: 10.1002/cpp.2493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Kimberley Gin
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
| | - Catherine Stewart
- South London and Maudsley NHS Foundation Trust United Kingdom of Great Britain and Northern Ireland London UK
| | - Suzanne Jolley
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
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Iorfino F, Scott EM, Carpenter JS, Cross SP, Hermens DF, Killedar M, Nichles A, Zmicerevska N, White D, Guastella AJ, Scott J, McGorry PD, Hickie IB. Clinical Stage Transitions in Persons Aged 12 to 25 Years Presenting to Early Intervention Mental Health Services With Anxiety, Mood, and Psychotic Disorders. JAMA Psychiatry 2019; 76:1167-1175. [PMID: 31461129 PMCID: PMC6714017 DOI: 10.1001/jamapsychiatry.2019.2360] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
Importance The large contribution of psychiatric disorders to premature death and persistent disability among young people means that earlier identification and enhanced long-term care for those who are most at risk of developing life-threatening or chronic disorders is critical. Clinical staging as an adjunct to diagnosis to address emerging psychiatric disorders has been proposed for young people presenting for care; however, the longer-term utility of this system has not been established. Objectives To determine the rates of transition from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders and to identify the demographic and clinical characteristics that are associated with the time course of these transitions. Design, Setting, and Participants A longitudinal, observational study of 2254 persons aged 12 to 25 years who obtained mental health care at 2 early intervention mental health services in Sydney, Australia, and were recruited to a research register between June 18, 2008, and July 24, 2018 (the Brain and Mind Centre Optymise Cohort). Main Outcomes and Measures The primary outcome of this study was transition from earlier to later clinical stages. A multistate Markov model was used to examine demographic (ie, age, sex, engagement in education, employment, or both) and clinical (ie, social and occupational function, clinical presentation, personal history of mental illness, physical health comorbidities, treatment use, self-harm, suicidal thoughts and behaviors) factors associated with these transitions. Results Of the 2254 individuals included in the study, mean (SD) age at baseline was 18.18 (3.33) years and 1330 (59.0%) were female. Data on race/ethnicity were not available. Median (interquartile range) follow-up was 14 (5-33) months. Of 685 participants at stage 1a (nonspecific symptoms), 253 (36.9%) transitioned to stage 1b (attenuated syndromes). Transition was associated with lower social functioning (hazard ratio [HR], 0.77; 95% CI, 0.66-0.90), engagement with education, employment, or both (HR, 0.47; 95% CI, 0.25-0.91), manic-like experiences (HR, 2.12; 95% CI, 1.19-3.78), psychotic-like experiences (HR, 2.13; 95% CI, 1.38-3.28), self-harm (HR, 1.42; 95% CI, 1.01-1.99), and older age (HR, 1.27; 95% CI, 1.11-1.45). Of 1370 stage 1b participants, 176 (12.8%) transitioned to stage 2 (full-threshold) disorders. Transition was associated with psychotic-like experiences (HR, 2.31; 95% CI, 1.65-3.23), circadian disturbance (HR, 1.66; 95% CI, 1.17-2.35), psychiatric medication (HR, 1.43; 95% CI, 1.03-1.99), childhood psychiatric disorder (HR, 1.62; 95% CI, 1.03-2.54), and older age (HR, 1.24; 95% CI, 1.05-1.45). Conclusions and Relevance Differential rates of progression from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders were observed in young persons who presented for care at various stages. Understanding the rate and factors associated with transition assists planning of stage-specific clinical interventions and secondary prevention trials.
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Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Elizabeth M. Scott
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
- The University of Notre Dame, St Vincent’s and Mater Clinical School, Sydney, New South Wales, Australia
| | - Joanne S. Carpenter
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Shane P. Cross
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Daniel F. Hermens
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Madhura Killedar
- Sydney Informatics Hub, University of Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Django White
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Adam J. Guastella
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, United Kingdom
| | - Patrick D. McGorry
- Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Ian B. Hickie
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
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Gross ME, Araujo DB, Zedelius CM, Schooler JW. Is perception the missing link between creativity, curiosity and schizotypy? Evidence from spontaneous eye-movements and responses to auditory oddball stimuli. Neuroimage 2019; 202:116125. [DOI: 10.1016/j.neuroimage.2019.116125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/01/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022] Open
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21
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Soneson E, Russo D, Knight C, Lafortune L, Heslin M, Stochl J, Georgiadis A, Galante J, Duschinsky R, Grey N, Gonzalez-Blanco L, Couche J, Griffiths M, Murray H, Reeve N, Hodgekins J, French P, Fowler D, Byford S, Dixon-Woods M, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:124. [PMID: 31122287 PMCID: PMC6533690 DOI: 10.1186/s13643-019-1041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions. METHODS Our search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis. DISCUSSION The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033869.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Margaret Heslin
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Alex Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Robbie Duschinsky
- The Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | | | - Leticia Gonzalez-Blanco
- Department of Psychiatry, University of Oviedo - CIBERSAM - Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - Juliet Couche
- Health in Mind, Sussex Partnership NHS Foundation Trust, Woodside, The Drive, Hellingly, East Sussex, BN27 4ER, UK
| | | | - Hannah Murray
- Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology, Elizabeth Fry Building, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK
| | - Sarah Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
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22
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Ajnakina O, David AS, Murray RM. 'At risk mental state' clinics for psychosis - an idea whose time has come - and gone! Psychol Med 2019; 49:529-534. [PMID: 30585562 DOI: 10.1017/s0033291718003859] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
At Risk Mental State (ARMS) clinics are specialised mental health services for young, help-seeking people, thought to be at ultra-high risk of developing psychosis. Their stated purpose is to reduce transitions from the ARMS state to clinical psychotic disorder. Reports of ARMS clinics provide 'evidence-based recommendations' or 'guidance' for the treatment of such individuals, and claim that such clinics prevent the development of psychosis. However, we note that in an area with a very well-developed ARMS clinic (South London), only a very small proportion (4%) of patients with first episode psychosis had previously been seen at this clinic with symptoms of the ARMS. We conclude that the task of reaching sufficient people to make a major contribution to the prevention of psychosis is beyond the power of ARMS clinics. Following the preventative approaches used for many medical disorders (e.g. lung cancer, coronary artery disease), we consider that a more effective way of preventing psychosis will be to adopt a public health approach; this should attempt to decrease exposure to environmental factors such as cannabis use which are known to increase risk of the disorder.
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Affiliation(s)
- Olesya Ajnakina
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Palermo, Italy
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23
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Abnormal reward prediction-error signalling in antipsychotic naive individuals with first-episode psychosis or clinical risk for psychosis. Neuropsychopharmacology 2018; 43:1691-1699. [PMID: 29748629 PMCID: PMC6006166 DOI: 10.1038/s41386-018-0056-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022]
Abstract
Ongoing research suggests preliminary, though not entirely consistent, evidence of neural abnormalities in signalling prediction errors in schizophrenia. Supporting theories suggest mechanistic links between the disruption of these processes and the generation of psychotic symptoms. However, it is unknown at what stage in the pathogenesis of psychosis these impairments in prediction-error signalling develop. One major confound in prior studies is the use of medicated patients with strongly varying disease durations. Our study aims to investigate the involvement of the meso-cortico-striatal circuitry during reward prediction-error signalling in earliest stages of psychosis. We studied patients with first-episode psychosis (FEP) and help-seeking individuals at-risk for psychosis due to sub-threshold prodromal psychotic symptoms. Patients with either FEP (n = 14), or at-risk for developing psychosis (n = 30), and healthy volunteers (n = 39) performed a reinforcement learning task during fMRI scanning. ANOVA revealed significant (p < 0.05 family-wise error corrected) prediction-error signalling differences between groups in the dopaminergic midbrain and right middle frontal gyrus (dorsolateral prefrontal cortex, DLPFC). FEP patients showed disrupted reward prediction-error signalling compared to controls in both regions. At-risk patients showed intermediate activation in the midbrain that significantly differed from controls and from FEP patients, but DLPFC activation that did not differ from controls. Our study confirms that FEP patients have abnormal meso-cortical signalling of reward-prediction errors, whereas reward-prediction-error dysfunction in the at-risk patients appears to show a more nuanced pattern of activation with a degree of midbrain impairment but preserved cortical function.
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24
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Blair MA, Nitzburg G, DeRosse P, Karlsgodt KH. Relationship between executive function, attachment style, and psychotic like experiences in typically developing youth. Schizophr Res 2018; 197:428-433. [PMID: 29510927 PMCID: PMC6120806 DOI: 10.1016/j.schres.2018.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 11/25/2022]
Abstract
Psychotic like experiences (PLE's) are common in the general population, particularly during adolescence, which has generated interest in how PLE's emerge, and the extent to which they reflect either risk for, or resilience to, psychosis. The "attachment-developmental-cognitive" (ADC) model is one effort to model the effect of risk factors on PLEs. The ADC model proposes attachment insecurity as an early environmental insult that can contribute to altered neurodevelopment, increasing the likelihood of PLE's and psychosis. In particular, early-life attachment disruptions may negatively impact numerous aspects of executive function (EF), including behavioral inhibition and emotion regulation. Yet despite the relationship of disrupted attachment to EF impairments, no studies have examined how these factors may combine to contribute to PLE's in adolescents. Here, we examined the relative contributions of daily-life EF and attachment difficulties (avoidance and anxiety) to PLEs in typically developing youth (N=52; ages 10-21). We found that EF deficits and high attachment insecurity both accounted for a significant proportion of the variance in PLE's, and interacted to predict PLE manifestation. Specifically, positive PLEs were predicted by greater trouble monitoring behavioral impact, less difficulty completing tasks, greater difficulty regulating emotional reactions, greater difficulty controlling impulses and higher attachment anxiety. Negative PLEs were predicted by greater difficulty in alternating attention, transitioning across situations, and regulating emotional reactions as well as higher attachment anxiety. These results are consistent with the ADC model, providing evidence that early-life attachment disruptions may impact behavioral regulation and emotional control, which together may contribute to PLEs.
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Affiliation(s)
- Melanie A. Blair
- Graduate Center—City University of New York, New York, NY, United States,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, United States,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of the Northwell Health System, Glen Oaks, NY, United States
| | - George Nitzburg
- Teachers College, Columbia University, New York, NY, United States,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, United States,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of the Northwell Health System, Glen Oaks, NY, United States
| | - Pamela DeRosse
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, United States,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of the Northwell Health System, Glen Oaks, NY, United States,Hofstra Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, United States
| | - Katherine H. Karlsgodt
- Depts of Psychology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, United States,Corresponding author at: Dept of Psychology, UCLA, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, United States, (K.H. Karlsgodt)
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25
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Perez J, Russo DA, Stochl J, Clarke J, Martin Z, Jassi C, French P, Fowler D, Jones PB. Common mental disorder including psychotic experiences: Trailblazing a new recovery pathway within the Improving Access to Psychological Therapies programme in England. Early Interv Psychiatry 2018; 12:497-504. [PMID: 28509391 DOI: 10.1111/eip.12434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/05/2017] [Accepted: 01/19/2017] [Indexed: 12/12/2022]
Abstract
Psychotic experiences, depressive and anxiety symptoms may be manifestations of a latent continuum of common mental distress. The Improving Access to Psychological Therapies (IAPT) programme has increased the reach of psychological treatments to people with common mental disorders in England. However, psychotic experiences are neither measured nor considered in therapy. We aimed to confirm the presence of psychotic experiences among IAPT service-users and determine whether these experiences are associated with higher depression/anxiety levels and poorer recovery. All service-users that attended the Fenland and Peterborough IAPT teams in Cambridgeshire between November 16, 2015 and January 29, 2016 participated in a service evaluation. In addition to routine mesures, such as the Generalized Anxiety Disorder-7 questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), we introduced a shortened version of the Community Assessment of Psychic Experiences (CAPE-P15) to measure psychotic experiences. Classes of individuals were identified with latent class analysis. Associations were reported using Pearson correlation coefficient. One hundred and seventy-three services-users were included, mostly females (N = 133; 76.9%). The mean age was 36.6 (SD = 13.3). Around 30% likely belonged to a class with psychotic experiences. CAPE-P15 frequency was significantly correlated to PHQ-9 (r = 0.44; P < .001) and GAD-7 (r = 0.32; P < .001). Similarly, CAPE-P15 distress and both PHQ-9 (r = 0.43; P < .001) and GAD-7 (r = 0.38; P < .001) were highly correlated. These associations were replicated after the initial period of the therapy, indicating poor recovery. Some IAPT service-users suffer psychotic experiences. Tailoring available evidence-based psychological therapies for these people in IAPT settings might trailblaze a new care pathway to improve recovery in this group.
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Affiliation(s)
- Jesus Perez
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - Debra A Russo
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - James Clarke
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Zoe Martin
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Christina Jassi
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, UK
| | - Peter B Jones
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
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26
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Depression and clinical high-risk states: Baseline presentation of depressed vs. non-depressed participants in the NAPLS-2 cohort. Schizophr Res 2018; 192:357-363. [PMID: 28578922 PMCID: PMC6342468 DOI: 10.1016/j.schres.2017.05.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/20/2022]
Abstract
Depressed mood appears to be highly prevalent in clinical high risk (CHR) samples. However, many prior CHR studies utilize modest size samples and do not report on the specific impact of depression on CHR symptoms. The aim of the current paper is to investigate the prevalence of depressive disorders and the impact of lifetime depression on baseline clinical presentation and longitudinal outcomes in a large cohort of individuals meeting CHR criteria in the second phase of the North American Prodrome Longitudinal Study (NAPLS-2). Depression was assessed both categorically (via DSM-IV-TR diagnoses) and symptomatically (using a clinician-rated scale of depressive symptoms) within a sample of 764 individuals at CHR and 279 controls. Current and lifetime depressive disorders were highly prevalent (60%) in this sample. Depression diagnoses were associated with more pronounced negative and general symptoms; individuals with remitted depression had significantly less severe negative, disorganized, and general symptoms and better social and role functioning relative to those with current depression. Current mood disturbance, as measured by scores on a clinician-rated symptom scale, contributed beyond the impact of positive and negative symptoms to impairments in social functioning. Both symptomatic and diagnostic baseline depression was significantly associated with decreased likelihood of remission from CHR status; however depression did not differentially distinguish persistent CHR status from transition to psychosis at follow-up. These findings suggest that depressed mood may function as a marker of poor prognosis in CHR, yet effective treatment of depression within this population can yield improvements in symptoms and functioning.
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27
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Chen F, Wang L, Wang J, Heeramun-Aubeeluck A, Yuan J, Zhao X. Applicability of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome in a college population. Early Interv Psychiatry 2016; 10:308-15. [PMID: 25113068 DOI: 10.1111/eip.12173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population. METHODS The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS). RESULTS The internal consistency reliability was good (Cronbach's α = 0.72). The test-retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39-0.67, P < 0.001). A cut-off CPQ-16 score of 9 was used to differentiate between those with a APS diagnosis on the SIPS versus those with no SIPS diagnoses; this cut-off value yielded 85% sensitivity, 87% specificity, a positive predictive value of 63% and a positive likelihood ratio of 6.69. The area under the ROC curve (AUC) was significant for the CPQ-16 total score (AUC = 0.93, SE = 0.026, 95% CI = 0.87-0.98, P < 0.001). Based on the proposed cut-off score, the CPQ-16 yielded a positive rate of 5.0% (29/579). CONCLUSIONS The CPQ-16, administered in a face-to-face interview, demonstrated high reliability and the ability to identify college students at risk for psychosis.
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Affiliation(s)
- Fazhan Chen
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Wang
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jikun Wang
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Jiabei Yuan
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xudong Zhao
- Department of Psychosomatic Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.,Faculty of Humanities and Behavioral Medicine, Tongji University School of Medicine, Shanghai, China
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28
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Variation in psychosocial influences according to the dimensions and content of children's unusual experiences: potential routes for the development of targeted interventions. Eur Child Adolesc Psychiatry 2016; 25:311-9. [PMID: 26149604 DOI: 10.1007/s00787-015-0739-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
The psychosocial processes implicated in the development and maintenance of psychosis differ according to both the dimensional attributes (conviction, frequency, associated distress, adverse life impact) and the content or type (e.g. grandiosity, hallucinations, paranoia) of the psychotic symptoms experienced. This has informed the development of 'targeted' cognitive behavioural therapy for psychosis (CBTp): interventions focusing on specific psychological processes in the context of particular symptom presentations. In adults, larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic CBTp approaches with multiple therapeutic foci. We set out to test the theoretical basis for developing targeted CBTp interventions for young people with distressing psychotic-like, or unusual, experiences (UEs). We investigated variations in the psychosocial processes previously associated with self-reported UE severity (reasoning, negative life events, emotional problems) according to UE dimensional attributes and content/type (using an established five-factor model) in a clinically referred sample of 72 young people aged 8-14 years. Regression analyses revealed associations of conviction and grandiosity with reasoning; of frequency, and hallucinations and paranoia, with negative life events; and of distress/adverse life impact, and paranoia and hallucinations, with emotional problems. We conclude that psychological targets for intervention differ according to particular characteristics of childhood UEs in much the same way as for psychotic symptoms in adults. The development of targeted interventions is therefore indicated, and tailoring therapy according to presentation should further improve clinical outcomes for these young people.
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29
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Mark W, Toulopoulou T. Psychometric Properties of "Community Assessment of Psychic Experiences": Review and Meta-analyses. Schizophr Bull 2016; 42:34-44. [PMID: 26150674 PMCID: PMC4681550 DOI: 10.1093/schbul/sbv088] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Community Assessment of Psychic Experiences (CAPE) has been used extensively as a measurement for psychosis proneness in clinical and research settings. However, no prior review and meta-analysis have comprehensively examined psychometric properties (reliability and validity) of CAPE scores across different studies. To study CAPE's internal reliability--ie, how well scale items correlate with one another--111 studies were reviewed. Of these, 18 reported unique internal reliability coefficients using data at hand, which were aggregated in a meta-analysis. Furthermore, to confirm the number and nature of factors tapped by CAPE, 17 factor analytic studies were reviewed and subjected to meta-analysis in cases of discrepancy. Results suggested that CAPE scores were psychometrically reliable--ie, scores obtained could be attributed to true score variance. Our review of factor analytic studies supported a 3-factor model for CAPE consisting of "Positive", "Negative", and "Depressive" subscales; and a tripartite structure for the Negative dimension consisting of "Social withdrawal", "Affective flattening", and "Avolition" subdimensions. Meta-analysis of factor analytic studies of the Positive dimension revealed a tridimensional structure consisting of "Bizarre experiences", "Delusional ideations", and "Perceptual anomalies". Information on reliability and validity of CAPE scores is important for ensuring accurate measurement of the psychosis proneness phenotype, which in turn facilitates early detection and intervention for psychotic disorders. Apart from enhancing the understanding of psychometric properties of CAPE scores, our review revealed questionable reporting practices possibly reflecting insufficient understanding regarding the significance of psychometric properties. We recommend increased focus on psychometrics in psychology programmes and clinical journals.
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30
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Wikström A, Tuulio-Henriksson A, Perälä J, Saarni S, Suvisaari J. Psychotic like experiences (PLE's) in middle-aged adults. Schizophr Res 2015; 169:313-317. [PMID: 26507638 DOI: 10.1016/j.schres.2015.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Annamaria Wikström
- National Institute for Health and Welfare, Department of Health, Mental Health Unit, PO Box 30, 00271 Helsinki, Finland; Department of Psychology, PO Box 9, University of Helsinki, 00014 Helsinki, Finland.
| | - Annamari Tuulio-Henriksson
- National Institute for Health and Welfare, Department of Health, Mental Health Unit, PO Box 30, 00271 Helsinki, Finland; Department of Psychology, PO Box 9, University of Helsinki, 00014 Helsinki, Finland; Social Insurance Institution, Research Department, PO Box 450, 00101 Helsinki, Finland.
| | - Jonna Perälä
- National Institute for Health and Welfare, Department of Health, Mental Health Unit, PO Box 30, 00271 Helsinki, Finland; Department of Psychiatry, PO Box 63, University of Helsinki, 00014 Helsinki, Finland.
| | - Samuli Saarni
- National Institute for Health and Welfare, Department of Health, Mental Health Unit, PO Box 30, 00271 Helsinki, Finland; Turku University Hospital and University of Turku, 20014 Turku, Finland.
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Health, Mental Health Unit, PO Box 30, 00271 Helsinki, Finland; Department of Social Psychiatry, Tampere School of Public Health, 33014 Tampere, Finland.
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31
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Arrondo G, Segarra N, Metastasio A, Ziauddeen H, Spencer J, Reinders NR, Dudas RB, Robbins TW, Fletcher PC, Murray GK. Reduction in ventral striatal activity when anticipating a reward in depression and schizophrenia: a replicated cross-diagnostic finding. Front Psychol 2015; 6:1280. [PMID: 26379600 PMCID: PMC4549553 DOI: 10.3389/fpsyg.2015.01280] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022] Open
Abstract
In the research domain framework (RDoC), dysfunctional reward expectation has been proposed to be a cross-diagnostic domain in psychiatry, which may contribute to symptoms common to various neuropsychiatric conditions, such as anhedonia or apathy/avolition. We used a modified version of the Monetary Incentive Delay (MID) paradigm to obtain functional MRI images from 22 patients with schizophrenia, 24 with depression and 21 controls. Anhedonia and other symptoms of depression, and overall positive and negative symptomatology were also measured. We hypothesized that the two clinical groups would have a reduced activity in the ventral striatum when anticipating reward (compared to anticipation of a neutral outcome) and that striatal activation would correlate with clinical measures of motivational problems and anhedonia. Results were consistent with the first hypothesis: two clusters in both the left and right ventral striatum were found to differ between the groups in reward anticipation. Post-hoc analysis showed that this was due to higher activation in the controls compared to the schizophrenia and the depression groups in the right ventral striatum, with activation differences between depression and controls also seen in the left ventral striatum. No differences were found between the two patient groups, and there were no areas of abnormal cortical activation in either group that survived correction for multiple comparisons. Reduced ventral striatal activity was related to greater anhedonia and overall depressive symptoms in the schizophrenia group, but not in the participants with depression. Findings are discussed in relation to previous literature but overall are supporting evidence of reward system dysfunction across the neuropsychiatric continuum, even if the specific clinical relevance is still not fully understood. We also discuss how the RDoC approach may help to solve some of the replication problems in psychiatric fMRI research.
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Affiliation(s)
- Gonzalo Arrondo
- Department of Psychiatry, University of CambridgeCambridge, UK
| | - Nuria Segarra
- Department of Psychiatry, University of CambridgeCambridge, UK
| | | | - Hisham Ziauddeen
- Department of Psychiatry, University of CambridgeCambridge, UK
- Wellcome Trust-MRC Institute of Metabolic ScienceCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
| | - Jennifer Spencer
- Department of Psychiatry, University of CambridgeCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
| | | | - Robert B. Dudas
- Department of Psychiatry, University of CambridgeCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
- Psychiatric Liaison Service, Ipswich HospitalNorfolk and Suffolk NHS Foundation Trust, UK
| | - Trevor W. Robbins
- Department of Psychology, University of CambridgeCambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridge, UK
| | - Paul C. Fletcher
- Department of Psychiatry, University of CambridgeCambridge, UK
- Wellcome Trust-MRC Institute of Metabolic ScienceCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridge, UK
| | - Graham K. Murray
- Department of Psychiatry, University of CambridgeCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustUK
- Behavioural and Clinical Neuroscience Institute, University of CambridgeCambridge, UK
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32
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Morenz R, Woolverton C, Frost RB, Kiewel NA, Breitborde NJK. Clinical correlates of distorted auditory perception in first-episode psychosis. Early Interv Psychiatry 2015; 9:248-51. [PMID: 24863860 DOI: 10.1111/eip.12150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 03/25/2014] [Indexed: 11/27/2022]
Abstract
AIM Auditory hallucinations are hypothesized to be based in distorted sensory perceptions, with increasingly distorted perceptions of reality possibly prompting the first psychotic phase of schizophrenia spectrum disorders. Our goal was to examine the association between distorted auditory perceptions and psychotic symptomatology, social functioning and quality of life among individuals with first-episode psychosis. METHODS Forty individuals with first-episode psychosis completed assessments of distorted auditory perception, psychotic symptomatology, social functioning and quality of life. RESULTS Both negative (greater symptomatology) and positive clinical correlates (better quality of life) were associated with greater distorted auditory perceptions. CONCLUSIONS Our findings suggest that distorted auditory perceptions are associated with both positive and negative clinical correlates among individuals with first-episode psychosis. These results highlight the potential clinical importance of balancing the goal of symptomatic reduction with the need to maintain healthy coping strategies that may be biologically and psychologically entwined with the symptoms of psychosis, themselves.
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Affiliation(s)
- Rachel Morenz
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA
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33
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Stochl J, Khandaker GM, Lewis G, Perez J, Goodyer IM, Zammit S, Sullivan S, Croudace TJ, Jones PB. Mood, anxiety and psychotic phenomena measure a common psychopathological factor. Psychol Med 2015; 45:1483-1493. [PMID: 25394403 DOI: 10.1017/s003329171400261x] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychotic phenomena are common in the general population but are excluded from diagnostic criteria for mild to moderate depression and anxiety despite their co-occurrence and shared risk factors. We used item response theory modelling to examine whether the co-occurrence of depressive, anxiety and psychotic phenomena is best explained by: (1) a single underlying factor; (2) two separate, uncorrelated factors; (3) two separate yet linked factors; or (4) two separate domains along with an underlying 'common mental distress' (CMD) factor. We defined where, along any latent continuum, the psychopathological items contributed most information. METHOD We performed a secondary analysis of cross-sectional, item-level information from measures of depression, anxiety and psychotic experiences in 6617 participants aged 13 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort and 977 participants aged 18 years from the ROOTS schools-based sample. We replicated results from one sample in the other and validated the latent factors against an earlier parental measure of mental state. RESULTS In both cohorts depression, anxiety and psychotic items were best represented as a bi-factor model with a single, unitary CMD factor on which psychotic items conveyed information about the more severe end (model 4); residual variation remained for psychotic items. The CMD factor was significantly associated with the prior parental measure. CONCLUSIONS Psychotic phenomena co-occur with depression and anxiety in teenagers and may be a marker of severity in a single, unitary dimension of CMD. Psychotic phenomena should be routinely included in epidemiological assessments of psychiatric morbidity, otherwise the most severe symptomatology remains unmeasured.
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Affiliation(s)
- J Stochl
- Department of Psychiatry,University of Cambridge,NIHR Biomedical Research Centre and CLAHRC East of England,Cambridge,UK
| | - G M Khandaker
- Department of Psychiatry,University of Cambridge,NIHR Biomedical Research Centre and CLAHRC East of England,Cambridge,UK
| | - G Lewis
- Mental Health Sciences Unit,University College London,London,UK
| | - J Perez
- Department of Psychiatry,University of Cambridge,NIHR Biomedical Research Centre and CLAHRC East of England,Cambridge,UK
| | - I M Goodyer
- Department of Psychiatry,University of Cambridge,NIHR Biomedical Research Centre and CLAHRC East of England,Cambridge,UK
| | - S Zammit
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine,Cardiff,UK
| | - S Sullivan
- Centre for Academic Mental Health,School of Social and Community Medicine, University of Bristol,Bristol,UK
| | - T J Croudace
- Mental Health and Addiction Research Group (MHARG),Hull York Medical School (HYMS) and Department of Health Sciences,Seebohm Rowntree Building,University of York,York,UK
| | - P B Jones
- Department of Psychiatry,University of Cambridge,NIHR Biomedical Research Centre and CLAHRC East of England,Cambridge,UK
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A preliminary investigation of schematic beliefs and unusual experiences in children. Eur Psychiatry 2015; 30:569-75. [PMID: 25591496 DOI: 10.1016/j.eurpsy.2014.12.006] [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: 07/12/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs. METHOD Sixty-seven children aged 8-14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS). RESULTS The BCSS was readily completed by participants, and scale psychometric properties were good. Children tended to view themselves and others positively. Internalising and externalising problems and UEDs were all associated with negative schematic beliefs; effect sizes were small to medium. CONCLUSIONS Schematic beliefs in young people can be measured using the BCSS, and negative schematic beliefs are associated with childhood psychopathology and with UEDs. Schematic beliefs may therefore form a useful target in psychological interventions for young people with UEDs.
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Poulton R, Van Ryzin MJ, Harold GT, Chamberlain P, Fowler D, Cannon M, Arseneault L, Leve LD. Effects of multidimensional treatment foster care on psychotic symptoms in girls. J Am Acad Child Adolesc Psychiatry 2014; 53:1279-87. [PMID: 25457926 PMCID: PMC4254696 DOI: 10.1016/j.jaac.2014.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/25/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence-a period of heightened risk for a wide range of psychopathology. METHOD This study was a randomized controlled trial (RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic Interview Schedule for Children [DISC]). RESULTS Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a 24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted beyond the initial intervention period. CONCLUSION Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial registration information-Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626.
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Affiliation(s)
- Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Gordon T. Harold
- School of Psychology, University of Sussex, UK, Tomsk State University, Tomsk, Russia, and the MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales
| | | | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | - Mary Cannon
- Royal College of Surgeons in Dublin and Beaumont Hospital, Dublin
| | | | - Leslie D. Leve
- University of Oregon and the Oregon Social Learning Center
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Khandaker GM, Stochl J, Zammit S, Lewis G, Jones PB. A population-based longitudinal study of childhood neurodevelopmental disorders, IQ and subsequent risk of psychotic experiences in adolescence. Psychol Med 2014; 44:3229-38. [PMID: 25066026 PMCID: PMC4180723 DOI: 10.1017/s0033291714000750] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Schizophrenia has a neurodevelopmental component to its origin, and may share overlapping pathogenic mechanisms with childhood neurodevelopmental disorders (NDs). Nevertheless, longitudinal studies of psychotic outcomes among individuals with NDs are limited. We report a population-based prospective study of six common childhood NDs, subsequent neurocognitive performance and the risk of psychotic experiences (PEs) in early adolescence. METHOD PEs were assessed by semi-structured interviews at age 13 years. IQ and working memory were measured between ages 9 and 11 years. The presence of six NDs (autism spectrum, dyslexia, dyspraxia, dysgraphia, dysorthographia, dyscalculia) was determined from parent-completed questionnaires at age 9 years. Linear regression calculated the mean difference in cognitive scores between children with and without NDs. Associations between NDs and PEs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs); effects of cognitive deficits were examined. Potential confounders included age, gender, father's social class, ethnicity and maternal education. RESULTS Out of 8220 children, 487 (5.9%) were reported to have NDs at age 9 years. Children with, compared with those without, NDs performed worse on all cognitive measures; the adjusted mean difference in total IQ was 6.84 (95% CI 5.00-8.69). The association between total IQ and NDs was linear (p < 0.0001). The risk of PEs was higher in those with, compared with those without, NDs; the adjusted OR for definite PEs was 1.76 (95% CI 1.11-2.79). IQ (but not working memory) deficit partly explained this association. CONCLUSIONS Higher risk of PEs in early adolescence among individuals with childhood ND is consistent with the neurodevelopmental hypothesis of schizophrenia.
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Affiliation(s)
- Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Mental Health Sciences Unit, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Zammit S, Hamshere M, Dwyer S, Georgiva L, Timpson N, Moskvina V, Richards A, Evans DM, Lewis G, Jones P, Owen MJ, O’Donovan MC. A population-based study of genetic variation and psychotic experiences in adolescents. Schizophr Bull 2014; 40:1254-62. [PMID: 24174267 PMCID: PMC4193688 DOI: 10.1093/schbul/sbt146] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychotic experiences are not uncommon in general population samples, but no studies have examined to what extent confirmed risk variants for schizophrenia are associated with such experiences. A total of 3483 children in a birth cohort study participated in semistructured interviews for psychotic experiences at ages 12 and 18. We examined whether (1) a composite measure of risk for schizophrenia conferred by common alleles (polygenic score) was associated with psychotic experiences, (2) variants with genome-wide evidence for association with schizophrenia were associated with psychotic experiences, and (3) we could identify genetic variants for psychotic experiences using a genome-wide association (GWA) approach. We found no evidence that a schizophrenia polygenic score, or variants showing genome-wide evidence of association with schizophrenia, were associated with adolescent psychotic experiences within the general population. In fact, individuals who had a higher number of risk alleles for genome-wide hits for schizophrenia showed a decreased risk of psychotic experiences. In the GWA study, no variants showed GWA for psychotic experiences, and there was no evidence that the strongest hits (P < 5 × 10(-5)) were enriched for variants associated with schizophrenia in large consortia. Although polygenic scores are weak tools for prediction of schizophrenia, they show strong evidence of association with this disorder. Our findings, however, lend little support to the hypothesis that psychotic experiences in population-based samples of adolescents share a comparable genetic architecture to schizophrenia, or that utilizing a broader and more common phenotype of psychotic experiences will be an efficient approach to increase understanding of the genetic etiology of schizophrenia.
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Affiliation(s)
- Stanley Zammit
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK; Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK;
| | - Marian Hamshere
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Sarah Dwyer
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lyudmila Georgiva
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nic Timpson
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Valentina Moskvina
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Alexander Richards
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - David M Evans
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Michael J. Owen
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Michael C. O’Donovan
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Khandaker GM, Stochl J, Zammit S, Lewis G, Jones PB. Childhood Epstein-Barr Virus infection and subsequent risk of psychotic experiences in adolescence: a population-based prospective serological study. Schizophr Res 2014; 158:19-24. [PMID: 25048425 PMCID: PMC4561501 DOI: 10.1016/j.schres.2014.05.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/25/2014] [Accepted: 05/15/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several studies suggest a link between early-life infection and adult schizophrenia. Cross-sectional studies have reported: (1) increased prevalence of Epstein-Barr Virus (EBV), a member of the Herpesviridae family in schizophrenia; (2) a possible role of Herpes simplex virus in cognitive dysfunction in schizophrenia and healthy controls. We report a longitudinal serological study of early-life EBV infection, childhood IQ, and subsequent risk of psychotic experiences (PE) in adolescence. METHODS Serum antibodies to EBV (anti-VCA IgG) were measured in 530 participants from the ALSPAC cohort at age 4 years. Assessments for IQ at age 9 and PE at age 13 were attended by 401 and 366 of these individuals, respectively. Logistic regression calculated odds ratio (OR) for PE in EBV-exposed, compared with unexposed group. Mean IQ scores were compared between these groups; effect of IQ on the EBV-PE association was examined. Potential confounders included age, gender, ethnicity, social class, household crowding, and concurrent depression and anxiety. RESULTS About 25% of the sample was exposed to EBV at age 4. EBV exposure was associated with subsequent risk of definite PE in adolescence; OR 5.37 (95% CI 1.71-16.87), which remained significant after confounding adjustment. EBV-exposed individuals compared with unexposed performed worse on all IQ measures; mean difference in full-scale IQ 4.15 (95% CI 0.44-7.87); however, this was explained by socio-demographic differences. The EBV-PE association was not explained by IQ. CONCLUSIONS Early-life exposure to EBV is associated with PE in adolescence, consistent with a role of infection/immune dysfunction in the aetiology of psychosis.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK; Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK; Division of Psychiatry, University College London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Ames CS, Jolley S, Laurens KR, Maddox L, Corrigall R, Browning S, Hirsch CR, Hassanali N, Bracegirdle K, Kuipers E. Modelling psychosocial influences on the distress and impairment caused by psychotic-like experiences in children and adolescents. Eur Child Adolesc Psychiatry 2014; 23:715-22. [PMID: 24337355 DOI: 10.1007/s00787-013-0500-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/19/2013] [Indexed: 11/24/2022]
Abstract
Psychological understanding of psychotic-like experiences (PLEs) occurring in childhood is limited, with no recognised conceptual framework to guide appropriate intervention. We examined the contribution to PLE severity of emotional, cognitive and socio-environmental mechanisms thought to influence the development and maintenance of psychosis. Forty 8-14 year olds referred to a community Child and Adolescent Mental Health Service completed a battery of questionnaires and assessments measuring severity of PLEs, emotional problems, cognitive biases, and negative life events. 85% of children assessed reported having experienced a PLE over the previous year; and 55% reported more than one. 60% had experienced at least one in the previous fortnight. Multiple linear regression demonstrated that each of the variables made a significant and independent contribution to PLE severity, after adjusting for verbal ability and age, accounting together for more than half of the variance (reasoning B = 6.324, p = .049; emotion B = 1.807, p = .005; life events B = 4.039, p = .001). PLEs were common in this clinical sample of children. Psychological factors implicated in the development and maintenance of psychosis in adults were also associated with PLE severity in these children. PLE severity may be reduced by targeting each of these factors in cognitive therapy, at this very early stage. Any improvements in emotional wellbeing and functioning may then increase future resilience.
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Affiliation(s)
- Catherine S Ames
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK,
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40
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Identification and characterization of college students with attenuated psychosis syndrome in China. Psychiatry Res 2014; 216:346-50. [PMID: 24636247 DOI: 10.1016/j.psychres.2014.01.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
Most studies on psychotic-like experiences in the non-clinical population were based on self-reported surveys, without any attempt to validate the clinical interview. The present study aimed to test whether the Attenuated Psychosis Syndrome (APS) could be detected in a college population by checking self-report results against an additional interview. A two-stage screening process was used in a sample of 579 college students (16-22 years old): a 16-item Chinese version of the Prodromal Questionnaire (CPQ-16) followed by the Structured Interview for Psychosis-Risk Syndromes (SIPS). Psychopathology symptoms were assessed using the Symptom Checklist-90 (SCL-90). There were 20 (3.5%) students who met the criteria for the APS according to SIPS. Compared with control students, the students with APS were more likely to be from divorced families and had more psychopathology based on the SCL-90. Certain factors on the SCL-90, including Obsessive-Compulsive (OBS), Interpersonal Sensitivity (INT), and Depression (DEP) were significantly correlated with positive psychosis risk symptoms on the SIPS, but only DEP had a strong correlation with the total score on the SIPS. These results demonstrate that the APS can be detected in a college sample and that psychosis risk symptoms are associated with co-occurring psychopathology.
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Cederlöf M, Ostberg P, Pettersson E, Anckarsäter H, Gumpert C, Lundström S, Lichtenstein P. Language and mathematical problems as precursors of psychotic-like experiences and juvenile mania symptoms. Psychol Med 2014; 44:1293-1302. [PMID: 23942194 DOI: 10.1017/s0033291713002018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) and juvenile mania in adolescence index risk for severe psychopathology in adulthood. The importance of childhood problems with communication, reading, speech and mathematics for the development of PLEs and juvenile mania is not well understood. METHOD Through the Child and Adolescent Twin Study in Sweden, we identified 5812 children. The parents were interviewed about their children's development at age 9 or 12 years. At age 15 or 18 years, children and parents completed questionnaires targeting current PLEs and juvenile mania symptoms. Logistic regressions were used to assess associations between problems with communication, reading, speech and mathematics and PLEs/juvenile mania symptoms. To evaluate the relative importance of genes and environment in these associations, we used bivariate twin analyses based on structural equation models. RESULTS Children with parent-endorsed childhood problems with communication, reading and mathematics had an increased risk of developing auditory hallucinations and parental-reported juvenile mania symptoms in adolescence. The most consistent finding was that children with childhood problems with communication, reading and mathematics had an increased risk of developing auditory hallucinations [for example, the risk for self-reported auditory hallucinations at age 15 was increased by 96% for children with communication problems: OR (odds ratio) 1.96, 95% confidence interval (CI) 1.33-2.88]. The twin analyses showed that genetic effects accounted for the increased risk of PLEs and juvenile mania symptoms among children with communication problems. CONCLUSIONS Childhood problems with communication, reading and mathematics predict PLEs and juvenile mania symptoms in adolescence. Similar to the case for schizophrenia and bipolar disorder, PLEs and juvenile mania may share genetic aetiological factors.
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Affiliation(s)
- M Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - P Ostberg
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - E Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Anckarsäter
- Department of Clinical Sciences, Forensic Psychiatry, Lund University, Sweden
| | - C Gumpert
- Section of Forensic Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Lundström
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Khandaker GM, Zammit S, Lewis G, Jones PB. A population-based study of atopic disorders and inflammatory markers in childhood before psychotic experiences in adolescence. Schizophr Res 2014; 152:139-45. [PMID: 24268471 PMCID: PMC3906534 DOI: 10.1016/j.schres.2013.09.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/10/2013] [Accepted: 09/23/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Schizophrenia is associated with atopy and increased inflammatory markers. We report a population-based longitudinal study of the associations between childhood atopic disorders, subsequent serum inflammatory markers, interleukin 6 (IL-6) and C-reactive protein (CRP), and the risk of psychotic experiences (PEs). METHOD PEs were assessed at age 13 years (n=6785). Presence of clinician-diagnosed atopic disorders (asthma and eczema) was determined from parent-completed questionnaires at age 10 years (n=7814). Serum IL-6 and CRP were measured at age 9 years (n=5076). Logistic regression examined the association between (1) atopy and PEs, (2) inflammatory markers and PEs, and (3) mediating effects of inflammatory markers on the atopy-PEs association. Linear regression examined the association between atopy and inflammatory markers. Age, gender, social class, ethnicity and body mass index were included as potential confounders. RESULTS At age 10 years, about 14% of the sample was reported to have asthma, 12% eczema, and 7% both asthma and eczema. Compared with children with no atopy, risk of PEs at age 13 years was increased for all of these groups; adjusted odds ratios (95% CI) were, respectively, 1.39 (1.10-1.77), 1.33 (1.04-1.69), and 1.44 (1.06-1.94). Atopy was associated with increased serum IL-6 and CRP; however, this did not mediate association between atopy and PEs. Inflammatory markers were not associated with later PEs. CONCLUSION Childhood atopic disorders increase the risk of psychotic experiences in adolescence. Follow-up of these individuals will be useful to determine the effect of atopy and inflammation on different trajectories of early-life PEs.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK.
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK; Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK; University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Brett C, Heriot-Maitland C, McGuire P, Peters E. Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 53:213-27. [PMID: 24261699 DOI: 10.1111/bjc.12036] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Psychotic-like anomalous experiences are not inherently distressing, nor do they inevitably lead to clinical conditions. However, distress is an important predictor of onset and relapse in psychosis, and a primary indicator of problematic mental health. This study aimed to identify factors that predict distress across three groups with anomalous experiences. DESIGN AND METHODS This study used a cross-sectional design. Participants in 'Diagnosed' (n = 35), 'At Risk' (n = 20), and 'Undiagnosed' (n = 36) groups completed the Appraisals of Anomalous Experiences Interview (AANEX; Brett et al., 2007, Br. J. Psychiatry, 191, s23), which taps anomalies experienced, appraisals, and other psychological and contextual variables. A series of ordinal logistic regression analyses was conducted to investigate which variables predicted anomaly-related distress. RESULTS Predictors of higher distress were anomalous states characterized by changes in awareness and cognitive functioning (rather than more typical positive symptoms), appraisals of experiences as caused by 'other people', and greater attempted control over experiences. Predictors of lower distress were 'spiritual' appraisals, greater perceived social support/understanding, greater perceived controllability, and reacting with a 'neutral response'. CONCLUSIONS While psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms.
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Affiliation(s)
- Caroline Brett
- Sussex Partnership NHS Foundation Trust, Early Intervention in Psychosis Service (EIPS), Brighton & Hove, UK; Department of Psychology (P077), Institute of Psychiatry, King's College London, UK
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Tiffin PA, Welsh P. Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches. J Child Psychol Psychiatry 2013; 54:1155-75. [PMID: 24102356 DOI: 10.1111/jcpp.12136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. METHODS This article reviews the literature relating to the assessment and management of 'at-risk mental states' (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970-December 2012. RESULTS Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. CONCLUSIONS A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying those at high risk for a variety of poor outcomes who may benefit most from intervention. There is also an urgent need for age-specific research in the area of psychosocial treatments for children and adolescents with schizophrenia.
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Affiliation(s)
- Paul A Tiffin
- School for Medicine, Pharmacy & Health, The Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, UK
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Fisher HL, Caspi A, Poulton R, Meier MH, Houts R, Harrington H, Arseneault L, Moffitt TE. Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychol Med 2013; 43:2077-86. [PMID: 23302254 PMCID: PMC3758773 DOI: 10.1017/s0033291712003091] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Childhood psychotic symptoms have been used as a subclinical phenotype of schizophrenia in etiological research and as a target for preventative interventions. However, recent studies have cast doubt on the specificity of these symptoms for schizophrenia, suggesting alternative outcomes such as anxiety and depression. Using a prospective longitudinal birth cohort we investigated whether childhood psychotic symptoms predicted a diagnosis of schizophrenia or other psychiatric disorders by 38 years of age. METHOD Participants were drawn from a birth cohort of 1037 children from Dunedin, New Zealand, who were followed prospectively to 38 years of age (96% retention rate). Structured clinical interviews were administered at age 11 to assess psychotic symptoms and study members underwent psychiatric assessments at ages 18, 21, 26, 32 and 38 to obtain past-year DSM-III-R/IV diagnoses and self-reports of attempted suicides since adolescence. RESULTS Psychotic symptoms at age 11 predicted elevated rates of research diagnoses of schizophrenia and posttraumatic stress disorder (PTSD) and also suicide attempts by age 38, even when controlling for gender, social class and childhood psychopathology. No significant associations were found for persistent anxiety, persistent depression, mania or persistent substance dependence. Very few of the children presenting with age-11 psychotic symptoms were free from disorder by age 38. CONCLUSIONS Childhood psychotic symptoms were not specific to a diagnosis of schizophrenia in adulthood and thus future studies of early symptoms should be cautious in extrapolating findings only to this clinical disorder. However, these symptoms may be useful as a marker of adult mental health problems more broadly.
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Affiliation(s)
- H L Fisher
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK.
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Hui C, Morcillo C, Russo DA, Stochl J, Shelley GF, Painter M, Jones PB, Perez J. Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophr Res 2013; 148:175-80. [PMID: 23773297 PMCID: PMC3744805 DOI: 10.1016/j.schres.2013.05.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers. METHOD Between February 2010 and September 2012 60 help-seeking HR individuals, aged 16-35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups. RESULTS HR individuals suffered a wide range of DSM-IV psychiatric disorders, mainly within the affective and anxiety diagnostic spectra. In comparison to healthy volunteers, young people at HR reported more suicidal ideation/intention, depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life. CONCLUSION The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis. A HR mental state may be associated not only with an increased risk for psychosis, but also other psychiatric disorders. Our findings may have implications for the future implementation of therapeutic interventions that this population could benefit from.
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Affiliation(s)
- Christy Hui
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Carmen Morcillo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Gillian F. Shelley
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Michelle Painter
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,Corresponding author at: Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EE, UK. Tel.: + 44 1223884360; fax: + 44 1223884362.
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Hickie IB, Scott J, Hermens DF, Scott EM, Naismith SL, Guastella AJ, Glozier N, McGorry PD. Clinical classification in mental health at the cross-roads: which direction next? BMC Med 2013; 11:125. [PMID: 23672522 PMCID: PMC3653738 DOI: 10.1186/1741-7015-11-125] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/18/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND After 30 years of consensus-derived diagnostic categories in mental health, it is time to head in new directions. Those categories placed great emphasis on enhanced reliability and the capacity to identify them via standardized checklists. Although this enhanced epidemiology and health services planning, it failed to link broad diagnostic groupings to underlying pathophysiology or specific treatment response. DISCUSSION It is time to adopt new goals that prioritize the validation of clinical entities and foster alternative strategies to support those goals. The value of new dimensions (notably clinical staging), that are both clinically relevant and directly related to emerging developmental and neurobiological research, is proposed. A strong emphasis on 'reverse translation' (that is, working back from the clinic to the laboratory) underpins these novel approaches. However, it relies on using diagnostic groupings that already have strong evidence of links to specific risk factors or patterns of treatment response. SUMMARY The strategies described abandon the historical divides between clinical neurology, psychiatry and psychology and adopt the promotion of pathways to illness models.
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Affiliation(s)
- Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- FondaMental Foundation, Fondation de Coopération Scientifique Hôpital A. Chenevier, 40 Rue de Mesly, Creteil, F-94000, France
- INSERM, U 955, IMRB, Psychiatry Genetic, Creteil, F-94000, France
| | - Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
- School of Medicine, The University of Notre Dame, 160 Oxford Street, Darlinghurst, Sydney, 2010, Australia
| | - Sharon L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Adam J Guastella
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Nick Glozier
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia
- Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia
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Hameed MA, Lewis AJ, Sullivan S, Zammit S. Child literacy and psychotic experiences in early adolescence: findings from the ALSPAC study. Schizophr Res 2013; 145:88-94. [PMID: 23395451 DOI: 10.1016/j.schres.2012.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/10/2012] [Accepted: 12/23/2012] [Indexed: 01/08/2023]
Abstract
The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the differences in literacy skills in children who later completed the psychotic like symptoms (PLIKS) interview at 12 years of age. We further examined the association between literacy skills over time in relation to the likelihood of reporting psychotic experiences (PEs). This study examined data from n=6790 children from the ALSPAC cohort who participated in the PLIKS semi-structured interview. Literacy skills such as spelling, basic real and non-real word reading, and reading skills and comprehension were assessed by an ALSPAC spelling task, Wechsler Objective Reading Dimension, and the revised Neale Analysis of Reading Ability (NARA II) respectively. Relative to the group unaffected by PEs, we found a lower performance in all measurements of child literacy skills in those with suspected or definite PEs. The majority of these differences persisted after adjusting for a range of covariates. In addition, both a consistently low pattern of performance and a decline were associated with suspected or definite PEs. Implications for preventative intervention models focussed on children at risk of developing psychotic disorders are discussed within the context of speech and language development.
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Affiliation(s)
- Mohajer A Hameed
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
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Curley AA, Fisher HL. Highlights from the Biennial International Congress on Schizophrenia Research (ICOSR), April 21-25, 2013. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2013; 7:68-72. [PMID: 23841955 DOI: 10.3371/csrp.cufi.070513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The 2013 International Congress on Schizophrenia Research, held in Orlando Grande Lakes, Florida, attracted over 1,000 attendees to the JW Marriott Hotel from 21-25 April 2013, not to mention the satellite meetings on cognition and the schizophrenia prodrome. With thanks to the Schizophrenia Research Forum (www.schizophreniaforum.org), a project of the Brain and Behavior Research Foundation, we bring you the following report on the Congress' sessions concerning DSM-5/ICD-11 and the psychosis continuum. We also want to thank Congress directors Carol Tamminga and Chuck Schulz, as well as meeting staff Dorothy Denton and Cristan Tamminga, for their gracious assistance.
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Affiliation(s)
- Allison A Curley
- Schizophrenia Research Forum, Brain and Behavior Research Foundation, Providence, RI 02906, USA
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Cannon M. Hearing voices--the significance of psychotic symptoms among young people. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:214-216. [PMID: 23021293 DOI: 10.1016/j.rpsm.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 06/01/2023]
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