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Zeng J, Zhang W, Lu X, Zhou H, Huang J, Xu Z, Liao H, Liang J, Liang M, Ye C, Sun T, Hu Y, She Q, Chen H, Guo Q, Yan L, Wu R, Li Z. The association of SOD and HsCRP with the efficacy of sulforaphane in schizophrenia patients with residual negative symptoms. Eur Arch Psychiatry Clin Neurosci 2024; 274:1083-1092. [PMID: 37728803 PMCID: PMC11226471 DOI: 10.1007/s00406-023-01679-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Emerging evidence indicates a connection between oxidative stress, immune-inflammatory processes, and the negative symptoms of schizophrenia. In addition to possessing potent antioxidant and anti-inflammatory properties, sulforaphane (SFN) has shown promise in enhancing cognitive function among individuals with schizophrenia. This study aims to investigate the efficacy of combined treatment with SFN in patients with schizophrenia who experience negative symptoms and its effect on the levels of superoxide dismutase (SOD) and the inflammatory marker, high-sensitivity C-reactive protein (HsCRP). DESIGN Forty-five patients with schizophrenia were recruited, who mainly experienced negative symptoms during a stable period. In addition to the original treatments, the patients received SFN tablets at a daily dose of 90 mg for 24 weeks. At baseline, 12 weeks, and 24 weeks, the participants were interviewed and evaluated. The reduction rate of the Positive and Negative Syndrome Scale (PANSS) was used to assess each participant. The side effects scale of Treatment Emergent Symptom Scale (TESS) was applied to assess the adverse reactions. Additionally, the levels of the SOD, HsCRP, and other indicators were examined. RESULTS The study findings revealed a significant decrease in PANSS negative subscale scores (P < 0.001). Furthermore, there was a significant increase in SOD activity and HsCRP levels (P < 0.001 and P < 0.05). Notably, the group of participants who exhibited a reduction in PANSS negative subscale scores demonstrated a significant improvement in HsCRP levels (P < 0.05). CONCLUSIONS Our study suggests that SFN may potentially serve as a safe adjunctive intervention to improve the negative symptoms of schizophrenia. The potential mechanism by which SFN improves negative symptoms in schizophrenia patients may involve its anti-inflammatory properties, specifically its ability to reduce HsCRP levels. Trial registration ClinicalTrial.gov (ID: NCT03451734).
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Affiliation(s)
- Jianfei Zeng
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Mingxin Road #36, Liwan District, Guangzhou, 510370, China
- Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen, China
| | - Weizhi Zhang
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Mingxin Road #36, Liwan District, Guangzhou, 510370, China
| | - Xiaobing Lu
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Mingxin Road #36, Liwan District, Guangzhou, 510370, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
| | - Hui Zhou
- Shiyan People's Hospital of Baoan District, Shenzhen, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenyu Xu
- Ganzhou People's Hospital of Jiangxi Province, Ganzhou, China
| | - Hairong Liao
- The Third People's Hospital of Foshan, Foshan, China
| | - Jiaquan Liang
- The Third People's Hospital of Foshan, Foshan, China
| | - Meihong Liang
- The Third People's Hospital of Foshan, Foshan, China
| | - Chan Ye
- University of Chinese Academy of Science-Shenzhen Hospital, Shenzhen, China
| | - Ting Sun
- Zhuhai Center for Chronic Disease Control/The Third People's Hospital of Zhuhai, Zhuhai, China
| | - Yutong Hu
- Zhuhai Center for Chronic Disease Control/The Third People's Hospital of Zhuhai, Zhuhai, China
| | - Qi She
- Zhuhai Center for Chronic Disease Control/The Third People's Hospital of Zhuhai, Zhuhai, China
| | - Haixia Chen
- Zhongshan Third People's Hospital, Zhongshan, China
| | - Qian Guo
- Zhaoqing Third People's Hospital, Zhaoqing, China
| | - LiuJiao Yan
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Mingxin Road #36, Liwan District, Guangzhou, 510370, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zezhi Li
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Mingxin Road #36, Liwan District, Guangzhou, 510370, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing, China.
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Lucarini V, Kazes M, Krebs E, Morin V, Godignon M, De Gasquet M, Ton T, Féron M, Tanguy G, Lévi A, Bellot C, Willard D, Auther AM, Cornblatt B, Bralet MC, Krebs MO. Validation of the French version of the Global Functioning: Social and Global Functioning: Role Scales in adolescents and young adults seeking help in early intervention clinics. Early Interv Psychiatry 2024; 18:3-9. [PMID: 37037927 DOI: 10.1111/eip.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
AIM Social and role functioning impairments characterize patients along the schizophrenia spectrum, but the existing evaluations tools do not specifically address younger population issues. The Global Functioning Social (GF:S) and Global Functioning Role (GF:R) scales have been specifically designed for that purpose. The aim of this study is to establish the reliability and concurrent validity of the French version of GF:S and GF:R scales. METHODS The two scales GF: Social (GF:S) and Role (GF:R) have first been translated into French and independently back translated and validated by the original authors. Between March 2021 and March 2022, we enrolled 51 participants (20.3 ± 3.7 years old; female = 22/51) amongst help-seekers referring to two different early mental health services in the Île-de-France. In an ecological design, participants met different diagnoses, 7 (13.7%) met the criteria for Ultra-High Risk of psychosis (UHR) using CAARMS criteria. RESULTS Inter-rater reliability was excellent for scores related to the past month and to the higher levels of functioning over the past year. Both scales showed good to excellent concurrent validity as measured by correlation with the Social and Occupational Functioning Assessment Scale (SOFAS) and the Personal and Social Performance Scale (PSP). CONCLUSION Overall, this study confirms the reliability and validity of the French version of the GF:S and GF:R scales. The use of these scales may improve the evaluation of social and occupational functioning in French-speaking young help-seekers, in a transdiagnostic approach, both in clinical and research settings.
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Affiliation(s)
- Valeria Lucarini
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Mathilde Kazes
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Emma Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Valentine Morin
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Maud Godignon
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Marie De Gasquet
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Trang Ton
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marion Féron
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Guillaume Tanguy
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Agnès Lévi
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Cécile Bellot
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Dominique Willard
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, New York, USA
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Marie-Cécile Bralet
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
- JENESIS/CRISALID, Pôle PRERPS, CHI EPSM Oise, Clermont de l'Oise, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
- CJAAD, Evaluation, Prevention and Therapeutic Innovation Department, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Institut de Psychiatrie, CNRS GDR 3557, Paris, France
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Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Menchetti M. Longitudinal evaluation on negative symptoms in young people at Ultra-High Risk (UHR) of psychosis: results from a 2-year follow-up study in a real-world care setting. Eur Arch Psychiatry Clin Neurosci 2023; 273:1761-1771. [PMID: 37029806 DOI: 10.1007/s00406-023-01600-2] [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: 11/25/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Negative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis. However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal stability of NS levels in young UHR subjects treated within a specialized "Early Intervention in Psychosis" (EIP) program across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment components offered within the EIP program. One hundred UHR individuals (aged 12-25 years) completed the Positive And Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the clinical severity of NS at least during the first year of treatment.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42100, Reggio Emilia, RE, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Simona Pupo
- Division of Pain Medicine, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, PR, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Università Degli Studi Di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
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Handest R, Molstrom IM, Gram Henriksen M, Hjorthøj C, Nordgaard J. A Systematic Review and Meta-Analysis of the Association Between Psychopathology and Social Functioning in Schizophrenia. Schizophr Bull 2023; 49:1470-1485. [PMID: 37260350 PMCID: PMC10686359 DOI: 10.1093/schbul/sbad075] [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: 06/02/2023]
Abstract
BACKGROUND Impaired social functioning is a major, but under-elucidated area of schizophrenia. It's typically understood as consequential to, eg, negative symptoms, but meta-analyses on the subject have not examined psychopathology in a broader perspective and there's severe heterogeneity in outcome measures. To enhance functional recovery from schizophrenia, a more comprehensive understanding of the nature of social functioning in schizophrenia is needed. STUDY DESIGN In this systematic review and meta-analysis, we searched PubMed, PsycInfo, and Ovid Embase for studies providing an association between psychopathology and social functioning. Meta-analyses of the regression and correlation coefficients were performed to explore associations between social functioning and psychopathology, as well as associations between their subdomains. STUDY RESULTS Thirty-six studies with a total of 4742 patients were included. Overall social functioning was associated with overall psychopathology (95% CI [-0.63; -0.37]), positive symptoms (95% CI [-0.39; -0.25]), negative symptoms (95% CI [-0.61; -0.42]), disorganized symptoms (95% CI [-0.54; -0.14]), depressive symptoms (95% CI [-0.33; -0.11]), and general psychopathology (95% CI [-0.60; -0.43]). There was significant heterogeneity in the results, with I2 ranging from 52% to 92%. CONCLUSIONS This is the first systematic review and meta-analysis to comprehensively examine associations between psychopathology and social functioning. The finding that all psychopathological subdomains seem to correlate with social functioning challenges the view that impaired social functioning in schizophrenia is mainly a result of negative symptoms. In line with classical psychopathological literature on schizophrenia, it may be more appropriate to consider impaired social functioning as a manifestation of the disorder itself.
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Affiliation(s)
- Rasmus Handest
- Mental Health Center Amager, Copenhagen University Hospital, København V, Denmark
| | - Ida-Marie Molstrom
- Mental Health Center Amager, Copenhagen University Hospital, København V, Denmark
| | - Mads Gram Henriksen
- Mental Health Center Amager, Copenhagen University Hospital, København V, Denmark
- Center for Subjectivity Research, Department of Communication, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health—CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Hellerup, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, Copenhagen University Hospital, København V, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Melillo A, Caporusso E, Giordano GM, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Mucci A, Galderisi S. Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review. J Clin Med 2023; 12:7095. [PMID: 38002707 PMCID: PMC10672428 DOI: 10.3390/jcm12227095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The present review aims to identify correlations between negative symptoms (NS) and deficits in neurocognition and social cognition in subjects with first-episode psychosis (FEP) and at-high-risk populations (HR). A systematic search of the literature published between 1 January 2005 and 31 December 2022 was conducted on PubMed, Scopus, and PsycInfo. Out of the 4599 records identified, a total of 32 studies met our inclusion/exclusion criteria. Data on a total of 3086 FEP and 1732 HR were collected. The available evidence shows that NS correlate with executive functioning and theory of mind deficits in FEP subjects, and with deficits in the processing speed, attention and vigilance, and working memory in HR subjects. Visual learning and memory do not correlate with NS in either FEP or HR subjects. More inconsistent findings were retrieved in relation to other cognitive domains in both samples. The available evidence is limited by sample and methodological heterogeneity across studies and was rated as poor or average quality for the majority of included studies in both FEP and CHR populations. Further research based on shared definitions of first-episode psychosis and at-risk states, as well as on more recent conceptualizations of negative symptoms and cognitive impairment, is highly needed.
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Affiliation(s)
| | | | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, 80138 Naples, Italy
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Teksin MG, Karslıoğlu EH, Arıkoğlu Y, Çayköylü A. Satisfaction of Patients and Their Relatives Who Are Reminded of Their Appointments and Treatments with " Treatment Collaboration Portal". PSYCHIAT CLIN PSYCH 2023; 33:163-169. [PMID: 38765311 PMCID: PMC11082580 DOI: 10.5152/pcp.2023.22578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/30/2023] [Indexed: 05/22/2024] Open
Abstract
Background Community Mental Health Centers have been established in Turkey for patients with chronic psychiatric disorders actively engaged in treatment. The Treatment Collaboration Portal is a web-based voice response platform offered to Community Mental Health Centres to support the treatment compliance processes of patients. The Treatment Collaboration Portal automatically reminds patients or their families of injection treatments and psychiatry appointments at regular intervals. The purpose of this study is to determine the satisfaction of patients or their relatives enrolled in the Treatment Collaboration Portal and the reasons why. Methods A semi-structured 1-item 6-point satisfaction questionnaire, which we prepared for the Treatment Collaboration Portal reminder calls, was administered to the volunteer participants who registered to the Treatment Collaboration Portal and Community Mental Health Centre. Satisfaction levels were determined first with the questionnaire, and then the reasons for satisfaction were investigated for each patient and their relatives. Results The questionnaire was given to 132 participants. About 121 participants were satisfied and 11 of them were dissatisfied. When the reasons for those who were satisfied with the application reminders were examined, it was seen that the most frequent one was "prevention of forgetfulness" (53.7%). A significant difference was found between the Treatment Collaboration Portal registration reasons and satisfaction status. Also, there was a difference between the people who patients live with and the "satisfied" and "unsatisfied" groups (P = .023). Conclusion All the reasons given by the group satisfied with Treatment Collaboration Portal use contribute to patients remaining in remission. Therefore, in clinical practice, it is very important to recognize these reasons.
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Affiliation(s)
- Meryem Gül Teksin
- Department of Psychiatry, University of Health Sciences, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | | | - Yasemin Arıkoğlu
- Department of Psychiatry, Ankara Oncology, Research and Training Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry, Ankara Oncology, Research and Training Hospital, Ankara, Turkey
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Investigation of social and cognitive predictors in non-transition ultra-high-risk' individuals for psychosis using spiking neural networks. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:10. [PMID: 36792634 PMCID: PMC9931713 DOI: 10.1038/s41537-023-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Abstract
Finding predictors of social and cognitive impairment in non-transition Ultra-High-Risk individuals (UHR) is critical in prognosis and planning of potential personalised intervention strategies. Social and cognitive functioning observed in youth at UHR for psychosis may be protective against transition to clinically relevant illness. The current study used a computational method known as Spiking Neural Network (SNN) to identify the cognitive and social predictors of transitioning outcome. Participants (90 UHR, 81 Healthy Control (HC)) completed batteries of neuropsychological tests in the domains of verbal memory, working memory, processing speed, attention, executive function along with social skills-based performance at baseline and 4 × 6-month follow-up intervals. The UHR status was recorded as Remitters, Converters or Maintained. SNN were used to model interactions between variables across groups over time and classify UHR status. The performance of SNN was examined relative to other machine learning methods. Higher interaction between social and cognitive variables was seen for the Maintained, than Remitter subgroup. Findings identified the most important cognitive and social variables (particularly verbal memory, processing speed, attention, affect and interpersonal social functioning) that showed discriminative patterns in the SNN models of HC vs UHR subgroups, with accuracies up to 80%; outperforming other machine learning models (56-64% based on 18 months data). This finding is indicative of a promising direction for early detection of social and cognitive impairment in UHR individuals that may not anticipate transition to psychosis and implicate early initiated interventions to stem the impact of clinical symptoms of psychosis.
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Petkari E, Priebe S. Subjective quality of life factorial structure across mental disorders: should we switch to assessing dimensions? Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01536-z. [PMID: 36571599 DOI: 10.1007/s00406-022-01536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
A two-factor structure of subjective quality of life (SQoL) was established for patients with schizophrenia with the dimensions being 'Life and Health' and 'Living Environment'. This study investigated whether the same structure applies in patients with mood and anxiety disorders and, if so, whether the dimension scores differ between the three diagnostic groups. SQoL data of 1366 patients with mood and 419 patients with anxiety disorders obtained on the Manchester Short Assessment of Quality of Life (MANSA) were retrieved from 3 multisite studies. We performed Confirmatory Factor Analyses (CFAs) based on the MANSA SQoL items of each diagnostic sample. Next, through a series of Kruskal-Wallis and Mann-Whitney tests, we compared the scores of the two factors across patients with mood disorders, anxiety disorders and schizophrenia. The two CFAs showed adequate fit of the two-factor structure across mood and anxiety disorders. The dimension scores on 'Life and Health' differed significantly between all three diagnostic groups. They were lowest in patients with anxiety disorders, higher in patients with mood disorders and highest in patients with schizophrenia. However, on the 'Living Environment' dimension, patients with mood disorders had significantly higher scores than patients with schizophrenia, whilst patients with anxiety disorders did not differ significantly from either other group. The findings suggest that a two-factor structure of SQoL applies across mental disorders. The two dimensions vary across diagnostic groups in different ways. Assessing two dimensions of SQoL may provide more specific and relevant information than global scores.
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Affiliation(s)
- Eleni Petkari
- School of Health Sciences, Universidad Internacional de la Rioja, Av. de la Paz, 137, 26006, Logroño, Spain.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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Xiao L, Tang X, Hu X, Feng X, Gong R, Wang F, Zhang X. Serum Level of Growth-Associated Protein 43 Is Associated with First-Episode Schizophrenia Patients without Antipsychotic Drugs Treatment. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4719271. [PMID: 35615548 PMCID: PMC9126667 DOI: 10.1155/2022/4719271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Nerve growth-associated protein 43 (GAP43) is closely related to neural development, axon regeneration, and synaptic reconstruction and is one of the important markers of neuronal damage. Therefore, in our study, enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum level of GAP43 protein in schizophrenia patients (n = 188), healthy controls (n = 200), and bipolar disorder patients (n = 200). The positive and negative syndrome scale (PANSS) was used to evaluate the mental status of schizophrenia patients, and the Scale of Social Function in Psychosis Inpatients (SSPI) was used to evaluate the social function of schizophrenia patients. According to this study, we found the serum GAP43 level was significantly higher in schizophrenia patients than in bipolar disorder patients, while serum GAP43 levels in bipolar disorder patients were significantly higher than those in control group. When the cut-off value was set as 2.328 ng/mL, the area under the curve (AUC) of serum GAP43 was 0.7795 (95% CI: 0.7431-0.8158) for diagnosis of schizophrenia. The sensitivity and specificity were 92.02% and 65.25%, respectively. However, no correlation between serum GAP43 and the total scores of PANSS scale in schizophrenia patients as well as between serum GAP43 level and SSPI were observed. Therefore, we believe that GAP43 may be a potential diagnostic marker for schizophrenia.
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Affiliation(s)
- Libin Xiao
- Department of Psychiatry, Nanjing Qinglongshan Mental Hospital, Nanjing 211123, Jiangsu, China
| | - Xiaowei Tang
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou 225003, Jiangsu, China
| | - Xiuxiu Hu
- The Second People's Hospital of Jiangning District, Nanjing 211103, Jiangsu, China
| | - Xiaotang Feng
- Department of Psychiatry, Nanjing Qinglongshan Mental Hospital, Nanjing 211123, Jiangsu, China
| | - Ronglan Gong
- Department of Psychiatry, Nanjing Qinglongshan Mental Hospital, Nanjing 211123, Jiangsu, China
| | - Fujun Wang
- Department of Psychiatry, Nanjing Qinglongshan Mental Hospital, Nanjing 211123, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
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11
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Korovaitseva GI, Oleichik IV, Golimbet VE. Investigation of the Relationship between Polymorphism of Human Leukocyte Antigen G (HLA-G) and Social Functioning of Patients with Schizophrenia. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422030073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Kuhney FS, Damme KSF, Pelletier-Baldelli A, Chun C, Ellman LM, Schiffman J, Mittal VA. Prevalence and Functional Consequences of Social Anxiety in Individuals at Clinical High-Risk for Psychosis: Perspective From a Community Sample Comparison. ACTA ACUST UNITED AC 2021; 2:sgab025. [PMID: 34308353 PMCID: PMC8295730 DOI: 10.1093/schizbullopen/sgab025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Social anxiety disorder (SAD) commonly occurs among individuals at clinical high-risk (CHR) for psychosis. Extant research has yet to examine the prevalence and clinical/functional correlates of SAD in this population compared to a community control (CC) sample. This comparison may improve the generalizability that traditional nonpsychiatric control samples cannot provide. Additionally, it remains unknown how SAD contributes to symptom severity and social impairments in individuals at CHR for psychosis. Methods Both CHR and CC groups were recruited from general community sources; CC participants were not excluded in this analysis on the basis of any psychopathology except psychosis. A total of 245 adolescents and young adults (CHR = 81; CC = 164) were administered the Social Phobia Scale, the Structured Interview for Psychosis-risk Syndromes, Structured Clinical Interview for DSM-5 Research Version, and the Social Functioning Scale. Results The CHR group was at increased risk for having SAD relative to CC (42% CHR; 13% CC; RR = 3.28) and, to a lesser degree, a non-SAD anxiety disorder (41% CHR; 29% CC; RR = 1.42). Greater social anxiety was related to higher levels of negative (r = 0.29) but not positive (r = 0.05) symptoms within the CHR group. Furthermore, elevated social anxiety was found to be linked with poor social functioning in the CHR group (r = -0.31). Conclusions These findings demonstrate the specificity of SAD over and above other anxiety disorders in individuals at CHR for psychosis and the critical target of SAD to treat subclinical psychotic symptoms and social functioning.
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Affiliation(s)
- Franchesca S Kuhney
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA
| | | | - Charlotte Chun
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA.,Department of Psychology, University of California at Irvine, Irvine, CA, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA.,Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL, USA.,Department of Psychiatry, Northwestern University, Chicago, IL, USA.,Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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13
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Multimodal prognosis of negative symptom severity in individuals at increased risk of developing psychosis. Transl Psychiatry 2021; 11:312. [PMID: 34031362 PMCID: PMC8144430 DOI: 10.1038/s41398-021-01409-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/12/2021] [Accepted: 04/30/2021] [Indexed: 12/21/2022] Open
Abstract
Negative symptoms occur frequently in individuals at clinical high risk (CHR) for psychosis and contribute to functional impairments. The aim of this study was to predict negative symptom severity in CHR after 9 months. Predictive models either included baseline negative symptoms measured with the Structured Interview for Psychosis-Risk Syndromes (SIPS-N), whole-brain gyrification, or both to forecast negative symptoms of at least moderate severity in 94 CHR. We also conducted sequential risk stratification to stratify CHR into different risk groups based on the SIPS-N and gyrification model. Additionally, we assessed the models' ability to predict functional outcomes in CHR and their transdiagnostic generalizability to predict negative symptoms in 96 patients with recent-onset psychosis (ROP) and 97 patients with recent-onset depression (ROD). Baseline SIPS-N and gyrification predicted moderate/severe negative symptoms with significant balanced accuracies of 68 and 62%, while the combined model achieved 73% accuracy. Sequential risk stratification stratified CHR into a high (83%), medium (40-64%), and low (19%) risk group regarding their risk of having moderate/severe negative symptoms at 9 months follow-up. The baseline SIPS-N model was also able to predict social (61%), but not role functioning (59%) at above-chance accuracies, whereas the gyrification model achieved significant accuracies in predicting both social (76%) and role (74%) functioning in CHR. Finally, only the baseline SIPS-N model showed transdiagnostic generalization to ROP (63%). This study delivers a multimodal prognostic model to identify those CHR with a clinically relevant negative symptom severity and functional impairments, potentially requiring further therapeutic consideration.
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14
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Sleep abnormalities in individuals at clinical high risk for psychosis. J Psychiatr Res 2021; 137:328-334. [PMID: 33744512 PMCID: PMC8085028 DOI: 10.1016/j.jpsychires.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
Youth at clinical high risk (CHR) represent a unique population enriched for precursors of major psychiatric disorders. Sleep disturbances are consistently reported in CHR individuals. However, there is a dearth of studies investigating quantifiable objective measures of sleep dysfunction in CHR youth. In this study, sleep high density (hd)-EEG recordings were collected in twenty-two CHR and twenty healthy control (HC) subjects. Sleep architecture parameters, as well as sleep EEG power spectra in five frequency bands, were computed and compared between CHR and HC groups during non-rapid eye movement (NREM) sleep. Furthermore, correlation analyses between sleep EEG power spectra, sleep architecture parameters, and clinical symptoms, assessed with the scale of prodromal symptoms (SOPS), were conducted in CHR participants. Our results show that CHR individuals had more wakefulness after sleep onset (WASO) compared to HC participants. CHR also showed a higher NREM sleep gamma EEG power, which was observed in a large fronto-parieto-occipital area, relative to HC. Additionally, higher NREM gamma activity in lateral fronto-occipital regions was associated with more WASO, and increased NREM gamma power in medial fronto/parietal areas correlated with worse SOPS negative symptoms. Altogether, these findings suggest that topographically specific increases in EEG gamma activity during NREM sleep represent neurophysiological signatures underlying some of the objectively assessed sleep disturbances and clinical symptoms of CHR individuals.
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15
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Herniman SE, Cotton SM, Allott KA, Phillips LJ, Wood SJ. The psychometric validity of the Montgomery-Åsberg Depression Rating Scale (MADRS) in recent onset schizophrenia spectrum disorders. Schizophr Res 2021; 228:373-381. [PMID: 33548838 DOI: 10.1016/j.schres.2020.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
Earlier recognition and accurate assessment of depressive symptoms is important to improving outcomes in individuals with recent-onset schizophrenia spectrum disorders (termed SSD hereafter)-regardless of whether positive psychotic symptoms are present or have resolved. The Montgomery-Åsberg Depression Rating Scale (MADRS) is frequently used to assess depressive symptoms in SSD, but no study has examined the psychometric validity of MADRS scores in individuals exclusively with SSD and sub-grouped by those with and without positive psychotic symptoms. This study involved baseline data from the Psychosis Recent Onset GRoningen Survey (PROGR-S). Measures used were: MADRS, depressive and negative subscales of Positive and Negative Syndrome Scale (PANSSD, PANSSN), and Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The MADRS total score had sufficient concurrent validity with PANSSD (evidence by ρ≥0.70), and insufficient divergent validity with PANSSN (evidenced by ρ ≥0.30), in the full cohort and when sub-grouped by positive psychotic symptoms. In symptom networks, divergent communities comprising either MADRS or PANSSN items were found, except the MADRS item inability to feel overlapped with PANSSN items. The most divergent MADRS items were sadness, pessimism, and suicidal thoughts. The MADRS total score had sufficient predictive validity for determining caseness for MDD based on SCAN, but the optimal cut-off differed in those with and without positive psychotic symptoms (MADRS≥18 versus MADRS≥11). The MADRS has sufficient validity for assessing depressive symptoms in SSD. Since scores might depend upon symptoms of SSD, MADRS≥11 and the presence of sadness, pessimism, or suicidal ideation might be the best indicator of MDD in SSD.
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Affiliation(s)
- Sarah E Herniman
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | - Sue M Cotton
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Kelly A Allott
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen J Wood
- Orygen, Melbourne, Australia; Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK
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16
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Relationship Between Symptomatic Dimensions and Global Functioning of Non-Help-Seeking Individuals at Risk for Psychosis. J Nerv Ment Dis 2020; 208:953-957. [PMID: 32925694 DOI: 10.1097/nmd.0000000000001237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aims to analyze the relationship between the symptomatic dimensions of psychosis and functioning of individuals at risk for psychosis (ultrahigh risk [UHR]) in a non-help-seeking UHR sample from the general population. The sample is the same as the one used in the Brazilian Subclinical Symptoms and Prodromal Psychosis cohort study. We applied questionnaires of functioning (Global Assessment of Functioning Scale) and symptomatic dimensions (Scale of Prodromal Symptoms). Next, we correlated the symptomatic dimensions with functioning. We found a significant relationship between avolition and uncommon thought content with poor functioning, whereas the remaining symptoms were not as relevant. Poor functioning was most related to avolition, a negative symptom, followed by unusual thought content, a positive symptom.
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17
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Rathnaiah M, Liddle EB, Gascoyne L, Kumar J, Zia Ul Haq Katshu M, Faruqi C, Kelly C, Gill M, Robson S, Brookes M, Palaniyappan L, Morris P, Liddle PF. Quantifying the Core Deficit in Classical Schizophrenia. ACTA ACUST UNITED AC 2020; 1:sgaa031. [PMID: 32803162 PMCID: PMC7418866 DOI: 10.1093/schizbullopen/sgaa031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the classical descriptions of schizophrenia, Kraepelin and Bleuler recognized disorganization and impoverishment of mental activity as fundamental symptoms. Their classical descriptions also included a tendency to persisting disability. The psychopathological processes underlying persisting disability in schizophrenia remain poorly understood. The delineation of a core deficit underlying persisting disability would be of value in predicting outcome and enhancing treatment. We tested the hypothesis that mental disorganization and impoverishment are associated with persisting impairments of cognition and role function, and together reflect a latent core deficit that is discernible in cases diagnosed by modern criteria. We used Confirmatory Factor Analysis to determine whether measures of disorganization, mental impoverishment, impaired cognition, and role functioning in 40 patients with schizophrenia represent a single latent variable. Disorganization scores were computed from the variance shared between disorganization measures from 3 commonly used symptom scales. Mental impoverishment scores were computed similarly. A single factor model exhibited a good fit, supporting the hypothesis that these measures reflect a core deficit. Persisting brain disorders are associated with a reduction in post-movement beta rebound (PMBR), the characteristic increase in electrophysiological beta amplitude that follows a motor response. Patients had significantly reduced PMBR compared with healthy controls. PMBR was negatively correlated with core deficit score. While the symptoms constituting impoverished and disorganized mental activity are dissociable in schizophrenia, nonetheless, the variance that these 2 symptom domains share with impaired cognition and role function, appears to reflect a pathophysiological process that might be described as the core deficit of classical schizophrenia.
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Affiliation(s)
- Mohanbabu Rathnaiah
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, Duncan McMillan House, Nottingham, UK
| | | | - Lauren Gascoyne
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Jyothika Kumar
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Mohammad Zia Ul Haq Katshu
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,Nottinghamshire Healthcare NHS Foundation Trust, Duncan McMillan House, Nottingham, UK
| | - Catherine Faruqi
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan McMillan House, Nottingham, UK
| | - Christina Kelly
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan McMillan House, Nottingham, UK
| | - Malkeet Gill
- Nottinghamshire Healthcare NHS Foundation Trust, Duncan McMillan House, Nottingham, UK
| | - Sian Robson
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Matt Brookes
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Lena Palaniyappan
- Department of Psychiatry and Robarts Research Institute, Western University, London, ON, Canada.,Lawson Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Peter Morris
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Peter F Liddle
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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18
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Klodnick VV, Malina C, Fagan MA, Johnson RP, Brenits A, Zeidner E, Viruet J. Meeting the Developmental Needs of Young Adults Diagnosed with Serious Mental Health Challenges: the Emerge Model. J Behav Health Serv Res 2020; 48:77-92. [PMID: 32394412 DOI: 10.1007/s11414-020-09699-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adult providers struggle to engage 18-25-year olds despite high rates of serious mental health challenges observed among this age group. A new model, called "Emerge," combines the intensive outreach and multidisciplinary team-based approach used in Assertive Community Treatment with Positive Youth Development principles and practices used in the Transition to Independence Process Model. Emerge bridges youth and adult services, focuses on supporting transition-to-adulthood milestone achievement, and is a sister team to Coordinated Specialty Care for recent psychosis onset. This paper describes Emerge components, practices, and findings from a feasibility pilot study using agency administrative data. Most prevalent goals were employment and social support/relationship related. The majority made progress on individual goals, engaged in employment and education, and experienced decreased psychiatric hospitalizations. Community mental health policy and practice implications are discussed, including funding blending of evidence-based practices for those transitioning to adulthood with youth-onset serious mental health conditions.
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Affiliation(s)
- Vanessa V Klodnick
- Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA.
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA.
| | - Candy Malina
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Marc A Fagan
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Rebecca P Johnson
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Ariel Brenits
- Research & Innovation, Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Eva Zeidner
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
| | - Jose Viruet
- Youth & Young Adult Services, Thresholds, Chicago, IL, USA
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19
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Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Nordentoft M. Experiential negative symptoms are more predictive of real-life functional outcome than expressive negative symptoms in clinical high-risk states. Schizophr Res 2020; 218:151-156. [PMID: 31980342 DOI: 10.1016/j.schres.2020.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/25/2019] [Accepted: 01/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Negative symptoms are key features of psychosis-spectrum disorders linked to psychosis development and functional impairments. This study investigated the predictive strength of negative symptoms domains on multiple aspects of real-life functional outcome in individuals at clinical high-risk (CHR) for psychosis. METHODS A total of 146 UHR individuals were enrolled in a randomized, clinical trial (RCT), with this being analyses secondary to the RCT. The participants were assessed at baseline with the Scale for the Assessment of Negative Symptoms (SANS) encompassing the four domains of affect, alogia, avolition, and anhedonia. Functioning measures, encompassing overall-, social-, and role functioning, self-report social functioning, and quality of life, were obtained at 12-month follow-up. Regression analyses elucidated on the relationship between the four negative symptom domains and functional outcomes. RESULTS Anhedonia and avolition were the aspects of negative symptoms most predictive of real-life functioning at 12-month follow-up explaining 7-20% of the variance on the outcome measures. Alogia was predictive of social functioning. These findings were maintained when controlling for the effect of neurocognition, antipsychotic medication, and depressive symptoms. DISCUSSION Our findings show experiential negative symptoms to predict multiple areas of real-life functioning and quality of life, while expressive negative symptoms exert a modest influence on the functional prognosis of CHR individuals. Experiential negative symptoms may therefore constitute an important treatment target in intervention approaches aimed at enhancing the functional outcome of CHR individuals.
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Affiliation(s)
- Louise Birkedal Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark.
| | - Tina Dam Kristensen
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
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20
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Evaluate the relationship between negative symptoms and functioning in youth at clinical high risk for psychosis. AIM Youth at CHR for psychosis often demonstrate significant negative symptoms and poor functioning, though the magnitude and direction of the relationship between the two remains unknown. The objective of this systematic review is to summarize the relationship between negative symptoms and functioning in CHR samples. METHOD Electronic databases CINAHL, EBM, Embase, MEDLINE, and PsycINFO were searched from inception. Studies were selected if they included any study that reported a relationship between negative symptoms and functioning in youth at clinical high risk (CHR). The correlation coefficient r was converted to Cohen's d, and all random-effects meta-analyses were performed using the transformed values. RESULTS Forty-one studies met the inclusion criteria, including a total of 4574 individuals at CHR for psychosis. Negative symptom total scores were significantly associated with poorer global functioning (d, -1.40; 95% CI, -1.82 to -0.98; I = 79.4%; p < .001 [9 studies, n = 782]), social functioning (d, -1.10; 95% CI, -1.27 to -0.93; I = 10.40%; p < .001 [12 studies, n = 811]), and role functioning (d, -0.96; 95% CI, -1.17 to -0.76; I = 41.1%; p < .001 [9 studies, n = 881]). In addition, negative symptoms were consistently associated with poor premorbid functioning. When examining negative symptom domains, avolition, anhedonia, and blunted affect were each significantly and independently associated with poorer social functioning and role functioning. In terms of prediction models, negative symptoms contributed to the prediction of lower functioning across multiple studies. CONCLUSION This meta-analysis demonstrates a strong relationship between negative symptoms and functioning in youth at clinical high risk for psychosis.
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21
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Herniman SE, Allott K, Phillips LJ, Wood SJ, Uren J, Mallawaarachchi SR, Cotton SM. Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression. Psychol Med 2019; 49:2463-2474. [PMID: 31524121 DOI: 10.1017/s0033291719002344] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES. METHODS This systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines. RESULTS Forty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1-30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3-58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49-28.68). Correlates of depressive psychopathology were also found. CONCLUSIONS At least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention - regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.
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Affiliation(s)
- Sarah E Herniman
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Jacqueline Uren
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sumudu R Mallawaarachchi
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre of Youth Mental Health, University of Melbourne, Melbourne, Australia
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22
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Vargas T, Ahmed AO, Strauss GP, Brandes CM, Walker EF, Buchanan RW, Gold JM, Mittal VA. The latent structure of depressive symptoms across clinical high risk and chronic phases of psychotic illness. Transl Psychiatry 2019; 9:229. [PMID: 31527596 PMCID: PMC6746855 DOI: 10.1038/s41398-019-0563-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 11/21/2022] Open
Abstract
Depressive symptoms are highly prevalent in psychotic populations and result in significant functional impairment. Limited knowledge of whether depressive symptoms are invariant across stages of illness curtails our ability to understand how these relate to illness progression. Clarifying the latent structure of depressive symptoms across stages of illness progression would aid etiological conceptualizations and preventive models. In the present study, one-factor (including all items) and two-factor (depression/hopelessness and guilt/self-depreciation) solutions were specified through confirmatory factor analysis (CFA). Measurement invariance analyses were undertaken across schizophrenia (SCZ; n = 312) and clinical high-risk (CHR; n = 175) groups to estimate whether the same construct is being measured across groups. Clinical correlates of the factors were examined. Results indicated that CHR individuals had a greater proportion of mood disorder diagnoses. Metric invariance held for the one-factor solution, and scalar invariance held for the two-factor solution. Notably, negative symptoms did not correlate with depressive symptoms in the SCZ group, though strong correlations were observed in CHR individuals. Positive symptoms were comparably associated with depressive symptoms in both groups. Results suggest depressive symptoms are more prevalent in CHR individuals. Targeting these symptoms may aid future efforts to identify risk of conversion. Further, some depressive symptoms may be systematically more endorsed in CHR individuals. Separating into depression/hopelessness and guilt/self-depreciation scores may aid comparability across stages of illness progression, though this issue deserves careful attention and future study.
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Affiliation(s)
- Teresa Vargas
- Northwestern University Department of Psychology, Evanston, IL, 60208, USA.
| | | | | | | | | | | | - James M Gold
- University of Maryland, Baltimore County, MD, 20742, USA
| | - Vijay A Mittal
- Northwestern University Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, and Institute for Innovations in Developmental Sciences, Evanston, IL, 60208, USA
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Azis M, Strauss GP, Walker E, Revelle W, Zinbarg R, Mittal V. Factor Analysis of Negative Symptom Items in the Structured Interview for Prodromal Syndromes. Schizophr Bull 2019; 45:1042-1050. [PMID: 30535399 PMCID: PMC6737478 DOI: 10.1093/schbul/sby177] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative symptoms occur early in the clinical high risk (CHR) state and indicate increased risk of conversion to psychotic disorder and poor functional outcome. However, while the negative symptom domain has shown to be parsimoniously explained by a 2-factor construct in schizophrenia, there has yet to be an established factor structure of negative symptoms in CHR. METHODS 214 individuals meeting the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria for CHR were recruited through 3 active research programs in the United States. Exploratory Factor Analysis was conducted on the 6 negative symptom items of the SIPS, and factors were evaluated with respect to functional outcome and depression. RESULTS Factor analysis indicated a 2-factor hierarchical model with 2 negative symptom dimensions reflecting volition (Occupational Functioning and Avolition) and emotion (Expression of Emotion, Experience of Emotion and Social Anhedonia). Linear Regression showed that the emotion factor was associated with poor social function, and the volition factor was associated with poor role function and depression. CONCLUSIONS Similar to factor solutions identified in adults diagnosed with psychotic disorders, results indicated that the SIPS negative symptom subscale is not a unidimensional construct. Rather, the SIPS negative subscale has 2 distinct factors that have different associations with clinical outcome and should be interpreted independently. Results have significant relevance for informing the valid assessment and conceptual interpretation of early clinical phenomenology in the psychosis prodrome.
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Affiliation(s)
- Matilda Azis
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | | | - Elaine Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, GA
| | - William Revelle
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | - Richard Zinbarg
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
| | - Vijay Mittal
- Department of Psychology, Department of Psychiatry, Department of Medical Social Sciences, Institute for Policy Research, Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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24
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Carrión RE, Auther AM, McLaughlin D, Olsen R, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Cornblatt BA. The Global Functioning: Social and Role Scales-Further Validation in a Large Sample of Adolescents and Young Adults at Clinical High Risk for Psychosis. Schizophr Bull 2019; 45:763-772. [PMID: 30351423 PMCID: PMC6581127 DOI: 10.1093/schbul/sby126] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Traditional measures for assessing functioning with adult patients with schizophrenia have been shown to be insufficient for assessing the issues that occur in adolescents and young adults at clinical high risk (CHR) for psychosis. The current study provides an expanded validation of the Global Functioning: Social (GF:Social) and Role (GF:Role) scales developed specifically for use with CHR individuals and explores the reliability and accuracy of the ratings, the validity of the scores in comparison to other established clinical measures, stability of functioning over a 2-year period, and psychosis predictive ability. METHODS Seven hundred fifty-five CHR individuals and 277 healthy control (HC) participants completed the GF:Social and Role scales at baseline as part of the North American Prodrome Longitudinal Study (NAPLS2). RESULTS Inter-rater reliability and accuracy were high for both scales. Correlations between the GF scores and other established clinical measures demonstrated acceptable convergent and discriminant validity. In addition, GF:Social and Role scores were unrelated to positive symptoms. CHR participants showed large impairments in social and role functioning over 2-years, relative to the HCs, even after adjusting for age, IQ, and attenuated positive symptoms. Finally, social decline prior to baseline was more pronounced in CHR converters, relative to non-converters. CONCLUSIONS The GF scales can be administered in a large-scale multi-site study with excellent inter-rater reliability and accuracy. CHR individuals showed social and role functioning impairments over time that were not confounded by positive symptom severity levels. The results of this study demonstrate that social decline is a particularly effective predictor of conversion outcome.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,To whom correspondence should be addressed; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, 75-59, 263rd Street, Glen Oaks, NY 11004, US; tel: 718-470-8878, fax: 718-470-8131, e-mail:
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Ruth Olsen
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA
| | | | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT,Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, CA
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | - Ming T Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA
| | | | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY,Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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25
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Kim HK, Park HY, Seo E, Bang M, Song YY, Lee SY, Kim KR, Park JY, Kang JI, Lee E, An SK. Factors Associated With Psychosocial Functioning and Outcome of Individuals With Recent-Onset Schizophrenia and at Ultra-High Risk for Psychosis. Front Psychiatry 2019; 10:459. [PMID: 31293463 PMCID: PMC6606785 DOI: 10.3389/fpsyt.2019.00459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%-30% within 1-2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31-0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
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Affiliation(s)
- Hyun Kyu Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunchong Seo
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yun Young Song
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Su Young Lee
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Park
- Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.,Section of Self, Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea
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26
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Boldrini T, Tanzilli A, Pontillo M, Chirumbolo A, Vicari S, Lingiardi V. Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review. Front Psychiatry 2019; 10:429. [PMID: 31333509 PMCID: PMC6625011 DOI: 10.3389/fpsyt.2019.00429] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/31/2019] [Indexed: 12/19/2022] Open
Abstract
Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and 2) examining the potential role of PDs in predicting transition from CHR state to a full-blown psychotic disorder. The systematic search of the empirical literature identified 17 relevant studies, including a total of 1,868 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of personality disorders in promoting more severe outcomes in CHR patients. The findings showed that the prevalence rate of personality disorders in CHR patients was 39.4% (95% CI [26.5%-52.3%]). More specifically, 13.4% (95% CI [8.2%-18.5%]) and 11.9% (95% CI [0.73%-16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on conversion to psychotic disorders showed contradictory and insufficient results concerning the potential significant impact of SPD. Conversely, no effect of BPD was found. This meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology, that may present with attenuated psychotic symptoms conjointly with distinct and very heterogeneous personality features. These findings support the need for improved understanding of both core psychological characteristics of CHR patients and differentiating aspects of personality that could have relevant clinical implications in promoting individualized preventive interventions and enhancing treatment effectiveness.
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Affiliation(s)
- Tommaso Boldrini
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.,Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Antonio Chirumbolo
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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